7. Nutritional Assessment Flashcards
3 components of total NRG expenditure
- Basal NRG expenditure (55-65% of total calories)
- Activity NRG expenditure (25-33%)
- Thermal effect of feeding (10% of calories)
- Sedentary hospitalized patient = ______kcal/kg of body weight will maintain weight.
- Acutely or severely ill patients (trauma, burn patient, etc.) = ______ Kcal/kg.
- Sedentary hospitalized patient = 30-35 kcal/kg of body weight
- Acutely or severely ill patients = 35-40 kcal/kg
RF to obesity
- Lifestyle = biggest RF
- Minority populations
RF to malnurition
- Older ppl who live alone
- Chronically ill pts (renal failure, celiac, COPD, CHF)
- Adolescents who eat and diet erratically
- Cancer pts undergoing chemo
- Drugs/ Alcoholics
- Homeless/lowSES
Nutritional deficits W/O weight loss = uncommon.
One exception is what?
- Anemia due to strict vegetarian or vegan diets may have B12 deficiency
Older adults should be screened for nutritional status using the acronym DETERMINE
- Disease that makes it hard to cook/eat
- Eating poorly
- Tooth loss or mouth pain
- Economic hardships
- Reduced social contacts
- Multuple meds
- Involuntary WL
- Need to assistance w self-care
- Elderly (>80YO)
when is WL significant
Unintentional WL of 5% over 6 months or 10% over a year.
% weight change =
[(usual weight - current weight)/usual weight] * 100
interview questions of WL should be directed to what
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
PE findings that provide info on nutritional status
- VS: height, weight and BMI
- Tricep skin thickness to assess subQ fat
- Rapid weight gain = fluid retention
- Tissue loss
Vit B3 deficiency = aka
Vitamin B3 = Niacin
Deficiency => pellegra = 3 D’s
- Diarrhea
- Photodermatitis in sun-exposed areas
- Dementria
Glossitis, burning paresthesia, stomatitis, vertigo
Vit C deficiency
- Scurvy = 4 H’s
- Hemorrhagic signs =>
- Gingivitis, inflamed gingiva, impaired wound healing,
- Hyperkeratosis of hair follicles => corkscrew hair
- Hypochondriasis
- Hematologic abnormalitis => perifollicular petachiae, bleeding
- Hemorrhagic signs =>
Vit D deficiency
- Rickets = softening and weakinging of bones in infants and kids before epiphyseal closes.
- After closed => osteomalacia
Vit B12 deficiency = aka
- Vit b12 = cobalamin
- Common in vegans/vegetarians and GI abnormalitis (celiacs, pancreatic disorder, atrophic gastritis)
- Hyperpigmentation in creases and folds
- Megaloblastic anemia
- Thrombocytopenia + anemia
- Weakness, paresthesias, numbness and ataxia
What do you think is the recommendation for an adult for vegetables/day? Fruits?
6 –9 fruits & vegetables
besst diet to eat
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
No meat + may or may not include eggs or dairy
vegetarian
no meat, eggs, dairy and honey
vegan
no meat + [eats eggs and dairy]
lacto-ovo-vegetarian
no meats + eats eggs & egg products but no dairy
ovo-vegetarian
vegetables, fruits, nuts, seeds, legums, grains, uncooked food = 75%-100
raw vegan
- What nutritional deficiency may result in a strict vegetarian or vegan diet?
- B12 (cobalamin)
- current recommendation of salt=
- average consumption of salt =
- why is salt bad =
- 2300mg/d
- 3400mg/d
- salt => directly increase BP and fluid retention
what is dash diet and how does it affect BP and cholesterol
- limit sodium to 2300mg/d
- decrease BP and LDL cholesterol
what are required on food labels
_____ MUST be labeled
- vit D, potassium, Ca, iron (vit A and C are optional)
- Major allergens (milk, eggs, peanuts)
- ________ means less than 5 mg of sodium per serving.
- _________ means less 35 mg of sodium or less per serving.
- _______ means 140 mg of sodium or less per serving.
- __________ means at least 25% less sodium than in the original product. ***
- __________ means at least 50% less sodium than the regular product. ***
- _________ means that no salt is added during processing. It does not mean that there is no sodium in the product***
- Salt/Sodium-Free means less than 5 mg of sodium per serving.
- Very Low Sodium means less 35 mg of sodium or less per serving.
- Low sodium means 140 mg of sodium or less per serving.
- Reduced Sodium means at least 25% less sodium than in the original product.
- Light in Sodium or Lightly Salted means at least 50% less sodium than the regular product.
- 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.
PE maneurvers to asses muscle strength = tell us about nutirional status
- grip strength = squeeze infex and middle fingers for 10 seconds
- ambulation = walk across and bac kroom
- LE strength against resistance
labs measure deficiency in what?
- CBC
- TSH
- Total protein and albumin
- CBC = iron, B12, folate
- TSH = iodine
- Total protein and albumin = protein calorie malnutrition
waist circumfrance that means obsese
men: >40’
women: >35’
Vit A deficiency
due to?
- epithelium problems = skin and eye due to hyperkeratosis
- problems with malapbsotion = crohns, celiacs, bariatric surgery, chronic mineral oil for constipation
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. 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)
goiter can be caused by ___ deficiency
iodine
iron deficiency can cause
- spooning of nail beds
- pale skin
- conjunctiva pallor
- glossitis
what can cause glossitis
- riboflavin (B2)
- niacin (B3)
- Folate (B9)
- Iron
most likely deficiency
niacin (B3) = photodermatitis in sun-exposed area
most likely deficiency
A.Riboflavin
B.Pyridoxine
C.Niacin
D.Iron
what people require a low salt hospital diet (1gm, 2gm, 3gm)
CV disease: CHF, HTN, Angina
hospital diet that requires a consistent carb diet
DB type 1 and 2
what can cause
- parotid gland enlargement
- dry and scaly skin
- conjunctiva pallor
- angular stomatitis
- parotid gland enlargement = protein
- dry and scaly skin = protein
- conjunctiva pallor = iron, B12, folate
- angular stomatitis = riboflavin, pyridoxine, niacin
