Clinical Nutrition: Chronic Disease, Therapeutic Diets, and Food Safety

Comprehensive practice flashcards covering medical nutrition therapy for chronic diseases (hypertension, dyslipidemia, diabetes, cancer, osteoporosis), therapeutic diets and nutrition support (enteral and parenteral care), and food safety, food security, and cultural dietary practices.

What are the diagnostic criteria and cutoff values for metabolic syndrome?

A client must meet at least $3$ of the following $5$ criteria: waist circumference above $40\,\text{in}$ in men or above $35\,\text{in}$ in women; triglycerides of $150\,\text{mg/dL}$ or higher; HDL cholesterol below $40\,\text{mg/dL}$ in men or below $50\,\text{mg/dL}$ in women; blood pressure of $130/85\,\text{mm\,Hg}$ or higher; and fasting blood glucose of $100\,\text{mg/dL}$ or higher.

What are the desirable blood lipid levels for total cholesterol, LDL, HDL, and triglycerides?

Desirable blood lipid targets are: total cholesterol below $200\,\text{mg/dL}$; LDL cholesterol below $100\,\text{mg/dL}$; HDL cholesterol of $40\,\text{mg/dL}$ or higher in men and $50\,\text{mg/dL}$ or higher in women ($60\,\text{mg/dL}$ or higher protects against disease); and fasting triglycerides below $150\,\text{mg/dL}$.

Which dietary factors primarily affect LDL cholesterol versus serum triglycerides?

LDL cholesterol is raised by saturated fat (limit to under $10\%$ of calories generally, or $5\text{ to }6\%$ when LDL is elevated) and trans fat, and is lowered by soluble fiber ($5\text{ to }10\,\text{g}$ daily) and plant sterols (about $2\,\text{g}$ daily). Triglycerides respond primarily to sugar and alcohol; cutting sugar-sweetened beverages, refined carbohydrates, and alcohol, while consuming omega-$3$ fatty acids from fish, lowers them.

What are the blood pressure classifications according to the 2025 AHA/ACC guidelines?

Normal: systolic below $120\,\text{mm\,Hg}$ and diastolic below $80\,\text{mm\,Hg}$. Elevated: systolic $120\text{ to }129\,\text{mm\,Hg}$ and diastolic below $80\,\text{mm\,Hg}$. Stage 1 hypertension: systolic $130\text{ to }139\,\text{mm\,Hg}$ or diastolic $80\text{ to }89\,\text{mm\,Hg}$. Stage 2 hypertension: systolic $140\,\text{mm\,Hg}$ or higher or diastolic $90\,\text{mm\,Hg}$ or higher. Severe: systolic above $180\,\text{mm\,Hg}$ and/or diastolic above $120\,\text{mm\,Hg}$. Either reading falling into a higher category places the client in that category.

What are the daily serving recommendations for a $2{,}000\text{-calorie}$ DASH eating plan?

Whole grains: $6\text{ to }8$ servings/day; vegetables: $4\text{ to }5$ servings/day; fruits: $4\text{ to }5$ servings/day; fat-free or low-fat dairy: $2\text{ to }3$ servings/day; lean meat, poultry, and fish: $6\,\text{oz}$ or less/day; nuts, seeds, and legumes: $4\text{ to }5$ servings/week; fats and oils: $2\text{ to }3$ servings/day; and sweets and added sugars: $5$ or fewer servings/week.

What do the FDA nutrient claims 'Sodium free,' 'Very low sodium,' and 'Low sodium' mean per serving?

'Sodium free' indicates less than $5\,\text{mg}$ of sodium per serving; 'Very low sodium' indicates $35\,\text{mg}$ or less per serving; and 'Low sodium' indicates $140\,\text{mg}$ or less per serving.

What is the daily weight protocol and threshold for notifying the provider in heart failure?

Instruct the client to weigh every morning after voiding, before breakfast, on the same scale, and wearing similar clothing. Report an unintentional weight gain of $2\text{ to }3\,\text{lb}$ (about $1\,\text{kg}$) in $1$ day or $5\,\text{lb}$ (about $2.3\,\text{kg}$) in $1$ week, recognizing that $1\,\text{kg}$ of weight gain equals approximately $1\,\text{L}$ of fluid retention.

