Download NURS 6204 MIDTERM EXAM LATEST STUDY 2024 (NOVEMBER) Adv. Health assessment and more Exams Nursing in PDF only on Docsity!
NURS 6204 MIDTERM EXAM LATEST STUDY 2024 (NOVEMBER)
Adv. Health assessment
How did the history of probiotics become more popularized? Elie Metchnikoff popularized the idea of fermented milk products that could beneficially alter the microbiota of GI tract.
- attirbuted long-life of Bulgarian peasants to their consumption of source milk What was the bacteria found in the Bulgarian milk called? Bacillus bulgaricus-->Lactobacillus delbrueckii subspecies Bulgaria and a type of cocci--
Streptooccus thermophilus What strains of probiotics are added to yogurts to help them survive through the upper gut Lactobacillus spp and Bifidobacterium spp Lactobacillus bifidus was renamed to Bifidobacterium bifidum Lactobacillus sporongenes has been renamed to bacillus coagulans Saccharomhyces boulardii is within which species Saccharomyces cerevisiae Traditional use of probiotics with/post antibiotics IBS IBD Gut infections
Constipation Dysbiosis Lactose intolerance Intestinal permeability Vaginal thrush What are some desirable characteristics of probiotics?
- human origin: survive conditions in human GIT
- gastric acid and bile salt stability: survive through stomach and small intestine
- adherence to intestinal mucosa-essential for immune cell modulation and competitive inhibition of pathogens
- colonization of intestinal tract-multiplication in intestines suggests daily ingestion may not be needed, immune cell modulation
- safety I food and documented clinical safety-adverse effects absent or minimal, accurate identification (genus, species,strain_
- production of anti-microbial compounds-normalization of GIT flora, supressed growth of pathogens
- antagonism against pathogenic organisms-prevention of adhesion and toxin production by pathogens
- clinically documented and validated health effects-clinicians can be confident in therapeutic effects, actions of strain match to pathology
- increased shelf life and stability during processing-all of above properties should be maintained during storage and processing essential characteristics of probiotic
- gastric acid and bile salt stability
- ability to adhere to intestinal cells
- ability to temporarily colonies gut
- clinically documented and validated health effects strains of bacteria within the same species may vary in regards to (6)
- shelf stability
- adherence capacity and method of adherence
- colonisation capacity
- ability to produce anti-microbial compounds
how do probiotics decrease visceral sensitivity? which GI disorder is this important for? by inducing cannabinoid and opioid receptor expression in colon cells
- IBS how do probiotics strengthen intestinal barrier? increasing mucin production in gut which provides protective coating between lumen and intestinal epithelial cells how do probiotics alter brain chemistry?
- interact with our own gut cells to produce more serotonin
- interact with immune cells to decrease inflammatory environment in body/brain which can help neurological activity how do probiotics beneficially alter metabolism? (5)
- decrease body-wide inflammation
- improve intestinal permeability
- improve blood sugar control
- enhance sense of satiety
- lower oxidative stress what defines a good quality probiotics supplement? (2)
- the characteristics of the strains contained in the supplement
- adequate viability Supplement red flags (5)
- not listing strain names on label
- refuse to tell you the strain names or uses "secret strain"
- contains non-existent species
- research results are extrapolated from other strains onto the ones contained in the product
- strains provided in insufficient dosages minimum effective dosage for probiotics
differs by strain but most successful probiotics research has utilized >10^9 CFU/dose at END of shelf-life not at point of manufacture if a formula contains multiple strains each strain must be present in amounts of 10^9 CFU (t/f) true is a higher probiotic dose always better? often yes, but most important to make sure strain prescribed is used for what you are treating you should use smaller doses of probiotics in infants/children (T/F) false, no need compared to adults probiotic dosing strategy for acute conditions (ex. infectious diarrhea, antibiotic associated diarrhea) higher dosages and more frequent applications probiotic dosing strategy for chronic conditions (IBS, type 2 diabetes, depression, anxiety, obesity, hay fever, eczema, food allergies) sustainable and less frequent dosages what does probiotic product viability depend upon
- proper manufacturing
- hardiness of strain
- packaging and storing the product in right amount of moisture and at correct Do all probiotics need to be refrigerated? no, some a room temp stable and some only need refrigeration after opening Probiotics that melt label claims
- natter healthy trinity
examples of gut bacteria that produce lactate
- bacteroides X
- e. coli
- klebsiella X
- lactobacillus
- streprococcus when do u consider d-lacate when prescribing probiotics?
