OTA 115 Discussion Questions

What is enteral tube nutrition and who is it given to?

Tube feeding for patients with working GI tract but unable to swallow or chew. Conditions include having a stroke or cancer that requires throat surgery. A short term tube is placed in the nose or long term surgically placed to be delivered straight liquid nutrients directly to the stomach.

OG (Oro-gastric), NG (Naso-gastric), and JG (Jejeno-gastric)

What are contaminants and why do we sometimes eat small amounts of them?

Foods **that are spoiled or tainted because they either contain microorganisms, such as bacteria or parasites, or toxic substances that make them unfit for consumption**. A food contaminant can be biological, chemical or physical in nature.

We sometimes eat small amounts of contaminants because not only can pesticides (chemical contaminants) not be fully removed by washing produce, but there are so many steps from the farm to fork that can result in food contamination that it is almost inevitable to consume a small amount at some point.

Why is thiamin important in the diet?

 Thiamine or better known as Thiamin is one of many B vitamins that are water-soluble. In the body, it is responsible for the metabolism of energy from carbohydrates and thus serves the function, growth, and development of cells. It can be consumed in foods such as fish, whole grains, eggs, legumes and peas, nuts and seeds, and meat. Most commonly found in the American diet of bread and cereals. Thiamin can also be found as a dietary supplement or a food additive. (Thiamine deficiency causes fatigue, irritability, poor memory, sleep distrubrnace and abdominal pain.)

Simple Carbohydrate

Carbohydrate that digests quickly. Quickly sends glucose into the bloodstream which is a source of energy for our bodies. Simple sugars (carbohydrates). Refined sugars (added sugar) and there are ones that are considered “naturally occurring”. The simple sugars found in refined sugars can contribute to weight gain. They give the body calories, but do not have any vitamins, minerals or fiber. The naturally occurring sugars have vitamins, minerals and fiber that are essential to our bodies. Simple sugars found in refined sugars are often found in foods eaten for desserts while naturally occurring sugars are found in fruit and milk. 

Complex Carbohydrates

Digested slower than simple carbohydrates. Glucose is released slower into the bloodstream. There are also different types of complex carbohydrates and there are some that are considered to be better options. Some examples of complex carbohydrate foods that are not great containing refined grains, white flour, white sugar, and white rice. These foods are processed which makes them less nutritious because they no longer contain many of the nutrients and fiber. Foods containing unrefined whole grains are considered to be the better option because they were not processed so they still contain the nutrients and fiber that our bodies need. 

What role does fiber play in nutrition?

Help regulate the body's use of sugars, helping to keep hunger and blood sugar in check. Great sources are whole grains, whole fruits and vegetables, legumes, and nuts. It can increase the weight and size of your stool and softens it. A bulky stool is easier to pass, decreasing your chance of constipation. If you have loose, watery stools, it may help to solidify the stool because it absorbs water and adds bulk to stool. Helps maintain bowel health.Indigestible material found in foods. It has various health benefits, including weight loss and improved digestive health.

What is body composition analysis, how is it measured, and what is the significance of it?

A reading your weight on a scale and breaking down how much of your weight is made up of fats, muscle and water. This can be done in a clinical setting, with X-rays, a personal training office with calipers, water or air chambers through displacement or through high-tech scales. Tetra Bioelectrical Impendence Analysis (BIA) scale is the most practical method.  To use this scale, one would step onto the scale and grab the pair of electrodes and stand still until the reading is done. The scale makes its reading based off height, age, sex and weight. All of that information one would enter into the scale before stepping onto its base.  Knowing one's body composition can be helpful for patients and practitioners alike. It benefits the patient when the doctor knows their body composition because then the doctor can project an accurate recovery time and implement effective treatment. There's scientific evidence that suggests that a healthy body composition reduces the risk of heart disease, cancer and diabetes. 

What are some precautions with foot care that should be taken by a person with diabetes?

Because of possible nerve damage the feeling in your feet can be taken away. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you may not notice a foreign object in your shoe. As a result, you could develop a blister or a sore. This could lead to an infection or a nonhealing wound that could put you at risk for an amputation.

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Inspect feet daily, wash feet daily in lukewarm water, be gentle with washing and drying feet (try blotting feet dry), cut nails carefully, wear clean dry socks, shake out shoes for foreign objects, never walk barefoot.

Explain what fatty acids are, including the benefits of them.

Essential building blocks of fat in bodies are digested into the blood, essential for energy storage in the body, and protect vital organs. When glucose is unavailable for energy, fatty acids are used instead. Healthy fats lower cholesterol and promote strong hearts and joints.

