Download Level 1 Clinical Rotation Worksheet - Dietetic Internship

Utah State University Dietetic Internship
Clinical Rotation Worksheet
This assignment is to benefit you! It will help prepare you to start your clinical rotation and it will be a great study
resource when preparing for your RD exam. Use your clinical textbooks as reference. Make sure if you are using
Internet resources that they are reliable.
Medical Terminology:
1. What do the following abbreviations mean?
c
NKA
p.o.
BP
b.i.d., BID
H.S., HS
CHF
COPD
CRF
CAD
CABG
Rad tx
ASHD
RQ
AHA
PFT
SBP
p
SOB
dx
DNR
t.i.d., TID
p.r.n.
WNL
HTN
CRI
CVA
MI
XRT
AODM
HDL
LFT
Hx
2. Give the meaning of the following prefixes. Give an example of a word using the prefix and
its definition.
anti
dis
hemo
endo
hyper
poly
brady
nephr
sub
cysto
angio
hepato
cyto
dys
meta
hemi
hypo
tachy
lith
gastr
spondyl
cerebro
osteo
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3. Give the meaning of the following suffixes. Give and example of a word using the suffix and
its definition.
osis
pathy
ostomy
ectomy
oma
trophy
plegia
megaly
scopy
itis
algia
lysis
penia
plasia
pnea
paresis
emia
For additional practice with medical terminology we recommend you complete a free online
medical terminology course. The course is free unless you want the certificate, which you don’t
need. To access the review course go to: http://www.dmu.edu/medterms/.
Charting/Documentation:
1. What does ADIME stand for?
2. What information is included with each letter?
A:
D:
I:
M/E:
Nutritional Assessment:
1. Figure out the BEE for a 55 y.o. male, 6ft. tall, 170 lbs.
2. Figure out the BEE for a 66 y.o. female, 5 ft. 2 in. tall, 145 lbs.
3. Figure out the energy requirements using kcal/kg and protein needs using g/kg for #1 and #2.
4. Figure out ideal body weight and % ideal body weight for #1 and #2.
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5. Give normal values for the following labs (these will vary depending on the lab, that’s okay!
This is to give you a general idea of what normal values are):
albumin
BUN
sodium
cholesterol
HDL
MCV
HGB
SGOT (AST)
SGPT (ALT
glucose
creatinine
potassium
triglycerides
LDL
RDW
HCT
amylase
lipase
6. Various laboratory tests are used for assessing the visceral protein status of a patient. What
are the normal levels? What is the half-life of each measure? What exactly does the lab tell
you? When the value is elevated or decreased what does it mean? When would you use the
different labs to assess acute changes in the protein status of a patient? What are limitations of
each of the lab tests (Use the table below to record your answers.)
Lab Test
Norm.
Level
HalfLife
What exactly
does the lab
mean?
What does it
mean when it
is elevated?
What does it
mean when it
is decreased?
When do you
use each lab to
assess changes?
Limitations
Serum
Albumin
Serum
Transferrin
PreAlbumin
RetinolBinding
Protein
(RBP)
Total
Lympocyte
Count
(TLC)
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7. How do you figure out total lymphocyte count (TLC)? What is the normal range? What is
this used for?
8. There are five labs that assess Red Blood Cells and the Iron Status in patients. Fill in the
table below answering each of the questions at the top of the columns for each value.
Lab
Test
Normal
Level
(men,
women)
What exactly
does the lab
mean? (cell size,
color)
What does it
mean when it is
elevated?
What does it
mean when it is
decreased?
When is each
test linked to
Anemia? (What
type of Anemia?)
HCT
HGB
MCV
TIBC
RDW
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9. What vitamin(s) are important to give alcoholics and why? What, if any, anemia(s) is (are)
seen in alcoholics?
10. What effect does dehydration have on albumin, sodium, BUN and creatinine? Why?
11. What percentage is considered a significant weight loss at one week, one month, and six
months?
12. What is cardiac catherization? Why is the procedure done? Define: stent, coronary
angioplasty (PTCA), coronary bypass surgery (CABG). What is the recommended diet for a
patient in the postoperative period, and then what may the diet be advanced o after the patient is
stabilized?
Cardiac Cath:
Stent:
PTC):
CABG:.
Postop Diet:
Advanced Diet:
13. What are the methods to calculate fluid requirements? Is there more than one way?
14. What does the nitrogen balance in a patient tell you? How is it measured? Define 1)
Positive Nitrogen Balance, 2) Negative Nitrogen Balance. (If your answer is anabolism and
catabolism describe the biochemical processes in the body. What is the big picture?)