- SBS
- damaged small intestine
- SIBO and brain fog
- severe symbiotic colonic environment with lack o D-lactate consuming species and Oxalobacter formigenes
- higher fat intake Histamine degradation is a strain-dependent train, NOT species dependent one (t/f) true of L. casei/L.plantarum strains how many can breakdown greater than 10% of histamine? L.casei 1/ 14% could degrade it L. plantarum 2/ 33%
- also need more studies in gut not in vitro studies of lactobacillus fermentum strains, what % assess satisfactory tolerance to gastric acid and bile? 4% of 90 tested
of 31 strains of lactobacillus plantarum, how many showed strong adhesion to mucin? ( means can compete to potential pathogens and stay in gut for a while 5/ which strain of lactobacillus rhamnosus show strongest ability to adhere to mucin L.rhamnosus GG Method of adherence matters ex. Lactobacillus plantarum 5 different adhere at all, 8 adhered but in variable amounts CIDCA 5310 vs CIDCA 537 in reducing colonocyte invasion by Salmonella arizonae only CIDCA 5310 was effective Some strains have variations in consuming specific prebiotics for growth (t/f) true different strains produce different metabolic end products and fermentation end products (SCFA)(t/f) true do different strains vary in production of anti-microbial compounds? yes Lactobacillus Reuteri strains can produce different amounts of reuterin (anti-microbial compound (t/f) true which L. acidophilus strains increased early serum igG levels? (La-14 or NCFM) La- 14
after a course of antibiotics (or other gut insult) you can reinoculate or "re-seed" your gut by eating fermented foods and kombucha (T/F) false, capacity to change pH and can help with candida. can restore ecosystem giving probiotics in food forms (yoghurt) is superior to supplement form (capsule, powder, tablet) (T/F) false does research find adverse effects of probiotics? no When has administration of species S. cerevisae var boulardii found to cause fungaemia?
- in severely immunocompromised or critically ill individuals
- generally associated with venous catheters good therapeutic yogurts yakult, activia (not in US), vaalia changes produced in kefir milk
- lactose-->lactic acid
- CO2 production
- increase free amino acids
- B vitamins and flavonoids increase
- production of antimicrobial compounds-active against some gram negative bugs
- production of polysaccharide that raise activity of proteolytic enzymes in GIT.
- oral consumption demonstrated anti-tomour activity and improvements in immune status (rats) kefir therapeutic properties (8)
- improve appetite, salivation, secretion of gastric acid and pancrealyticl enzymes, improve functional capacity of proteolytic enzymes
- good source of easily assimilated FAA
- useful in travelers diarrhea and UTIs (prevention and treatment)
- diuretic effect (increase urea excretion)
- cholesterol lowering effect
- normalizing effect on bowel
- improves immune function (macrophages)
- improves resistance to catching respiratory tract infections microorganisms in sauerkraut and kimchi Leuconostoc mesenteroides Lactobacillus plantarum Lactobacillus brevis Streptococcus faecalis and Pediococcus pentosaceus benefits of sauerkraut and kimchi
- 600% increase in Vitamin C content
- low GI, organic acids delay gastric emptying
- fermentation decreases agricultural pesticides
- rich in L. plantarum strains
- stimulate intestinal peristalsis (laxative effect) due to acetylcholine and lactylcholine content
- contain glutaric acid (glutamate) and indole- 3 - carbinol (improve estrogen metabolism
- contains anti-fungal compounds
- contain polyamines (help leaky gut) benefits of polyamines cell renewal and regeneration intestinal hyperpermeability (leaky gut) how is something fermented? fermentation is the conversion of CHO (sugar) into acid or alcohol under anaerobic conditions (yeast-related or bacterial)
- major aim of fermenting organism is energy production for itself
- by-products of this energy production cause a number of other metabolic and biochemical changes to take place
miso history/effects on GIT aspergillus oryzae and saccharomyces rouxii. unlikely to have probiotic effec.t unpasteurised miso does contain amylases and proteases. aid in digestion of proteins and starches (if not denatured by heat) history of sourdough bread/effects on GIT fermented dough contains >10^9 microorganisms of Lactobacillus plantarum
- if eaten raw good probiotic, when cooked good sources of bacterial metabolites and dead bacteria
- not probiotic food prebiotics defintion non digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in colon how can food ingredients be classified as prebiotics?
- neither hydrolyzed nor absorbed in stomach or Small Intestine
- act as selective substrate for one or a limited number of potentially beneficial commensal bacteria in large intestine
- change in colonic microflora ecosystem towards healthier composition
- induce lumina or systemic changes that improve the health of the host. most commonly available and best researched prebiotics
- FOS
- Lactulose
- GOS Fibers that are NOT prebiotics but are colonic foods that are utilized by a number of different bacterial species in bowel slippery elm, pectin, psyillum husk, guar gum how do prebiotics work?