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The body produces palmitic acid a saturated fatty acid and produces oleic acid which is an unsaturated fatty acid. Saturated fatty acids and trans fats are commonly associated with an increased risk of coronary heart disease. Omega- 3 fatty acids are an example of what is considered “healthy fats” and help aid in supporting heart health and lowering triglycerides. Although most humans naturally have a wide variety of fatty acids in their diet, most professionals recommend incorporating and intaking other lipids and essential fatty acids. This can help reduce inflammation which leads to several diseases and a decline in health.

Hospital Associated Deconditioning (HAD)

Functional decline caused or worsened by hospitalization, unrelated to a neurological or orthopedic condition. Happens more and much faster for older adults since about half of all hospitalized patients are over the age of 65 

Postintensive Care Syndrome (PCIS)

New or worsening impairment in physical (ICU-acquired neuromuscular weakness), cognitive (thinking and judgment), or mental health status arising after critical illness and persisting beyond discharge from the acute care setting

Deconditioning Not Related to Hospitalization

Defined as other causes of deconditioning not involving bed rest or immobility related to hospitalization. “Individuals can become deconditioned outside of the hospital due to lack of activity and/ or mobility, such as casting for a broken bone, being paralyzed, being less active combined with changes in the body associated with aging, and being placed on bed rest due to complications during pregnancy”

What type of diet can cause a deficiency of Vitamin B-12?

No meat, fish, poultry, or dairy.

What types of symptoms are present in Vitamin B-12 deficicency?

Seizures, Depression, Dementia, Memory loss, Confusion, Numbness/Tingling in hands and legs with nerve damage, weakness, fatigue.

Megaloblastic anemia —a condition of larger than normal sized red blood cells and a smaller than normal amount; this occurs because there is not enough vitamin B12 in the diet or poor absorption

Pernicious anemia —a type of megaloblastic anemia caused by a lack of intrinsic factors so that vitamin B12 is not absorbed

What does folate do?

Vitamin B which is found naturally in foods such as asparagus, green leafy vegetables, oranges/orange juice, beef liver, peanuts and beans. Helps form DNA & RNA and is involved in protein metabolism.  It also helps with red blood cells and produce cell development. There are supplements called folate acid that people can take to make sure they stay healthy. Helps prevent birth defects, neural tube defects in spine and brain like spine bifida. Supplements.

What is the reccomended way for an obese elderly person to lose weight?

Burn more calories than being intake.  It is also important that they eat veggies, fruits, whole grains, fish, and low-fat dairy. Muscle mass is lost as we age so it is important to do strength training. This can include weight machines at the gym. Obesity has effects on daily physical functions. It can lead to social isolation and mental distress.

How are different types of insulin categorized?

* Onset (how quickly they act)
* Peak (how long it takes to achieve maximum impact)
* Duration (how long they last before they wear off)
* Concentration (Insulins sold in the U.S. have a concentration of 100 units per ml or U100

Rapid-acting insulin?

Starts working about 15 minutes after injection, peaks about 1 to 2 hours and lasts between 2 to 4 hours

Types: Insulin aspart, Insulin glulisine, Insulin lispro

Regular or short-acting insulin?

Reaches the bloodstream within 30 minutes after injection, peaks within 2 to 3 hours and lasts about 3 to 6 hours

Types: Human Regular

Intermediate-acting insulin?

Starts working about 2 to 4 hours after injection, peaks 4 to 12 hours and lasts about 12 to 18 hours

Types: NPH

Long-acting insulin?

starts working several hours after injection, works to lower glucose levels for up to 24 hours

Types: Degludec, Detemir, Glargine

Ultra long-acting insulin?

Starts working in about 6 hours, it does not peak and lasts 36 hours or longer

Types: Glargine u-300

Where do we get Vitamin D and what is the primary function of this vitamin?

Direct sunlight and from eating fatty fish or drinking fortified milk. When the sun hits our skin, the ultra violet rays activates a certain protein in our skin which then causes a chemical reaction. It helps the body absorb and retain calcium which is critical for bone health.

Who are at risk for Vitamin D deficiency?

Geriatric, Obese, and Post-menopausal Populations (Estrogen levels drop which activates enzyme to break down vitamin D)

What is PEM

Protein Energy Malnutrition, condition due to the lack of energy caused by a “deficiency of all the macronutrients and many micronutrients”, affecting those who are not provided with calories and proteins. This condition can be graded as either mild, moderate, or severe and can be diagnosed through the identification of the dietary history of the patient. Severity is calculated through the reference of their BMI and lab tests.

Primary PEU/M?

 usually caused by lack of access to nutritional foods in the elderly or young.

Secondary PEU/M?

can be cause by GI disorders, wasting disorders (cancer/AIDS) or conditions that increase metabolic demand (burns, trauma, surgery).  

What is the glycemic index?

Is a value assigned to foods based on how quickly and how high those foods cause increases in blood glucose levels. It allows for blood sugar management. The food we intake is so important because it affects our blood sugar. Specifically, how the food is cooked. Whether it be processed, home made, and the nutrients it contains. Foods are categorized in three different ratings of low, medium, or high and ranked on a scale of 0-100. Low foods measure between 55 or less, medium 56-69, and high is 70 or above. 

Low glycemic index foods stimulates weight loss,

while foods high on the glycemic index scale help with energy recovery after exercise, or to offset hypo-glycemia. 

TPN or Total Parenteral Nutrition?

This is a feeding method that provides most of the nutrients that the body needs through an IV pump. This is considered a medication to manage and treat malnourishment. For pt NPO. Short period of time/several months based on condition. Renal/Hepatic Impairment Populations benefit mostly. As well as pregnant and postpartum populations.

How is TPN admistered?

Admistered by a central venous catheter. It can be through three central veins in the body: femoral vein, subclavian vein, internal jugular vein. Implantable ports are used to administer TPN. These are ports implanted under the chest's skin and inserted into the superior vena cava. 

Speech is?

Sound of spoken language and includes the formation of a sound, the nature of the sound quality. The ability to physically produce individual sounds and sound patterns related to a specific language. It is the act of speaking or the action of producing or articulating.  Vocal form of communication that includes sounds or a combination of sounds that function as a principal carrier of meaning and is spoken or written in the form of a word, sentence, or conversation. These spoken words are a component of language and consist of one or more morphemes which are the smallest units

Language is?

The words we use and how we use them to share ideas and get what we want. Not just purely based on the act of speaking, but does involve writing in order to express one’s feelings or thoughts. A human form of speech, which is either spoken or written. We communicate in either form in order to deliver or receive meaningful messages

Sensory Modulation Disorder

This type of SPD affects how an individual receives, perceives and regulates sensory information.

Sensory Discrimination Disorder

This type of SPD affects how an individual processes and interprets sensory information.

Sensory Based Motor Disorder

This type of SPD affects how an individual moves, plans and performs tasks that involve sensory input.

Pragmatic Language

Using of appropriate communication in social situations. It is knowing what to say, how to say it, and when to say it. Consists of the social language skills that we use in our daily interactions with others. It can be utilized for using language for different, changing language according to the listener or situation, & following rules for conversation.

How should a premature infant be assessed for failure to thrive?

Measuring premature baby weight, height, and head circumstance to see trajectory falls in the average expected growth percentile. Recording and monitoring adjusted age weight and development growth for expected gestational age. Consultation and Referral to a collague or physician. Managing and addressing causes for changes toward proper nutrition.

What types of cancer are exclusive to children?

Leukemia, Brain and spinal tumors, neuroblastoma, wilms tumor, lymphomas, rhabdomyosacroma, bone cancers, pancreatoblastoma, malignant rhabdoid, and melanotic neuroectodermal tumors (MNTI).

Leukemia

Occurs in the bone marrow and blood. These are the most common types of cancers that occur in childhood. There is acute lymphocytic leukemia known as ALL. And there is acute myeloid leukemia AML. 

Neuroblastoma

They start in nerve cells found in a developing embryo or fetus. It can start anywhere and it's rare that it would start in children older then 10. 

Wilms tumor

Starts in the kidneys. It is rare that it will start in both. It's uncommon in older children. 

Malignant Rhabdoid

A tumors that starts in the kidneys, but also occurs in soft tissues or in the brain. The first sign of this tumor can often times be the discovery of a lump in the child's abdomen. The child may also have difficulty urinating or have blood in their urine. 

Melanotic Neuroectodermal Turmors (MNTI)

The tumors grow rapidly and arise from the neural crest cells. Most reported cases are in the head and neck. Also, it is not uncommon for it to be found in the neoplasm, skull, and mandible. In rare cases it can be found in the ovaries, testis and femur.

Righting reactions

Come into play when the vestibular system detects that the body is no longer upright and erect. Head righting aligns the eyes with the horizon and the rest of the body follows.

Equilibrium reactions (after 6 months of age, keep balance)

Help to restore balance when the center of gravity is disturbed or displaced. It includes counter-rotation of the head and trunk away from the direction of displacement, and the use of the extremities. This reaction occurs as the body is displaced forward, back or to the sides.

