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PCM IV Final > 7. Nutritional Assessment > Flashcards

7. Nutritional Assessment Flashcards

1
Q

3 components of total NRG expenditure

A
  1. Basal NRG expenditure (55-65% of total calories)
  2. Activity NRG expenditure (25-33%)
  3. Thermal effect of feeding (10% of calories)
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2
Q
  • Sedentary hospitalized patient = ______kcal/kg of body weight will maintain weight.
  • Acutely or severely ill patients (trauma, burn patient, etc.) = ______ Kcal/kg.
A
  • Sedentary hospitalized patient = 30-35 kcal/kg of body weight
  • Acutely or severely ill patients = 35-40 kcal/kg
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3
Q

RF to obesity

A
  1. Lifestyle = biggest RF
  2. Minority populations
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4
Q

RF to malnurition

A
  1. Older ppl who live alone
  2. Chronically ill pts (renal failure, celiac, COPD, CHF)
  3. Adolescents who eat and diet erratically
  4. Cancer pts undergoing chemo
  5. Drugs/ Alcoholics
  6. Homeless/lowSES
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5
Q

Nutritional deficits W/O weight loss = uncommon.

One exception is what?

A
  • Anemia due to strict vegetarian or vegan diets may have B12 deficiency
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6
Q

Older adults should be screened for nutritional status using the acronym DETERMINE

A
  1. Disease that makes it hard to cook/eat
  2. Eating poorly
  3. Tooth loss or mouth pain
  4. Economic hardships
  5. Reduced social contacts
  6. Multuple meds
  7. Involuntary WL
  8. Need to assistance w self-care
  9. Elderly (>80YO)
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7
Q

when is WL significant

A

Unintentional WL of 5% over 6 months or 10% over a year.

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8
Q

% weight change =

A

[(usual weight - current weight)/usual weight] * 100

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9
Q

interview questions of WL should be directed to what

A

common areas that cause WL

1. Decreased caloric intake due to anorexia, hardtime swallowing, self-care, depression

2. Malabsorption and maldigestion: diarrhea, fatty stools

3. Impaired metabolism or increase requirements

4. Increase losses or excretions: vommit, diarrhea, open wounds

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10
Q

PE findings that provide info on nutritional status

A
  1. VS: height, weight and BMI
  2. Tricep skin thickness to assess subQ fat
  3. Rapid weight gain = fluid retention
  4. Tissue loss
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11
Q

Vit B3 deficiency = aka

A

Vitamin B3 = Niacin

Deficiency => pellegra = 3 D’s

  1. Diarrhea
  2. Photodermatitis in sun-exposed areas
  3. Dementria

Glossitis, burning paresthesia, stomatitis, vertigo

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12
Q

Vit C deficiency

A
  • Scurvy = 4 H’s
    1. ​Hemorrhagic signs =>
      1. Gingivitis, inflamed gingiva, impaired wound healing,
    2. Hyperkeratosis of hair follicles => corkscrew hair
    3. Hypochondriasis
    4. Hematologic abnormalitis => perifollicular petachiae, bleeding
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13
Q

Vit D deficiency

A
  • Rickets = softening and weakinging of bones in infants and kids before epiphyseal closes.
  • After closed => osteomalacia
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14
Q

Vit B12 deficiency = aka

A
  • Vit b12 = cobalamin
  • Common in vegans/vegetarians and GI abnormalitis (celiacs, pancreatic disorder, atrophic gastritis)
    1. Hyperpigmentation in creases and folds
    2. Megaloblastic anemia
    3. Thrombocytopenia + anemia
    4. Weakness, paresthesias, numbness and ataxia
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15
Q

What do you think is the recommendation for an adult for vegetables/day? Fruits?