15. The usual goal for nitrogen balance is:
a.
0 to +1
b.
+2 to +4
c.
+3 to +6
d.
+5 to +8
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16. Define respiratory quotient (RQ). What are the RQ values for CHO, Protein and Fat? What
increases or decreases the RQ? What does the term mixed fuels mean? When is the RQ
important? How do dietitians use the RQ of a patient?
17. What is the significance of knowing a patient’s RQ?
a. to determine if a patient needs respiratory assistance
b. to assess whether a patient is accumulating fat stores or using fat stores for and energy
source.
c. to determine the relationship between oxygen (O 2 ) consumed and carbon dioxide
(CO 2 ) produced
d. b and c
e. all of the above
18. What are the following medications used for and what significant drug-nutrient interaction
do they have? Give the corresponding brand name or generic name.
Digoxin
INH
Lasix
Dilantin
Glyburide
diltiazem
Insulin
prednisone
Nardil
Coumadin
Tetracyline
19. After trauma or serious medical incident, patients will experience many metabolic changes
often referred to the “Ebb” (occurring hours after the incident) and “Flow” (occurring days to
weeks after the incident) phases. What are the specific metabolic changes that occur in each
phase? (Hint: there are at least 5 more changes in each phase)
“Ebb” Phase (hours)
• Decreased body temperature
•
“Flow” Phase (days to weeks)
• Increased body temperature
•
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20. Label the site of secretion and absorption for ALL of the following nutrients, enzymes, and
anatomy on the following diagram of the gastrointestinal tract. (Write what type of transport is
needed for absorption next to each of the nutrients; active, passive etc.)
Pancreatic Enzymes
Stomach
Calcium
HCL
Pepsin
Alcohol
Bicarbonate
Mouth
Magnesium
Vitamin C
NA+
Iron
K+
Glucose
Bile Salt
SO4
Rectum
Pyridoxine
Feces
ClVitamin B 12
Cholesterol
Thiamin (B 1 )
Vitamin A
Folic Acid
Amino Acids
di- and tri- peptides
H2O
Riboflavin (B 2 )
Ileum
Fat
Colon
Vitamin K (bacterial)
Salivary Amylase
Food and Drink
Anus
Water
Galactose
Fructose
Bile
Water Soluble Vitamins
Gallbladder (arrowed box)
Duodenum
GI Tract
Brush Border Enzymes
Pancreas (arrowed box)
Jejunum
Esophagus
(arrowed box)
Lymphatic System (Draw in what nutrients are absorbed into here before going into the circulatory
system.)
*Those items in red have been done for you to get you started! See next page.
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Label the box below
with where in the GI
nutrients are absorbed
into the circulatory
system.
GI Tract
Food/Drink
Mouth
Pepsin
Stomach
?
water
?
Circulatory System
?
Ileum
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Measurements:
1. NaCl is approximately _____% Na
1000 mg Na/ 2,540 mg NaCl = 39.37
2. 60 mEq K = __ _ mg K+ (What is the conversion factor to convert K+ to mEq? ______)
3. 1500 mg NA = ____mEq Na+ (What is the conversion factor to convert Na+ to mEq? ______)
4. 1 oz. = ______ cc (approximately)
5. 1 inch = _____cm
6. 1 kg = ______lbs
7. 1 cup = ______ oz = ________ cc
8. 1 cc = _____ ml
9. 60 gm Protein = _____ gm Nitrogen
Diseases/Diets:
1. Give the appropriate diet modifications for:
a) hepatic encephalopathy
b) Congestive Heart Failure
c) diverticulosis and diverticulitis
d) ascites
e) COPD
f) pancreatitis
g) hyperlipidemia
h) obesity
i) diabetes
2. What vitamins are most likely to be given to a patient who is a chronic alcoholic? Why?
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3. Why is protein restricted in patients with encephalopathy? What is the significance of using
branched chain amino acids (BCAA) in patients with encephalopathy? What are the pros and
cons of BCAA treatment in patients with encephalopathy?
4. What is the ingredient in salt substitute that should be of concern to us? Why?
5. If a patient is on spironolactone and on a low sodium diet without salt substitute, what should
you expect to see happen to his K+ level? Why?
6. What would you expect to see happen to his K+ level if he is given HCTZ? Why?
7. What are the symptoms of hypokalemia? How do you treat it?
8. List 5 foods high in potassium.
9. Discuss the American Heart Association (AHA) Step 1 and Step 2 diets.
10. When is a HIV+ patient classified as having AIDS? What are some nutritional concerns of
patients with HIV+ versus AIDS if any?