What diagnostic laboratory thresholds define prediabetes and diabetes mellitus?

Prediabetes: A1C of $5.7\%\text{ to }6.4\%$, fasting plasma glucose of $100\text{ to }125\,\text{mg/dL}$, or 2-hour oral glucose tolerance test (OGTT) of $140\text{ to }199\,\text{mg/dL}$. Diabetes: A1C of $6.5\%$ or higher, fasting plasma glucose of $126\,\text{mg/dL}$ or higher, 2-hour OGTT of $200\,\text{mg/dL}$ or higher, or a random plasma glucose of $200\,\text{mg/dL}$ or higher in the presence of classic symptoms.

How is the diabetes plate method organized, and what defines one carbohydrate choice?

The plate method divides a plate into half nonstarchy vegetables, one quarter lean protein, and one quarter carbohydrate foods (paired with water or a zero-calorie beverage). One carbohydrate choice equals $15\,\text{g}$ of carbohydrate, which corresponds to $1$ slice of bread, $1/3\,\text{cup}$ of cooked rice or pasta, $1$ small fruit, or $1/2\,\text{cup}$ of starchy vegetables.

What is the 15-15 rule for hypoglycemia, and why are peanut butter and chocolate avoided as immediate treatments?

For a blood glucose below $70\,\text{mg/dL}$ in a conscious client who can swallow, give $15\,\text{g}$ of rapid-acting simple carbohydrate ($4\,\text{oz}$ fruit juice or regular soda, $3\text{ to }4$ glucose tablets, or $1\,\text{tbsp}$ sugar/honey). Recheck blood glucose in $15$ minutes and repeat if it remains below $70\,\text{mg/dL}$. Peanut butter and chocolate contain dietary fat, which delays gastric emptying and slows glucose absorption; they should only be used as follow-up snacks once euglycemia is restored.

What critical guidelines must a client with diabetes follow on 'sick days'?

Continue taking prescribed insulin or oral diabetes agents; monitor blood glucose every $3\text{ to }4$ hours; check urine ketones if glucose is above $240\,\text{mg/dL}$; consume approximately $50\,\text{g}$ of carbohydrates every $3\text{ to }4$ hours via liquids or soft foods (such as juice, soda, broth with crackers, or gelatin) if solid meals are not tolerated; drink fluids hourly; and contact the healthcare provider for persistent vomiting, uncontrolled hyperglycemia, or moderate-to-large ketonuria.

What nutritional interventions help manage stomatitis/mucositis and dysgeusia (metallic taste) in cancer therapy?

For stomatitis/mucositis, serve soft, bland, cool foods, encourage the use of a straw, and rinse the mouth with normal saline rather than alcohol-containing mouthwashes. For a metallic taste, instruct the client to use plastic utensils rather than metal ones, marinate meats, or replace red meat with alternative protein sources such as eggs, dairy, poultry, or legumes.

What DEXA T-scores define osteopenia and osteoporosis, and what administration instructions are required for alendronate?

A T-score of $-1.0$ or higher is normal, $-1.0\text{ to }-2.5$ indicates osteopenia, and $-2.5$ or lower indicates osteoporosis. For oral bisphosphonates (alendronate): take the medication first thing in the morning with $8\,\text{oz}$ of plain water on an empty stomach, remain fully upright (sitting or standing) for at least $30$ minutes, and consume no food, beverages, or other medications for $30$ minutes to prevent esophageal irritation and ulceration.

How do clear liquid and full liquid hospital diets differ in physical criteria and allowances?

Clear liquids must be transparent when held to light at room temperature (e.g., water, clear broth, gelatin, popsicles, apple juice, cranberry juice, clear soda, tea/coffee without milk) and leave minimal residue; they are nutritionally inadequate and for short-term use only. Full liquid diets include all clear liquids plus foods that liquefy at body temperature, such as milk, pudding, custard, ice cream, strained cream soups, and refined cooked cereals.

