Editing Nutrition – RN Flashcards (section)

== Therapeutic Diets ==

;How does protein prescription differ before dialysis versus on hemodialysis?
:Restricted to roughly 0.6 to 0.8 g/kg/day before dialysis to limit nitrogenous waste, then increased to about 1.2 g/kg/day once dialysis begins because amino acids are lost into the dialysate.

;Why must phosphate binders be taken with meals?
:They bind dietary phosphorus within the gastrointestinal lumen so it is excreted in stool. Taken between meals, there is no dietary phosphorus present and the drug is ineffective.

;Why are salt substitutes dangerous for certain clients?
:They are potassium chloride. They can cause life-threatening hyperkalemia in clients with chronic kidney disease or those taking ACE inhibitors, angiotensin receptor blockers, or potassium-sparing diuretics such as spironolactone.

;Name high-potassium foods a renal client should limit.
:Bananas, oranges and orange juice, potatoes, tomatoes and tomato products, avocado, spinach, melons, dried fruit, legumes, nuts, and salt substitutes.

;Contrast the fiber prescription for diverticulitis and diverticulosis.
:Diverticul'''itis''' (acute inflammation) requires a low-residue, low-fiber diet during the flare, with advancement to high fiber after resolution. Diverticul'''osis''' requires a high-fiber diet to prevent future flares.

;What dietary changes manage dumping syndrome?
:Small frequent meals, high protein, moderate fat, low simple carbohydrate, fluids between meals rather than with meals, and reclining for 20 to 30 minutes after eating.

;Which grains must be eliminated in celiac disease, and which are safe?
:Eliminate wheat, rye, and barley. Safe options include rice, corn, quinoa, buckwheat, millet, amaranth, sorghum, and certified gluten-free oats. Cross-contamination from shared equipment is a common cause of persistent symptoms.

;Is protein restricted in cirrhosis with hepatic encephalopathy?
:No. Blanket protein restriction is outdated and worsens sarcopenia. Adequate protein and calories are provided, with sodium and often fluid restricted for ascites, and encephalopathy managed with lactulose and rifaximin.

;How is hypoglycemia treated in a conscious client, and why does alcohol matter?
:Rule of 15: 15 g of fast-acting carbohydrate, recheck in 15 minutes, repeat if still below 70 mg/dL, then a protein and carbohydrate snack if the next meal is more than an hour away. Alcohol without food suppresses hepatic gluconeogenesis and causes delayed hypoglycemia.