- ingestion
- prebiotics transfers to colon
- fermented by selected components of flora (bifidobacteria)
- improved microbiota comp 3 types of FOS
- inulin
- oligofructose
- neosugar inulin largest FOS, extracted from chicory roots using only hot water oligofructose medium-chain FOS, produced from inulin using enzymatic hydrolysis neosugar short-chain FOS, synthesized using fungal organism that converts sucrose to FOS uses of FOS
- treatment of dysbiosis. enhances bifidobacteria and decreases growth of E.Coli, clostridia, bacteriodes
- enhancement of immunity
- enhanced Ca absorption (via decrease in colonic pH which results in increased Ca solubility, enhances expression of calbindin-D9k
- improved bioavailability of phytoestrogens
- improved efficacy of medicinal herbs by enhancing microbial beta-glucosidase activity in colon.(especially important post AB therapy)
- hyperlipidemia (improves serum lipid parameters)
- damaged intestinal or colonic mucosa (trophic healing effects on GIT)
- treatment of atopic eczema (atopic infants have dysbiosis)
- Promotion of satiety (lower gherkin and higher peptide YY which is satiety hormone)
- treatment of ulcerative colitis optimum lactulose dosages 3 - 20g/day in most conditions 10g 2x daily is optimal treatment of constipation- 15 - 40g/day management of liver disease-35g/day forms of lactulose
- syrup-sold from most chemists in laxative section (Lac-dol, Duphalac, Actilax) 3 tsp daily
- powder-not currently on market side effects/safety of lactulose
- abdominal bloating, flatulence, abdominal pain, distention
- diarrhea (with high initial dose)
- start with low dose (1 tsp daily and slowly increase optimal dose GOS (what is it?)
- non-digestible CHO produced from lactose using b-galactosidases
- resistant to digestion by host-secreted enzymes in SI
- reach terminal ileum and colon intact
- become available to those members of the colonic microbiota metabolically equipped to metabolize these specific oligosaccharides use of GOS
- treats dysbiosis (mostly bifidobacteria)
- treatment of constipation
- prevention of atopic disease with FOS
- increased resistance to infections in combo with FOS
- treatment of IBS (3.5g/day optimal dose/7g/day improved symptoms but increased bloating)
- improved Ca absorption (20g/day) increased in post-menopausal women
- MetS decrease in serum CRP, insulin, totalC, triglyceride
- prevention of GIT Infection
- prevention of travelers diarrhea GOS dosing 2.5-15g/day
- research shows no apparent dose response (>5g/day most effective)
- treatment of IBS-3.5g/day
- prevention of travelers diarrhea-2.6g/day
- enhance Ca- 5 - 20g/day side effects/safety of GOS start with low dose abdominal bloating, flatulence, abdominal pain, distention but can diminish over time and less likely to cause these other S&S than other prebiotic sugars definition of colonic foods foods entering the colon and serving as substrates for the endogenous colonic bacteria, thus indirectly providing the host with energy, metabolic substrates and essential micronutrients colonic foods escape digestion and absorption in the upper GIT to reach the colon intact (T/F) true members of colonic microflora ferment colonic foods to produce what SCFA, hydrogen, methane, CO through the production of what, the ingestion of colonic foods plays a pivotal role in the health of the host SCFA what does a colonic foods lack that prebiotics possess specificity of fermentation
Larch Arabinogalactans (LA) type of soluble fiber
- extracted from wood of Western Larch (Larix Occidentalis) using water extraction process
- composed of monosaccharides galactose and arabinose and with small amounts of glucuronic acid potential uses of LA
- hepatic encephalopathy decrease ammonia production but lactulose more substantiated for this condition
- prevention of colon cancer
- in vitro immune stimulant
- effects on beneficial bacteria inconsistent
- may improve stool consistency (inconsistent results) dosage of LA/side effects available as white, powder with slightly sweet taste and mild pine-like odor. 5 - 30g/day in divided doses.
- 3 tsp- 4 Tab/day side effects: bloating and flatulene synbiotics benefits contain both prebiotics and probiotics
- enhance survival of probiotic bacteria through upper GIT
- improve implantation of probiotic in colon
- stimulating effect on growth and/or activities of both exogenously provided probiotic strain(s) and endogenous inhabitants of the bowel. what criteria should a synbiotic be assessed for
- probiotic used well researched strain
- prebiotic truly a prebiotic?
- does prebiotic enhance growth of exact probiotic strain in product
- are both agents included in therapeutic doses?
Bifidobacterium lactose Bb12 can utilize which prebiotics? GOS, lactulose, FOS L. rhamnosus GG uses which prebiotics? GOS L. acidophilus NCFM and L. acidophilus DDS-1 can utilize which prebiotic FOS define eubiosis normal stae of affairs in healthy GIT. state of balance within GIT microbial population maintained by sensitive interactions between living/non-living components in this enclave of external environment human GIT microflora contain 10^4 viable organisms (T/F) false, 10^ the human GIT microbiota can be considered an additional human organ (T/F) true count of bacteria in colon is higher and ecosystem becomes more complex (T/F) true, stomach and duodenum has least amount of bacteria and least complex ecoystem what is most important component of GIT microflora colonic microflora what are 3 main enterotypes
- bactericides (enterotype 1)