What nursing actions ensure safe feeding in a client with dysphagia, and why are mixed textures prohibited?

Position the client upright at $90^\circ$, instruct them to tuck their chin toward the chest when swallowing, administer small single bites, avoid using straws unless cleared by a speech-language pathologist, check for oral pocketing, and keep the client upright for at least $30$ minutes after eating. Mixed textures (such as vegetable soup with chunks or cereal in milk) must be avoided because combining liquids and solids creates two concurrent transit speeds, making airway protection and coordination extremely difficult.

What dietary management is indicated for gastroesophageal reflux disease (GERD) versus peptic ulcer disease (PUD)?

For GERD: provide small, frequent meals, avoid recumbency for $2\text{ to }3$ hours following meals, elevate the head of the bed $6\text{ to }8\,\text{in}$, and avoid lower esophageal sphincter-relaxing substances (fatty foods, chocolate, peppermint, caffeine, alcohol). For PUD: avoid bedtime snacks (which trigger nocturnal acid production), avoid NSAIDs, and eliminate individual pain-triggering foods, caffeine, alcohol, black pepper, and chili powder (milk is no longer used for ulcer healing because it stimulates rebound acid secretion).

What medical nutrition therapies are prescribed for celiac disease, inflammatory bowel disease flares, diverticulosis, and acute diverticulitis?

Celiac disease mandates a lifelong gluten-free diet (avoid wheat, barley, and rye; oats must be certified gluten-free). Inflammatory bowel disease during acute flares requires a low-fiber, high-protein, high-calorie diet with small, frequent meals. Diverticulosis requires a high-fiber diet ($25\text{ to }35\,\text{g}$ daily) with plenty of fluids (seeds and nuts do not need to be eliminated). Acute diverticulitis requires clear liquids followed by a low-fiber progression until the flare resolves.

How do protein, potassium, and fluid restrictions differ between pre-dialysis chronic kidney disease and hemodialysis?

Pre-dialysis CKD restricts protein to $0.6\text{ to }0.8\,\text{g/kg/day}$ to minimize uremic waste, whereas hemodialysis requires an increased protein intake of $1.0\text{ to }1.2\,\text{g/kg/day}$ due to dialytic protein losses. Potassium is restricted in hemodialysis (and limited in pre-dialysis if serum levels rise); salt substitutes must be strictly avoided because they are composed of potassium chloride. Fluid in hemodialysis is restricted to daily urine output plus $500\text{ to }1{,}000\,\text{mL/day}$.

Which enteral tube routes are indicated for short-term versus long-term nutrition, and which routes prohibit bolus feedings?

Nasogastric (NG) and nasointestinal (NI) tubes are indicated for short-term access (under $4$ weeks); percutaneous endoscopic gastrostomy (PEG) and jejunostomy (J) tubes provide long-term access. NI and J-tubes deliver formula directly past the pylorus into the small intestine and must strictly receive continuous infusion by pump; bolus feedings into the small intestine precipitate severe dumping syndrome.

How is the placement of a newly inserted blind enteral feeding tube verified, and what ongoing checks are required?

An initial radiographic X-ray is required to confirm placement of a newly placed blind tube before any feeding or medication is instilled. Ongoing verification before each intermittent feed or medication involves inspecting the external insertion length marking and testing aspirate pH ($\le 5$ suggests gastric placement). Auscultation of injected air is unreliable and should not be used.

What are the head-of-bed, flushing, and hang-time rules for enteral tube feedings?

Maintain the head of the bed elevated to $30\text{ to }45^\circ$ during feedings and for $30\text{ to }60$ minutes following bolus delivery. Flush the tube with $30\,\text{mL}$ of water every $4$ hours during continuous feeding, and flush with $15\,\text{mL}$ between separate medications. Formula hang time is capped at $8$ hours for an open system ($4$ hours for reconstituted powder), and the administration bag and tubing must be replaced every $24$ hours.

How do peripheral parenteral nutrition (PPN) and total parenteral nutrition (TPN) differ in venous access, dextrose concentration, and complications?

