Nutrition and Medical Nutrition Therapy
Nutrition fundamentals
Review energy-yielding nutrients (carbohydrate 4 kcal/g, protein 4, fat 9, alcohol 7), digestion and absorption, and requirements across the lifecycle. Nutrition screening identifies risk; assessment estimates intake, weight history, laboratory values, and physical findings. Traps: serum albumin is an inflammation marker, not a reliable short-term nutrition-status indicator; prealbumin is similarly affected.
Medical nutrition therapy
For diabetes, carbohydrate consistency and counting matter: one carbohydrate choice equals 15 g carbohydrate; label reading and portion estimation are tested. Renal diets limit sodium, potassium, phosphorus, and sometimes protein and fluid; salt substitutes are high in potassium and are a common trap. Cardiac diets emphasize sodium and saturated-fat reduction. Dysphagia questions test texture and liquid modification: know the levels and that thin liquids are often restricted, not encouraged. Enteral nutrition requires verified tube placement, head-of-bed elevation, and tolerance monitoring; parenteral nutrition requires sterile technique and gradual advancement.
Food-drug interactions and allergies
Warfarin and vitamin K consistency, MAO inhibitors and tyramine, grapefruit and certain drugs, and allergen avoidance with cross-contact controls are high-yield topics.
Worked example
A resident's lunch contains 45 g carbohydrate. Using 15 g per choice, that is 45 / 15 = 3 carbohydrate choices. If the meal plan allows 4 choices (60 g), add one choice, such as a small fruit or one slice of bread, rather than assuming a free food is carbohydrate-free.