A

6 –9 fruits & vegetables

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16
Q

besst diet to eat

A

mediterranean: plant based, small portions of eggs/dairy/poultry and fish, MINIMAL red meat, sugar, flour, butter, fats

1-2 glasses of red win/day

17
Q

No meat + may or may not include eggs or dairy

A

vegetarian

18
Q

no meat, eggs, dairy and honey

A

vegan

19
Q

no meat + [eats eggs and dairy]

A

lacto-ovo-vegetarian

20
Q

no meats + eats eggs & egg products but no dairy

A

ovo-vegetarian

21
Q

vegetables, fruits, nuts, seeds, legums, grains, uncooked food = 75%-100

A

raw vegan

22
Q
  1. What nutritional deficiency may result in a strict vegetarian or vegan diet?
A
  1. B12 (cobalamin)
23
Q
  1. current recommendation of salt=
  2. average consumption of salt =
  3. why is salt bad =
A
  1. 2300mg/d
  2. 3400mg/d
  3. salt => directly increase BP and fluid retention
24
Q

what is dash diet and how does it affect BP and cholesterol

A
  • limit sodium to 2300mg/d
  • decrease BP and LDL cholesterol
25
Q

what are required on food labels

_____ MUST be labeled

A
  • vit D, potassium, Ca, iron (vit A and C are optional)
  • Major allergens (milk, eggs, peanuts)
26
Q
  1. ________ means less than 5 mg of sodium per serving.
  2. _________ means less 35 mg of sodium or less per serving.
  3. _______ means 140 mg of sodium or less per serving.
  4. __________ means at least 25% less sodium than in the original product. ***
  5. __________ means at least 50% less sodium than the regular product. ***
  6. _________ means that no salt is added during processing. It does not mean that there is no sodium in the product***
A
  1. Salt/Sodium-Free means less than 5 mg of sodium per serving.
  2. Very Low Sodium means less 35 mg of sodium or less per serving.
  3. Low sodium means 140 mg of sodium or less per serving.
  4. Reduced Sodium means at least 25% less sodium than in the original product.
  5. Light in Sodium or Lightly Salted means at least 50% less sodium than the regular product.
  6. No-Salt-Added or Unsalted means that no salt is added during processing. It does not mean that there is no sodium in the product.
27
Q

PE maneurvers to asses muscle strength = tell us about nutirional status

A
  1. grip strength = squeeze infex and middle fingers for 10 seconds
  2. ambulation = walk across and bac kroom
  3. LE strength against resistance
28
Q

labs measure deficiency in what?

  1. CBC
  2. TSH
  3. Total protein and albumin
A
  1. CBC = iron, B12, folate
  2. TSH = iodine
  3. Total protein and albumin = protein calorie malnutrition
29
Q

waist circumfrance that means obsese

A

men: >40’
women: >35’

30
Q

Vit A deficiency

due to?

A
  1. epithelium problems = skin and eye due to hyperkeratosis
  2. problems with malapbsotion = crohns, celiacs, bariatric surgery, chronic mineral oil for constipation
31
Q

Which of the following is a risk factor for vitamin D deficiency?

A. Elderly nursing home resident

B.Treatment for seizure disorders

C.Dark-skinned patients living in northern climates

D.Patients with milk/dairy allergy

E.All of the above

A

A. Elderly nursing home resident

B.Treatment for seizure disorders

C.Dark-skinned patients living in northern climates

D.Patients with milk allergy

E.All of the above (no sun, no milk/dairy, too much sunscreen)

32
Q

goiter can be caused by ___ deficiency

A

iodine

33
Q

iron deficiency can cause

A
  1. spooning of nail beds
  2. pale skin
  3. conjunctiva pallor
  4. glossitis
34
Q

what can cause glossitis

A
  1. riboflavin (B2)
  2. niacin (B3)
  3. Folate (B9)
  4. Iron
35
Q

most likely deficiency

A

niacin (B3) = photodermatitis in sun-exposed area

36
Q

most likely deficiency

A

A.Riboflavin

B.Pyridoxine

C.Niacin

D.Iron

37
Q

what people require a low salt hospital diet (1gm, 2gm, 3gm)

A

CV disease: CHF, HTN, Angina

38
Q

hospital diet that requires a consistent carb diet

A

DB type 1 and 2

39
Q

what can cause

  1. parotid gland enlargement
  2. dry and scaly skin
  3. conjunctiva pallor
  4. angular stomatitis
A
  1. parotid gland enlargement = protein
  2. dry and scaly skin = protein
  3. conjunctiva pallor = iron, B12, folate
  4. angular stomatitis = riboflavin, pyridoxine, niacin

PCM IV Final (12 decks)

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