Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UG Biochemistry > 10. Nutritional > Flashcards

10. Nutritional Flashcards

1
Q

Define nutritional assessment

A

The evaluation of an individual’s nutritional status + nutrient requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is nutritional assessment so important?

A

Acute + chronic malnutrition prevalent
Over and under-nutrition increasing

As indicated by national diet + nutrition survey 2008-2012;
Sugars: 11% limit (4-18 years higher)
Sat fat: 11% limit (19-64 years 12.6%)
Salt: 6g/day (>65 years 7.2g/day)
Fruit + veg: 5 portions/day (19+ years eating less, particulary girls 11-18 years)

Oily fish: average intake well below rec 1 portion/week in all age groups

Vit D: low vit D status in 23% adults + 22% children over whole year
- increases to 40% in both groups in winter

Iron: 46% girls + 23% women low iron intakes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does the northern Irish diet compare to the rest of the UK?

A

Consume more unhealthy foods;
- milk/cream, carcass meat, butter, fresh potatoes (+78%)

Less healthy foods;
- margarine (-60%), fresh fish, fruit juice, other fresh produce

People living in London consumed nearly twice as much fresh fruit + veg as people living in N Ireland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is nutritional status assessed?

A

History
Examination
Lab tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What factors are identified in a general medical history that affect or indicate nutritional status?

A 
Obesity
Hyperlipidemia/CVD
Hypertension
Diabetes
Alcoholism
Failure-to-thrive
Eating disorder
Weight loss/gain
Lactose intolerance
GI disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What medications + vitamin/mineral supplements affect nutritional status?

A

Pharmaceutical agents
Over the counter medications
Vitamin + mineral intake
Herbal remedies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What social history + diet information (non medical) can be useful in a general history for assessing nutritional status?

A

Lifestyle assessment: employment + exercise
Alcohol history
Following special diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is a persons functional status assessed?

A

By Activities of Daily Living (ADLs);

  • bathing
  • dressing
  • toileting
  • transferring
  • continence
  • feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is a persons diet history determined?

A
  1. 24 hour recall
  2. food frequency
  3. usual intake
  4. food record
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the 24 hour recall method for determining diet history

A

Documents pts intake of all food + beverage during previous 24 hr period

Ideal for;
- pts with diabetes: ability to assess timing of meals, snacks, insulin injections

Limitations;
- many pts do not rmb what they ate + cannot accurately estimate quantities consumed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the Food Frequency method for determining diet history

A

Estimate the frequency + quantity of foods eaten during a weekly/monthly period;

  • how often do you consume X during a typical week?
  • how often do you eat out during a typical week?

Ideal method to evaluate intake of;

  • fat
  • sodium
  • sugar
  • dairy
  • fruit/veg intake

Ideal for;

  • pts with CVD, hypertension, osteoporosis
  • pts questioning requirement of vitamin supp
  • elderly pts who avoid food groups

Limitations;
- many pts do not remember what they ate + cannot accurately estimate quantities consumed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the Usual Intake Method of determining diet history

A

Documents a pts usual intake, including breakfast, lunch, dinner + snacks

Ideal for;

  • elderly pts (assess no meals eaten/skipped)
  • infants/children/adolescents whose diets are not varied

Limitations;
- many pts not consistent with eating habits + state there is no usual pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List what a physical exam can reveal about a pts nutritional status

A 
Head/neck: temporal wasting
Triceps: skin fold measurements
Hands: interosseus muscle wasting
Mouth: condition of teeth, gums, tongue
Abdomen: ascites, site of jejunostomy tube
Skin: xanthomas, rash, edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is commonly examined in a laboratory evaluation of nutritional status?

A

Anaemia: Fe, folate, vitamin B12
Micronutrients
General malnutrition: serum proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Discuss the lab evaluation of serum proteins in assessing nutritional status

A

Albumin: 18-20 day half life

  • slow fall in malnut/slow rise with repletion
  • 50-60% blood plasma proteins
  • ref range: 3.5-6.5 g/dL

Transferrin: 8-9 day half life

  • influenced by status of iron stores
  • TIBC measures capacity to bind iron with tf
  • TIBC ref range: 250-370ug/dL

Prealbumin: 2-3 day half life

  • decreases early in malnut/increases quick with repletion
  • ref range: 19-38mg/dL
Changes in serum proteins indicate;
Normal/increased levels;
 - increased synthesis
 - decreased losses
 - dehydration
 - well nourished

Decreased levels;

  • decreased synthesis
  • increased losses
  • dilutional effect
  • malnutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define malnutrition

A

An unintentional weight loss of greater than 10% of body weight associated with serum albumin <3.5g/dL

17
Q

What types of pts are at risk of malnutrition?