PPN is infused via a peripheral IV, contains $10\%$ or less dextrose, is indicated for mild, short-term support (up to $2$ weeks), and carries a primary risk of phlebitis. TPN requires central venous access (PICC, tunneled catheter, or implanted port), contains up to $50\text{ to }70\%$ dextrose before mixing, meets complete long-term nutritional needs, and carries major risks of catheter-related bloodstream infections, hyperosmolar metabolic shifts, and severe hyperglycemia.

What must the nurse do if an active TPN infusion bag runs out before the next scheduled bag is delivered?

Immediately hang and infuse an IV bag of $10\%$ dextrose in water ($\text{D}_{10}\text{W}$) at the same ordered infusion rate to prevent profound rebound hypoglycemia.

What are the clinical signs of a central line air embolism, and what emergency position must the client assume?

Signs include sudden acute dyspnea, sharp chest pain, and profound hypotension. Immediately clamp the catheter tubing, place the client in the left lateral Trendelenburg position (left side with the head lower than the feet), administer oxygen, and summon emergency medical assistance; this positioning traps air in the right atrium and prevents it from entering the pulmonary artery.

What is the hallmark electrolyte disturbance of refeeding syndrome, and how is the syndrome prevented?

Severe hypophosphatemia (normal phosphate is $3.0\text{ to }4.5\,\text{mg/dL}$), accompanied by rapid drops in serum potassium and magnesium as insulin surges drive these ions intracellularly. It is prevented by identifying starved or severely malnourished patients, initiating nutrition support at a low caloric rate, advancing slowly over several days, administering thiamine before carbohydrate reintroduction, and closely monitoring serum electrolytes daily.

What distinct health risks and food sources are associated with Salmonella, Campylobacter, and E. coli O157:H7?

Salmonella (raw poultry, eggs, unpasteurized dairy, produce) causes fever, cramps, and diarrhea, and is the deadliest foodborne pathogen in the U.S. Campylobacter (undercooked poultry, unpasteurized milk) causes watery or bloody diarrhea and can trigger Guillain-Barré syndrome. E. coli O157:H7 (undercooked ground beef, raw leafy greens, unpasteurized juice) produces bloody diarrhea and severe abdominal cramps, and can trigger hemolytic uremic syndrome (HUS) in children (requiring close monitoring of urine output).

Why do Listeria monocytogenes and Clostridium botulinum pose severe clinical concerns?

Listeria monocytogenes can proliferate at refrigerator temperatures and is transmitted via unheated deli meats, hot dogs, unpasteurized soft cheeses, and smoked seafood; it crosses the placenta, causing miscarriage, stillbirth, or neonatal sepsis. Clostridium botulinum produces a neurotoxin in improperly canned goods and raw honey, manifesting as diplopia, dysphagia, and descending paralysis; it is a life-threatening emergency, and honey is strictly forbidden in infants under $12$ months of age.

How do the clinical presentation and sanitation rules differ between Norovirus and Staphylococcus aureus foodborne illnesses?

Norovirus produces sudden vomiting and diarrhea lasting $1\text{ to }3$ days and spreads rapidly; it requires thorough hand hygiene with soap and water because alcohol-based hand gels are ineffective against it. Staphylococcus aureus is an intoxication resulting from preformed enterotoxins on foods handled post-cooking (pastries, salads, sliced meats); it causes rapid onset vomiting within $30\,\text{minutes to }8\,\text{hours}$, and reheating food does not inactivate the preformed heat-stable toxin.

What are the four core food safety steps, and what instruction applies to raw poultry?

The four core steps are Clean, Separate, Cook, and Chill. Handwashing requires soap and water scrubbing for at least $20$ seconds. Raw poultry must never be washed before cooking, because splashing water spreads bacteria across sinks, prep surfaces, and nearby foods.

What are the minimum safe internal cooking temperatures for poultry, ground meats, and whole meat cuts?