11. Compare soluble vs. insoluble fiber and the physiological effects of each on/in the human
body. Name 3 sources of soluble fiber.
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12. A 77 y.o. male patient with CAD is 6’ tall and weighs 209 lbs. His fasting lipid profile is as
follows: total cholesterol 281, triglycerides 227, HDL 25
What are the blood lipid level classifications for total cholesterol, LDL, HDL and triglycerides
(i.e. what is high, low, normal, etc)?
What is the patient’s LDL level?
What is his cholesterol:HDL ratio? What is the desirable level for men and women?
What type of diet would you put him on?
What other information would help you in developing your nutrition care plan for this patient?
13. List the grams of carbohydrate, protein and fat and calories in each of the diabetes exchange
categories. Note: some categories may have multiple amounts; please list all of them.
Food Item
Carbohydrates (gms) Protein (gms)
Starch
Fruit
Milk
Fat-free, 1%
2%
Whole
Nonstarchy
Vegetables
Meat
Lean
Medium-Fat
High-Fat
Fat:
Fat (gms)
Calories
* You will need to memorize the grams of CHO, Protein, and Fat for the different exchanges as you progress through your rotations.
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14. Give 3 diabetic diet principles to help improve compliance and nutritional practices of
diabetic patients.
15.
Define Type I Diabetes (IDDM)
Define Type II Diabetes (DM)
16. What effect does alcohol have on blood glucose? What are the metabolic
pathways/processes of alcohol?
17. What are the symptoms of an insulin reaction? What is the pathophysiology of an insulin
reaction? (What is going on inside the patient’s body? Metabolic pathways.)
18. What is the definition of sliding scale insulin? When is one used?
19. Discuss the following: (difference, acting, time, when used)
Regular Insulin:
NPH Insulin:
Humalog or Novolog or Apidra Insulin:
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Lantus or Levemir Insulin:
20. What do high MCV and high RDW indicate?
MCV:
RDW:
21. How does fever affect BMR? What changes need to be made in a patient’s diet that is
running a fever of 101 degrees F?
22. What alterations are needed for a dysphagia diet?
23. Define the following:
Embolism:
Aneurysm:
Thrombosis:
Arterioscelorsis:
Atherosclerosis:
24. That foods are not allowed on a gluten free diet?
What foods are allowed?
25. What is the dietary treatment of a hiatal hernia?
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26. Define marasmus and kwashiorkor. What are the differences, i.e. physical appearance,
laboratory values? How are they treated nutritionally?
Marasmus:
Kwashiorkor:
Nutrition Support:
1. Calculate how many calories and protein a patient is receiving each day from a tube feeding
of Nutren 1.0, Jevity or Fibersource HN, full strength, at 75 ml/hr.
What is the difference between Nutren 1.0, Jevity, and Fibersource HN?
What is the difference between Fibersource HN/Jevity & Osmolite 1 cal/Isosource HN cal?
2. Is the above feeding of Nutren 1.0/Jevity/Fibersource, full strength, at 75 ml/hr adequate for a
55 y.o. male with cancer who is 6’ tall, weighs 170 lbs. and has an albumin of 3.0? Explain.
3. How much free water is this feeding providing? How much additional water is needed to
meet the patient’s fluid requirements?
4. What is the sodium content of the above feeding?
5. What does isotonic mean?
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6. Discuss calories/protein content and reasons for use of the following enteral products:
Tube Feedings
Ensure
Brand
Abbott
Jevity 1.0 Cal
Abbott
Nutren 1.0
Nestle
Osmolite 1.0
Abbott
Nutren 1.0 Fiber
Nestle
Fibersource HN
Nestle
Promote
Abbott
Isosource 1.5 cal
Nestle
Two Cal HN
Abbott
Nutren 2.0
Nestle
Pulmocare
Abbott
Nepro
Abbott
Impact
Nestle
Resource Arginaid
Nestle
Calories/ml
gm Pro/ml
Indications
7. What is refeeding syndrome? What is it caused by and how can it be prevented? What is the
pathophysiology of what is going on during refeeding syndrome?
8. Refeeding syndrome is characterized by:
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a.
b.
c.
d.
hypocholermia, hyponatremia, alkalosis
hypophosphatemia, fever, hyperkalemia
hypomagnesemia, hypophosphatemia, hypokalemia
hyponatremia, hypomagnesemia, hypophosphatemia
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