CF is an autosomal recessive disorder. What does that mean?

Autosomal recessive disorder, two copies of abnormal gene must be present. An autosomal disorder is caused by a mutation in one of the first 22 non-sex chromosomes. In order for the disease to develop by recessive inheritance, both of the genes in the pair must be abnormal. Sometimes people have a gene pair with only one abnormal gene. This means that they are a carrier of the gene and that they could possibly pass it down to their children. 

Limbic system

Is involved in behavioral & emotional responses, detecting threats in the environment and processing fear as well as learning. It is composed of different structures of the brain, but the two major structures are thehippocampus and the amygdala. 

Hippocampus

Stores memiry, spatial orientation, and is key in learning.

Amygdala

Control and regulate emotions/responses, and emotional learning 

Autistic people have decreased amount of cerebellum tissue,

which coordinates movement/balance, cognition and social interaction.

Spastic CP

Increased muscle tone and have awkward movements due to their stiff muscles. 

Dyskinetic Cerebral Palsy

CP problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking.

Ataxic Cerebral Palsy

CP problems with balance and cooridination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something.

What does contracture mean? Common is Spastic CP

The tightening of the muscles, tendons, skin and nearby tissues. This causes joints to become very stiff to move and shorten. Contracture prevents normal movement of a joint and other body parts. 

The rooting reflex

is the baby’s ability to turn its head towards your hand if you stock its cheek. This is done to check its ability to turn its head towards the nipple.

The sucking reflex

 is the ability of the baby to latch and suck onto the nipple when it is placed deeply into the mouth.

The startle or Moro reflex 

is made of 3 distinct parts where the baby spreads out their arms, pulls their arms back tight into their chest, and then starts crying.

How do SSRIs or Selective Serotonin Reuptake Inhibitors work?

They work by selectively blocking the reuptake of the neurotransmitter serotonin in the brain, which helps increase the levels of serotonin available to the brain cells, improving mood, and reducing anxiety.

Serious side effects of SSRIs

Suicidual thoughts or behaviors, high serotonin syndrome, increased risk of bleeding or bruising, or low sodium levels.

Generalized Anxiety Disorder (GAD)

when a person experiences persistent and excessive worry about everyday events, activities, or situations, such as work, health, or social interactions. The worry is often challenging to control and can interfere with daily functioning.

Panic disorder

sudden and unexpected panic attacks, which are intense episodes of fear or discomfort that usually last a few minutes. During a panic attack, a person may experience physical symptoms such as chest pain, sweating, and trembling.

Social Anxiety Disorder (SAD)

condition in which a person experiences intense fear and discomfort in social situations, such as parties, meetings, or public speaking. People with SAD may avoid social situations or endure them with significant distress.

Obsessive-complusive disorder (OCD)

Condition where a person experiences intrusive and repetitive thoughts (obsessions) and/or engages in repetitive behaviors or mental acts known as (compulsions) in response to these thoughts. These compulsions can be time-consuming and interfere with daily activities.

Agoraphobia

Someone with this anxiety has a specific fear of places and situations in which the person feels anxious or panicky, open spaces, crowded places, and places from which escape seems complicated.

How do Serotonin-Norepinephrine reuptake inhibitors work?

Class of antidepressant medications that are commonly used to treat mood disorders, such as depression and anxiety. They work by increasing the levels of two neurotransmitters in the brain, serotonin and norepinephrine, which are thought to be involved in regulating mood, anxiety, and cognitive function. help to enhance and prolong the activity of these neurotransmitters, ultimately leading to an improvement in mood and a reduction in symptoms of depression and anxiety.

How does Lithium?

Mood stabilizer. It affects sodium flow through nerve and muscle cells in the body, which affects excitation or mania. It works by changing the release of chemicals like dopamine or serotonin in your brain. It acts on the central nervous system and helps you gain more control over your emotions. It treats mood disorders such as mania, hypomania, regular periods of depression, bipolar disorder, and it is also used to reduce aggressive or self-harming behavior. Stablizes excitation and depression cycle.

What is complex trauma?

Repeated interpersonal trauma where victim is traumatized in captivity, and there is no perceived way to escape.

How do Monoamine Oxidase Inhibitors work?

They are used as antidepressants and treat other mental health disorders such as panic attacks, and social phobia. The way it works is to remove/breakdown neurotransmitters such as serotonin, dopamine, and norepinephrine from the brain in order to keep your mood stable. It also prevents the breakdown of tyramine.