Poultry, stuffing, casseroles, and reheated leftovers must reach at least $165^\circ\text{F}$; ground beef, pork, lamb, and egg dishes must reach at least $160^\circ\text{F}$; and whole cuts of beef, pork, veal, and lamb require an internal temperature of $145^\circ\text{F}$ followed by a mandatory $3\text{-minute}$ rest time (fish also requires $145^\circ\text{F}$). The danger zone where bacteria rapidly multiply is $40^\circ\text{F to }140^\circ\text{F}$.

What are the safe food cooling, refrigeration, and leftovers storage time limits?

Refrigerate perishable foods within $2$ hours of preparation, or within $1$ hour if the outside ambient temperature exceeds $90^\circ\text{F}$. Refrigerator temperatures must be maintained at $40^\circ\text{F}$ or below, and freezers at $0^\circ\text{F}$. Leftovers must be eaten or discarded within $3\text{ to }4$ days. Foods should be thawed in the refrigerator, under cold running water, or in a microwave—never at room temperature on the kitchen counter.

What foods must be avoided during pregnancy to prevent foodborne illness and fetal harm, and what fish are encouraged?

Avoid deli meats and hot dogs (unless reheated until steaming hot), unpasteurized milk and soft cheeses, refrigerated smoked seafood, raw sprouts, raw fish/eggs, and high-mercury predatory fish (shark, swordfish, king mackerel, tilefish, and bigeye tuna) which harm fetal brain development. Low-mercury fish (such as salmon, shrimp, and canned light tuna) are encouraged at $2\text{ to }3$ servings per week.

What nine foods represent the major food allergens required to be identified on U.S. food labels?

Milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans, and sesame.

How does the Hunger Vital Sign screen for food insecurity, and what denotes a positive screen?

It evaluates two statements regarding the previous $12$ months: (1) 'We worried whether our food would run out before we got money to buy more,' and (2) 'The food we bought just didn't last, and we didn't have money to get more.' An answer of 'often true' or 'sometimes true' to either statement constitutes a positive screen, requiring nonjudgmental support and referral to social services or food programs.

What client populations and nutritional benefits are targeted by SNAP, WIC, and the Older Americans Act?

SNAP provides monthly electronic benefit transfer (EBT) card allocations for food purchases to low-income individuals and families. WIC serves low-income pregnant, postpartum, and breastfeeding clients, infants, and children up to age $5$ who are at nutritional risk, providing specified nutrient-dense foods, formula, and lactation support. The Older Americans Act provides congregate dining and home-delivered meals (e.g., Meals on Wheels) to adults aged $60$ and older with no income eligibility requirement.

How do stunting, wasting, and hidden hunger differ in global child malnutrition?

Stunting is defined as low height-for-age resulting from chronic undernutrition and is often permanent. Wasting is defined as low weight-for-height resulting from acute, severe undernutrition and carries a high immediate risk of mortality. Hidden hunger refers to chronic micronutrient deficiencies in essential vitamins and minerals, specifically iron, vitamin A, iodine, and zinc.

What are the essential dietary restrictions of Kosher (Judaism) and Halal (Islam) traditions?

Kosher rules prohibit pork and shellfish, forbid combining meat and dairy products in the same meal, require fasting on Yom Kippur, and mandate unleavened bread during Passover. Halal rules prohibit pork and alcohol, and require daily fasting from dawn to sunset during the holy month of Ramadan (with exemptions for acute illness and pregnancy).

What dietary traditions are observed by Seventh-day Adventists, Latter-day Saints, and Catholics?

Seventh-day Adventists commonly adhere to a lacto-ovo vegetarian diet and avoid pork, shellfish, alcohol, and frequently caffeine. Latter-day Saints (Mormons) prohibit alcohol, tobacco, coffee, and tea. Catholics observe dietary fasting on Ash Wednesday and Good Friday, and abstain from meat on Fridays during Lent.

Which common pharmaceutical formulations can cause religious or cultural dietary conflicts?

Medication capsules formulated from animal gelatin (frequently porcine collagen), anticoagulant therapy using porcine-derived heparin, and elixirs or liquid oral medicines containing alcohol.