Nutrition Support in the Pediatric Patient exam with correct answers
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Nutrition Support in the Pediatric Patient
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Nutrition Support In The Pediatric Patient
Which of the following children is at greatest risk for iron deficiency anemia?
1: 3 month-old term infant exclusively fed human milk
2: 4 month corrected gestational age, former preemie on a transitional formula
3: 10 month-old switched from formula to whole milk
4: 17 month-old "picky eater" ...
Which of the following children is at greatest risk for iron deficiency anemia?
1: 3 month-old term infant exclusively fed human milk
2: 4 month corrected gestational age, former preemie on a transitional formula
3: 10 month-old switched from formula to whole milk
4: 17 month-old \"picky eater\" correct answers3: 10 month-old switched from formula to whole milk;
Iron deficiency anemia is the most common nutritional deficiency in childhood. Term infants usually have
adequate iron stores up to 6 months of age. Infant formulas are fortified with sufficient iron to meet the
needs of growing infants. The iron content of breast milk, though efficiently absorbed, is much lower
compared to infant formula. Exclusively breastfed infants require additional iron starting at 4-6 months
of age. This can be provided by complementary foods or iron supplementation. The iron content of cow's
milk is similar to human breast milk but the bioavailability is very low due to inhibitory effect of calcium
on iron absorption. Due to the inadequate nutritional composition, cow's milk should not be introduced
before 12 months of age. A child with picky eating habits may or may not be at increased risk of iron
deficiency anemia depending on which foods they are willing to consume. Diet assessment should be
done to determine if iron supplementation is warranted.
An obese 12-year-old female is admitted to the hospital for an evaluation of sleep apnea. A diet history
reveals that she drinks three cans of soda, 24 ounces of juice, and 8 ounces of chocolate milk daily. In
what mineral may she be deficient?
1: Calcium
2: Phosphorus
3: Selenium
4: Potassium correct answers1. Calcium; Total energy intake from beverages has been increasing in the
US diet over the past two decades. It has been noted that sugar-sweetened beverages have contributed
significantly to this increase. During this same time period, intake of milk has decreased leading to
concerns for inadequate calcium intake in children. Studies have shown that female adolescents are
most at risk for inadequate calcium intake. Though consumption of sugar-sweetened beverages is on a
decreasing trend, intake remains well above recommendations. The American Academy of Pediatrics
(AAP) currently recommends limiting juice intake to 4 oz per day for toddlers, 4-6 oz per day for
preschoolers and 8 oz per day for school-age children and adolescents. The APP also recommends
increased dietary intake of calcium and vitamin D-containing foods and beverages for optimal bone
health. Current recommendations are for 2 to 3 servings of dairy per day for young children and 4
servings per day for adolescents.
,A child with cerebral palsy and a gastrostomy tube is admitted to the hospital for a fundoplication. This
procedure is used to manage
1: gastroesophageal reflux (GER).
2: oral/motor dysfunction.
3: malnutrition.
4: esophagitis. correct answers1. Gastroesophageal reflux; Gastroesophageal reflux (GER) is frequently
seen in the children with neurological impairment. Initial management of these patients should include
changes to feeding regimen, positioning as well as medications for reflux and motility. Though many
patients will respond well to these changes, some will be refractory to treatment. In patients with
intractable GER, a fundoplication may be performed. Given the potential for postoperative
complications, this should only be considered in patients who have failed medical treatment. Conversion
to a gastrojejunostomy tube could also be considered as an alternative to fundoplication.
Premature infants are at increased risk of metabolic bone disease in all of the following scenarios EXCEPT
1: short duration parenteral nutrition.
2: cholestasis.
3: chronic steroid use.
4: very low birth weight. correct answers1. short duration parenteral nutrition; Metabolic bone disease
(MBD) is a multifactorial condition characterized by osteopenia and osteomalacia. Studies have shown
that MBD is most often seen in very low birth weight infants, particularly those weighing <1500 grams.
Other risk factors associated with MBD are chronic steroid use, chronic diuretic use, prolonged duration
of parenteral nutrition, immobilization and cholestasis.
When used in assessment of critically ill children, how do predictive equations compare to indirect
calorimetry?
1: No consistent comparison can be found
2: Equations typically overestimate needs
3: Equations typically underestimate needs
4: Equations correlate well with indirect calorimetry correct answers1. No consistent comparison can be
found; Though many equations exist to predict energy expenditure in children, all have been found to
either over or underestimate resting energy expenditure. Indirect calorimetry continues to be the gold
standard for assessment of energy needs in the critically ill patient and should be used whenever
possible. When indirect calorimetry is not available, the Schofield or World Health Organization equation
may be used.
, A 13-year-old boy whose body mass index (BMI) is at the 97th percentile on the Centers for Disease
Control and Prevention growth chart for age and sex would be classified as
1: underweight.
2: healthy weight.
3: overweight.
4: obese. correct answers4: Obese; BMI is a screening tool used to identify children over 2 years of age
and adolescents who are outside of their healthy weight ranges. Children with age and sex specific BMIs
between the 85th and 94th percentiles are classified as overweight and those with BMIs greater than or
equal to 95th percentile are classified as obese.
Which of the following is NOT associated with a delayed bone age in a child with short stature?
1: Hypothyroidism
2: Precocious puberty
3: Cushing syndrome
4: Growth hormone deficiency correct answers2: Precocious puberty; One of the most useful diagnostic
tests in assessing a child with abnormal growth is a "bone age". The bone age is evaluated by a
radiography of the patient's knees or left wrist. Using established norms for different ages and sexes, a
trained observer can estimate the degree of maturation of the bones. Precocious puberty is usually
associated with an advanced bone age, while children with genetic short stature typically have a bone
age similar to their chronological age. Hypothyroidism, growth hormone deficiency and Cushing
syndrome all are associated with a delayed bone age.
Which of the following preterm growth charts allows for comparison for preterm infants from 22 weeks
gestational age up through 10 weeks post term age?
1: Fenton
2: Ehrenkranz
3: Dancis
4: Lubchenco correct answers1. The Fenton growth chart, updated from data previously collected by
Babson and Benda, has many benefits over other available growth charts. Data was collected from a
large sample size and validation of the chart occurred by using data from the National Institute of Child
Health and Human Neonatal Research Network; CDC growth charts; intrauterine growth data, and
postnatal growth data. The data is cross sectional and is best used to assess growth over time. A major
advantage is that it allows for tracking of growth from 22 weeks gestational age up through 10 weeks
post term age.
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