A

50% of hospitalised surgical pts experience malnutrition

18
Q

What is MUST + how is it used in nutritional assessment?

A

MUST = Malnutrition Universal Screening Tool

5 step screening tool to identify adults who are;

  • malnourished
  • at risk of malnutrition (undernutrition)
  • obese

Includes management guidelines - can be used to develop care plan

Used in hospitals, community + other care settings
Step 1: height + weight = BMI score
Step 2: note % unplanned weight loss + score
Step 3: Establish acute disease effect + score
Step 4: Add scores from previous steps to obtain overall risk of malnutrition
Step 5: Use management guidelines/local policy to develop care plan

19
Q

What is malnutrition associated with (regardless of aetiology)?

A 
Sub-optimal surgical outcome
Increased rate of infection
Longer hospital stay
Impaired wound healing
Frequent hospital re-admission for elderly
More frequent post-op complications
Increased risk of death
20
Q

What are the 2 main types of malnutrition?

A

Marasmus: protein-energy malnutrition
Kwashiorkor: protein malnutrition

21
Q

Describe marasmus

A

Protein-energy malnutrition;

  • severe tissue wasting
  • excessive loss of lean body mass + fat stores
  • dehydration
  • weight loss

S+Ss;

  • normal hair
  • old man appearance
  • thin limbs with little muscle or fat
  • very underweight body
22
Q

Describe kwashiorkor

A

Protein malnutrition;

  • retarded growth
  • changes in skin + hair pigmentation
  • edema
  • low serum albumin

S+Ss;

  • swelling of legs (edema)
  • sparse hair
  • moon face with little interest in surroundings
  • flaky appearance of skin
  • swollen abdomen
  • thin muscles but fat present
23
Q

Describe the main mechanisms of malnutrition

A

Impaired dietary intake

Malabsorption;

  • coeliac disease
  • Crohn’s disease
  • short bowel syndrome (trauma/surgery, etc)
24
Q

What are the routes for nutritional support?

A 
Oral supplements
Tube feeding;
 - nasogastric (NG)
 - naso-jejunal (NJ)
 - gastrostomy
 - jejunostomy
Parenteral (IV)
25
Q

Which is better: enteral (GI tract) or parenteral (IV) nutrition? Why?

A

Better to use gut if possible

Animal studies nourished by TPN without enteral feedings;
Atrophy of small bowel mucosa;
- decreased mucosal mass
- decreased enzyme activity

Decreased intestinal adaptive changes after small bowel resection

Bacterial translocation from GI tract to circulatory system can lead to sepsis

26
Q

When is TPN possibly indicated?

A

Malabsorption
Massive bowel resection may result in short bowl syndrome (ischemia, trauma, malignancy)
GI tract obstruction
Impaired GI motility (ileus, pseudo-obstruction)
Abdominal trauma, injury or infection
Inflammatory bowel disease (Crohn’s, ulcerative colitis)
Severe pancreatitis

27
Q

How is TPN administered?

A

TPN solutions are hypertonic

Infused via central venous catheter

28
Q

Describe the Food Record Method for determining diet history

A

Written record by pt of everything they ate/drank over a 2-4 day period;

Ideal for;

  • pts with difficulty losing weight
  • pts who are eating out of control + gaining weight
  • brittle diabetics
  • emotional eaters

Limitations;

  • many pts not motivated to write down everything (although those who do lose weight)
  • difficult for physicians to take the time to review + comment (especially if not trained)
29
Q

What characteristics can be measured in a physical exam to assist with nutritional assessment?

A

Cachexia (weakness/wasting due to illness)
Obesity
Height/weight + BMI
Location of body fat - abdominal or gluteal region

30
Q

Describe the use of BMI in assessing pt nutritional status

A

Body mass index defined as weight (kg)/height (m2)

  • replaces the Metropolitan Life height/weight tables
  • correlates significantly with body fat, morbidity + mortality

Limitations;
- may be an overestimate of body fat in a very fit individual

Underweight: <18.5
Normal weight: 19-24.9
Overweight: 25-29.9
Class I obesity: 30-34.9
Class II obesity: 35-39.9
Class III obesity: >=40

UG Biochemistry (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions