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Master Deck > ASPEN Self-Assessment: Nutrition Assessment > Flashcards

ASPEN Self-Assessment: Nutrition Assessment Flashcards

1
Q

(T/F)
Catabolism of endogenous substrate including fat stored in adipose tissue (lipolysis) is common in both forms of malnutrition.

A

TRUE.
Hypoglycemia and ketosis are characteristic of starvation.
Hypermetabolism and hyperglycemia are characteristic of stress-related malnutrition.

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2
Q

Explain albumin.

A

A negative acute-phase protein.
Levels decrease in response to stress and hypoalbuminemia is more a reflection of the degrees of stress resulting from disease, injury, and inflammation than nutritional status.
Hypoalbuminemia has been associated with increased short-term mortality, length of hospital stay, and complications and correlates strongly with 30-day mortality.

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3
Q

Explain hyperhomocysteinemia.

A

Has been linked to an increased risk for coronary atherosclerosis.
Studies have shown that folic acid, vitamin B6, and vitamin B12 supplementation can reduce plasma homocysteine concentrations.
It is not known whether hyperhomocysteinemia is a causative factor of atherosclerosis or simply a marker of vascular disease.

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4
Q

What are the appropriate fluid requirements for each below?

  • Healthy adults, aged 18-55
  • Healthy adults, aged 55-75
  • Healthy adults, older than 75
  • Fluid restriction
A
  • Healthy, aged 18-55: 35 ml/kg
  • Healthy, aged 55-75: 30 ml/kg
  • Healthy, older than 75: 25 ml/kg
  • FR: Less than 25 ml/kg
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5
Q

Which amino acid is a key fuel for the small intestine?

A

Glutamine
It is essential for small intestinal structure and function.
Could be useful to supplement glutamine to patients who are suffering trauma or receiving PN.

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6
Q

What are two conditionally essential amino acids?

A

Glutamine & Arginine

  • Other conditionally essential AAs are: Cysteine, glycine, proline, and tyrosine
  • Conditionally essential AAs are synthesized from other AAs under normal conditions but require a dietary source in order to meet increased needs caused by metabolic stress.
    (a) Example: Arginine becomes conditionally essential for wound healing.
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7
Q

Explain the recommendations for vitamin A deficiency with and without concurrent corticosteroid therapy.

A

For deficiency: 2,000 to 200,000 IU/day (606 - 60,600 RAE/day)

To counteract the inhibitory effects that steroids have on collagen synthesis and connective tissue repair: 3,000 to 15,000 RAE/day x 7 days orally

To enhance wound healing with concurrent corticosteroid use: 3,000 to 4,500 RAE/day orally

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8
Q

Zinc deficiency is most commonly associated with?

A

Diarrhea
The overall biochemical functions of zinc can be categorized as catalytic, structural, and/or regulatory in nature. Additional zinc is recommended in patients with additional losses from thermal injury, excessive GI losses such as diarrhea, decubitus ulcers, and high output fistulas

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9
Q

Copper toxicity is associated with what disease?

A

Liver Disease

  • Copper toxicity can cause severe N/D/V. More serious manifestations with acute or more chronic toxic ingestion or Wilson’s disease include: coma, hepatic necrosis, liver failure, renal failure, vascular collapse, and death.
  • Since about 80% of copper is excreted in the bile, patients who have liver disease should be monitored and supplementation reduced or eliminated.
  • HD increases copper losses
  • Enteral zinc supplementation can complete with copper for absorption.
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10
Q

What can result in an invalid IC measurement?

A

Chest tube leak

  • IC is a respiratory measurement that under proper conditions is equivalent to metabolism, any factor that violates these conditions is a contraindication to IC.
  • Examples: air leaks; extracorporeal membrane oxygenation(ECMO); HD; FiO2 > 60 in mech. vented patients; and for spontaneously breathing patients - reliance on supplemental oxygen; inability to cooperate with measurement, and claustrophobia or anxiety

-If RMR is the desired value to be measured (it usually is), then any factor that prevents that patient from being at rest or cooperating with the device operator is also a contraindication.

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11
Q

Explain REE.

A

Resting Energy Expenditure

  • REE measured under steady stable conditions closely approximates true 24-hour energy expenditure.
  • The addition of a stress or activity factor may not be necessary and could result in overfeeding.
  • If a patient is measured while fasting or if feedings are intermittently provided, it is reasonable to allow an additional 5% factor to account for thermogenesis.
  • Therefore, a critically ill patient’s energy delivery in response to REE does not need to be modified when measured by IC. AKA No stress/activity factors are needed.
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12
Q

Explain respiratory quotient (RQ).

A

RQ = CO2 produced/O2 consumed

Defined as the volume of CO2 released over the volume of O2 absorbed during respiration.

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13
Q

RQ <0.7 or >1.0 means?

A

Hypoventilation or hyperventilation

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14
Q

RQ of 0.71 means?

A

Primarily fat oxidation

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15
Q

RQ of 0.82 means?

A

Primarily protein oxidation

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16
Q

RQ of 0.85 means?

A

Suggests mixed substrate utilization

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17
Q

RQ of 1.0 means?

A

Carbohydrate oxidation

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18
Q

Facts about Crohn’s disease.

A

Malnutrition is the most common in this form of inflammatory bowel disease because Crohn’s usually involves the small intestine

  • Can impact any area of the GI tract (mouth to anus)
  • Depending on severity of illness, weight loss has been reported in 20% to 85% of those with Crohn’s
  • 65-75% of inpatients and more than 50% of outpatients experience significant weight loss
  • Possible mechanism for malnutrition in this disease: Malabsorption from diseased small bowel mucosa; increased nutrient requirements from active inflammation; and reduced oral food intake due to abdominal discomfort and diarrhea
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19
Q

Explain appropriate treatment for ascites.

  • Fluid
  • Sodium
  • Protein
A

Includes fluids and sodium restriction.

  • Protein intake: 1.0 - 1.5 g/kg/day for patients with cirrhosis.
  • While optimum nutrition support may not be possible, use of maximally concentrated solutions provides the best opportunity to avoid further salt and fluid overload while providing necessary substrate for anabolism
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20
Q

Where is dietary fat primarily absorbed?

A

Duodenum and proximal jejunum

  • Dietary fat is absorbed in the proximal small bowel
  • Lingual lipase released in the mouth and gastric lipase produced in the stomach have a limited role in fat digestion in healthy adults.
  • Bile acids secreted by the liver as well as lipase and colipase produced by the pancreas aid in the micellar solubilization and absorption of dietary fat.
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21
Q

Resections and nutrient absorption.

A

Resections of the proximal bowel, including the duodenum and proximal jejunum, are generally better tolerated because of ileal compensation and adaption.

  • In general, ileal resection is poorly tolerated because of adaptive hyperplasia in the remaining jejunum is limited.
  • The ileocecal valve slows intestinal transit allowing for greater absorption of nutrients.
  • Colon has critical roles in fluid and nutrient absorption.
  • Therefore, patients lacking a colon are at greater risk of dehydration.
  • The colon is capable of salvaging calories through anaerobic bacterial fermentation of undigested carbohydrates into SCFAs.
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22
Q

Explain methotrexate.

A

Methotrexate acts by interfering with the normal intracellular metabolism of FOLATE.

  • Drug used to treat cancer
  • It is a folate analogue that became available in the 1950s
  • Structurally similar to FOLATE
  • It competitively inhibits dihydrofolate reductase (an enzyme that catalyses the conversion of dihydrofolate to tetrahydrofolate, a cofactor in the synthesis of purine nucleotides and thymidylate.
  • Therefore, methotrexate impairs malignant growth by interfering with the DNA synthesis, repair and cellular replication.
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23
Q

Copper deficiency is associated with?

A

Microcytic hypochromic anemia

  • Patients on long-term PN have developed anemia, leukopenia, neutropenia, and skeletal abnormalities.
  • Other symptoms of copper deficiency are: sensory ataxia, lower extremity spasticity, parathesis in extremities, leukopenia, neutropenia, and hypercholesterolemia
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24
Q

Deficiencies of B12 or folate result in what?

A

Macrocytic anemia (large red blood cells)

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25
Q

Does a prominent iliac crest pertain to muscle or fat loss?

A

SubQ fat loss

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26
Q

Explain SGA

A

Subjective Global Assessment (SGA)

  • Uses 5 historical components (weight history, dietary intakes, GI symptoms, functional status, and metabolic demand)
  • 3 physical components (Fat depletion, muscle wasting, and nutrition-related edema)
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27
Q

(TRUE/FALSE) SGA is appropriate for use in critically ill patients?

A

FALSE

ASPEN and SCCM recommend the use of NRS-2002 or NUTRIC tool to determine risk in this patient population.

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28
Q

Explain NRS-2002 tool.

A

Appropriate for critically ill patients (5 Factors):

  1. Unintentional weight loss
  2. BMI
  3. Disease severity
  4. Impaired general condition
  5. Age >70
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29
Q

Explain the NUTRIC tool.

A

Appropriate for critically ill patients (5 Factors)
“Nutrition Risk in Critically Ill”
**Focuses on the severity of illness

  1. Age
  2. APACHE II score (ICU mortality prediction score)
  3. SOFA (Sequential Organ Failure Assessment)
  4. # of comorbidities
  5. Days from hospital to ICU admission
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30
Q

Explain NRI tool.

A

“Nutritional Risk Index (NRI)”

Uses serum albumin and the ratio of current weight to the usual weight

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31
Q

What does an elevated C-reactive protein indicate?

A

Inflammatory status, which may be the reason for hypoalbuminemia.
-Positive acute-phase proteins such as CRP increase during inflammation, whereas negative acute-phase proteins concentrations such as albumin and pre-albumin decrease during inflammation.

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32
Q

Where is iron primarily absorbed?

A

Jejunum

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33
Q

Cheilosis is a physical symptom associated with a deficiency of?

A

Riboflavin

-Cheilosis = cracking of the corners of the mouth

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34
Q

What compromises the reliability of urinary urea nitrogen to calculate nitrogen balance

A

creatinine clearance <50mL/min

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35
Q

What micronutrient has been shown to decrease plasma homocysteine concentrations

A

folic acid

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36
Q

hyperhomocysteinemia concentrations has been associated with an increased risk of

A

atherosclerosis

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37
Q

which three micronutrients can be supplemented to decrease homocysteine levels in plasma to decrease the risk of atherosclerosis

A

folic acid, vitamin B12 and vitamin B6

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38
Q

what is the most appropriate fluid requirement for a healthy 78 year old adults

A

25mL/kg/day

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39
Q

what is the recommended fluid requirement for healthy adults between the ages of 18-55

A

35mL/kg/day

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40
Q

what is the recommended fluid requirement for adults between the ages of 55 and 75 years old

A

30mL/kg/day

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41
Q

what is the recommended fluid requirement for adults with fluid restriction such as CHF

A

25mL/kg/day

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42
Q

What enzyme initiates the digestive process of carbohydrates in the mouth

A

salivary amylase

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43
Q

Lipase is an enzyme released by the pancreas that helps the digestion of

A

fat

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44
Q

Lactase and Maltase are enzymes located in the ______ of the small intestine to aid in intraluminal carbohydrate digestion

A

brush border

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45
Q

Iron is primarily absorbed in the __________ and ________ in the _______ state. Gastric ____ is very important in maintaining dietary iron in the _____ state

A

duodenum and jejunum
ferrous
acid
ferrous

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46
Q

What amino acid is most crucial in small intestine structure and function

A

glutamine

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47
Q

In persons with phenylketonuria (PKU), tyrosine becomes an essential amino acid due to a deficiency of

A

the phenylalanine hydroxylase enzyme

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48
Q

Phenylalanine Hydroxylase catalyzes the hydroxylation of phenylalanine to _______, so phenylalanine levels become _____ and _____ levels are decreased

A

tyrosine
elevated
tyrosine

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49
Q

Conditionally essential amino acids are synthesized from other amino acids under normal conditions but require increased needs from dietary sources during ________. For example, arginine becomes conditionally essential for _______ and _____ during trauma

A

stress
wound healing
glutamine

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50
Q

glutamine becomes conditionally essential during

A

trauma

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51
Q

arginine becomes conditionally essential during

A

wound healing

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52
Q

What are the conditionally essential amino acids

A

arginine, cysteine, glutamine, glycerin, proline, tyrosine

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53
Q

An NPO post operative patient has been on 2 in 1 PN for 3 weeks. He develops hair loss, diffuse scaly dermatitis, anemia and thrombocytopenia. What is the probable cause

A

he has not been getting ILE for 3 weeks

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54
Q

Provision of fat free PN for ____ weeks has resulted in essential fatty acid deficiency

A

3 weeks

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55
Q

Essential Fatty Acid deficiency usually results after ___ weeks of fat free PN, although signs and symptoms of deficiency can be as early as ___ to ____ days

A

10-20 days

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56
Q

what are the signs and symptoms of EFAD

A

alopecia, scaly dermatitis, impaired wound healing, anemia, thrombocytopenia

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57
Q

Provide __ to ___% total calories from ____ or ____ ILE to prevent EFAD

A

4-10% total calories

soy of safflower oil ILE

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58
Q

Which IV fluid most closely resembles jejunal and ileal electrolyte content

A

lactated ringers

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59
Q

Fluids and electrolytes of the jejunum contains ____ mEq of sodium, ___ mEq of potassium, ___ mEq of chloride and ____ mEq of bicarb

A

95-120 mEq of sodium
5-15 mEq of potassium
80-130 mEq of chloride
10-20 mEq of bicarb

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60
Q

Fluids and electrolytes of the ileum contains ____ mEq of sodium, ___mEq of potassium, ___ mEq of chloride and ___ mEq of bicarb

A

110-130 mEq of sodium
10-20 mEq of potassium
90-110 mEq of chloride
20-30 mEq of bicarb

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61
Q

Lactated Ringers IV solution contains ___ mEq/L of sodium, ___ mEq/L of potassium ____ mEq/L of chloride, ____ mEq/L of lactate and ___ mEq/L of calcium

A 
130 mEq/L of sodium
4 mEq/L of potassium
109 mEq of chloride
28 mEq/L of lactate
2.7 mEq/L of calcium
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62
Q

Normal saline contains ___ mEq/L of sodium, ____mEq/L of chloride

A

154 mEq/L sodium

154 mEq/L chloride

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63
Q

Half Normal saline contains ___ mEq/L of sodium and ____ mEq/L of chloride

A

77 mEq/L sodium

77 mEq/L chloride

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64
Q

Dextrose and half normal saline contains ____ g/L of glucose, ___ mEq/L of sodium and ____ mEq/L of chloride

A

50 g/L dextrose
77 mEq/L sodium
77 mEq/L chloride

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65
Q

What are the clinical symptoms of inappropriate diuretic hormone (SIADH)

A

increased urinary sodium
hyponatremia
increased urinary osmolality

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66
Q

a disorder of sodium and water balance caused by inappropriate release of anti-diuretic hormone which causes increased total body water which causes dilution hyponatremia

A

SIADH

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67
Q

In SIADH, increased sodium and osmolality of the urine is due to

A

excessive water retention/re-absorption

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68
Q

In SIADH to compensate for the expansion of the extracellular fluid, aldosterone secretion is inhibited to maintain

A

euvolemia

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69
Q

A 45 year old patient with chronic corticosteroid use has suspected vitamin A deficiency. Supplementation of vitamin A (3,000 to 5,000 IU) should be given at a max of ____ days

A

7 days

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70
Q

what are the main functions of vitamin A

A

wound healing, cell differentiation, and collagen synthesis

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71
Q

what is the typical dose for vitamin A supplementation

A

3,000 to 5,000 IU for 7 days

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72
Q

when should vitamin A be supplemented

A

to enhance wound healing with corticoid steroid therapy

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73
Q

Corticosteroid therapy has been shown to decrease vitamin ______

A

vitamin A

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74
Q

A patient with alcoholism is admitted with a small bowel obstruction and is started on PN. The PN provides 400 grams of dextrose, If after 3 days, the patient develops mental status changes, it is most likely due to a deficiency of

A

thiamine

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75
Q

alcohol related thiamine deficiency presents as

A

Wernicke’s Encephalopathy

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76
Q

Symptoms of Wernicke’s Encephalopathy are

A

mental status changes, confusion, nystagmus, gait ataxia

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77
Q

The glucose load in PN is associated with PN increases metabolic demand for ____ which is essential for glucose metabolism

A

thiamine

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78
Q

Lactic acidosis can be a result of which vitamin deficiency

A

thiamine

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79
Q

Thiamine is required for ____ metabolism. When Pyruvate is converted to acetyl CoA. If thiamine is not present, pyruvate will convert to production of _____ fermentation

A

glucose

lactic acid fermentation

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80
Q

In addition to aggressive refeeding, what else places patients at high risk for hypophosphatemia

A

DKA

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81
Q

Which patients are at the highest risk for hypophosphatemia

A

malnourished, DKA, chronic alcoholism, respiratory and metabolic acidosis, critical illness

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82
Q

Insulin is an anabolic hormone that drives potassium and phosphorous into the cells causing serum _____ of these electrolytes

A

depletion

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83
Q

in DKA, large amounts of ____ is lost in urine from the osmotic diuresis resulted from hyperglycemia

A

phosphorous

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84
Q

The risk of metastatic calcification in soft tissues begins to increase when the product of serum calcium and phosphorous exceeds

A

55 mEq

85
Q

Hyperphoshpatemia can cause which issues

A

soft tissue and vascular calcification
hyperparathyroidism
renal osteodystorphy

86
Q

Zinc deficiency is most commonly associated with

A

diarrhea

87
Q

what are the functions of zinc

A

catalytic reactions
structural function
regulatory functions

88
Q

When is additional zinc provision recommended

A

thermal injury (burns)
excessive GI loss from diarrhea
decubitus ulcers
high output fistulas

89
Q

Copper toxicity is associated with ___ disease

A

liver

90
Q

what are the signs of copper toxicity

A

severe nausea, diarrhea

91
Q

Copper toxicity can cause

A 
Wilson's disease
Coma 
Hepatic Necrosis
Liver Failure
Renal Failure
Death
92
Q

80% of copper is excreted via

A

bile

93
Q

a patient with liver disease should be monitored and supplemented or be

A

decreased or eliminated

94
Q

Hemolysis increases copper

A

loss

95
Q

Enteral zinc supplementation can compete with ____ for absorption

A

copper

96
Q

Hepatic encephalopathy is most likely to be improved by which trace element

A

zinc

97
Q

Liver disease can cause altered ____ metabolism leading to decreased serum ____ levels. ____ supplementation has been shown to help in hepatic encephalopathy

A

zinc
zinc
zinc

98
Q

In hepatic encephalopathy zinc should be supplemented in doses of ____ mg/day for 3 months

A

150 mg per day

99
Q

What is the function of aluminum in PN solutions

A

Aluminum has NO KNOWN BIOLOGICAL function

100
Q

Aluminum is only present in PN as

A

a contaminant

101
Q

What can result in an invalid indirect calorimetry measurement

A 
air leak
chest tube leak
extracorperoal membrane oxygenation
hemodialysis
FiO2 >60% in mechanically ventilated patients/spontaneously breathing patients
reliance on supplementation oxygen
unable to cooperate
claustrophobia
anxiety
102
Q

How should a critically ill patient’s energy delivery be modified in response to resting energy expenditure measured by indirect calorimetry

A

use the caloric target WITHOUT adding a stress or activity factor

103
Q

in calculating energy delivery, should a stress or activity factor be added

A

no, it can result in overfeeding

104
Q

A respiratory quotient of 0.87 most likely suggests

A

mixed substrate utilization

105
Q

RQ measures CO2 _____ divided by O2 _____

A

CO2 produced

O2 consumed

106
Q

An RQ 0.7 or less likely indicates and >1 likely indicates

A

hyperventilation , hypoventilation

107
Q

An RQ of 0.71 indicates primarily ____ oxidation

A

fat

108
Q

An RQ of 0.82 indicates primarily ____ oxidation

A

protein

109
Q

An RQ of 0.85 indicates _____ oxidation

A

mixed substrate

110
Q

An RQ of 1.0 indicates primarily ____ oxidation

A

carbohydrate

111
Q

which predictive equation has demonstrated the greatest accuracy in estimating actual resting metabolic rate in healthy obese and non-obese adults

A

Mifflin St. Jeor

112
Q

Cheilosis is a physical symptom associated with a deficiency of _____, which can include hyperemia, edema of the oral mucosa, angular stomatitis, or glossitis

A

riboflavin

113
Q

Malnutrition is most common in which form of IBD due to its involvement in the small intestine where micronutrients are absorbed

A

Chron’s Disease

114
Q

A patient with end stage liver disease with refractory ascites awaiting liver transplantation is on PN due to intolerance to tube feeding. Sodium is 123 mEq/L. In addition to fluid restriction, what changes to his PN prescription is most appropriate?

A

restrict sodium

give 1.5 g/kg/day of protein

115
Q

What is the dietary recommendations for patients on ascites

A

fluid and sodium restriction 1-1.5 g/kg/day of protein with cirrhosis

116
Q

_______ nutrition formula should be used with patients who have ascites from ESLF to avoid further sodium and fluid overload

A

concentrated

117
Q

Arginine supplementation should be used most cautiously in patients with

A

septic shock

118
Q

arginine increases the production of ______ which causes vasodilation. Providing arginine during septic shock would further exacerbate ______

A

nitrous oxide

hemodynamic instability

119
Q

the normal length of the small intestine in adults is about

A

300-600 cm long

120
Q

when the small bowel is less than _____ cm, to an end jejunostomy/ileostomy, PN and hydration will likely be needed

A

120 cm

121
Q

The presence of an ileocecal valve and colon significantly improves _____ , ______ and _____ absorption. If the ileocecal valve is left intact, a patient may NOT need PN with as little as 60 cm left of the small bowel

A

fluid, electrolytes, and short chain fatty acids

122
Q

What is the primary fuel of colonocytes

A

short chain fatty acids

123
Q

the three primary short chain fatty acids are

A

butyrate, acetate and propionate

124
Q

short chain fatty acids can provide up to ______ kcals in short bowel syndrome

A

1,000 kcals

125
Q

Dietary fat is predominantly absorbed in what part of the GI tract

A

duodenum and proximal jejunum

126
Q

Gastrectomy patients are at risk for a deficiency of which vitamin

A

B12

127
Q

___ is the total or partial removal of the stomach

A

gastrectomy

128
Q

the _____ cells of the stomach produce intrinsic factor

A

parietal cells

129
Q

Intrinsic factor aids in the absorption of ___ in the small bowel

A

vitamin B12

130
Q

When the stomach is resected, there is no longer adequate intrinsic factor to bind is B12 and may result in

A

deficiency

131
Q

what areas of the GI tract has the the LEAST impact on nutrient absorption and intestinal adaptation following significant intestinal resection?

A

jejunum

132
Q

resecting the proximal bowel (duodenum & upper jejunum) is usually _____ tolerated than ilelal resection

A

BETTER tolerated because the ileum is good at adaptation of absorption of nutrients

133
Q

the jejunum _____ adapt well when the ileum is resected

A

doesn’t

134
Q

preservation of the ____ is important as it slows intestinal transit allowing for better absorption of nutrients

A

ileocecal valve

135
Q

The colon is critical for ___ and ____ absorption. patients without a colon are at increased risk for _____ but can salvage calories through _____________

A

water & nutrient absorption
dehydration
anaerobic bacterial fermentation of undigested carbohydrates into short chain fatty acids

136
Q

During fasting, fuel oxidation shifts from carbs to mainly ____ oxidation

A

lipid

137
Q

During fasting lipolysis will _____, glycogenesis will ____, gluconeogenesis and glucose oxidation will ______

A

Increase
decrease
decrease. The body increases lipid oxidation to provide the body with fatty acids for energy

138
Q

how much fluid per day is required to maintain fluid balance in an average healthy adult

A

25-35mL/kg/day

139
Q

Valproic acid has been shown to induce a deficiency of ______

A

carnitine

140
Q

Valproic acid is a ____ drug and can cause a deficiency in carnitine

A

anti epileptic drug

141
Q

Carnitine plays a role in fatty acid metabolism and is an essential cofactor in the elimination of ___ and ___ from the body

A

valproic acid and ammonia

142
Q

carnitine supplementation should be considered for patients

A

in a coma, with elevated ammonia, have liver disease or with valproic acid medications >450mg/day

143
Q

methotrexate acts by interfering with the normal intracellular metabolism of which of the following nutrients

A

folate

144
Q

Methotrexate is a ____ drug and ______ analogue, so that it’s binding sites are commentative

A

chemotherapeutic drug

folate

145
Q

Methotrexate competes with folate for absorption to catalyze the function of the enzyme dihydrofolate reductase, which converts dihydrofolate to tetrahydrofolate, a cofactor for the production of purine synthesis making up ______

A

DNA

146
Q

what vitamin absorption is most likely to be impaired with chronic use of proton pump inhibitors

A

B12

147
Q

the process to identify someone who may be malnourished or at risk for malnutrition, to determine if a comprehensive nutrition assessment is indicated

A

screening

148
Q

a positive screening result should result in

A

a nutrition consult

149
Q

This screening tool is used mostly in the elderly. Describes food intake, appetite, chewing/swallowing, weight loss in 3 months, mobility issues, recent psych distress, neuropsych and BMI. The higher the points, the higher the risk

A

Mini Nutrition Assessment

150
Q

what is the validated tool for the diagnosis of malnutrition

A

Subjective Global Assessment

151
Q

this tool assesses weight changes, dietary intake changes, GI symptoms, functional capacity, edema, and disease related nutrition requirements. Scoring is based on well nourished, moderately malnourished or severely malnourished

A

Subjective Global Assessment

152
Q

Social/Environmental malnutrition has ______ level of inflammation

A

no

153
Q

pure, chronic starvation, anorexia nervosa, ETOH abuse, homelessness and psychological issues are ____ types of malnutrition

A

social/environmental

154
Q

a chronic condition is considered how long per CMS standards

A

1 month or greater

155
Q

organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenia obesity, COPD, CHF, CA, and IBD are examples of ____ malnutrition

A

mild/moderate; chronic disease

156
Q

acute malnutrition has a _____degree of inflammation

A

high

157
Q

major infection, burns, trauma, closed head injuries are examples of _____ malnutrition

A

acute malnutrition

158
Q

criteria for severe acute malnutrition

A 
<50% po > 5 days
>2% weight loss x 1 week
>5% weight loss x 1 month
>7.5% weight loss x 3 months
moderate fat loss
moderate muscle loss
moderate to severe edema
159
Q

criteria for severe chronic malnutrition

A 
=75% po intake >/= 1 month
>5% weight loss x 1 month
>7.5% weight loss x 3 months
>10% weight loss x 6 months
>20% weight loss x 1 year
severe fat wasting
severe muscle wasting
severe edema 
below standards handgrip strength
160
Q

criteria for severe social/environmental nutrition

A 
<= 50% po intake x >/= 1 month
>5% weight loss x 1 month
>7.5% weight loss x 3 months
> 10% weight loss x 6 months
>20% weight loss x 1 year
severe fat loss
severe muscle loss
below standards handgrip strength 
severe edema
161
Q

Tools to assess dietary intake

A

direct from patient or family, from RN, 24 hour recall, 3 day recall, % meal eaten from EMR, indirect calorimetery

162
Q

unintended weight loss is a ______ indicator of malnutrition

A

well validated

163
Q

the most readily available tool inpatient to assess loss of subcutaneous fat/muscle

A

NFPE

164
Q

a tool to evaluate decreased function in identification of malnutrition

A

hand grip strength (average of 3 tests)

165
Q

hand grip strength is a _____ predictor of nutrition status

A

independent

166
Q

is handgrip strength a validated tool

A

yes

167
Q

positive acute phase proteins

A

CRP, fibrinogen, antibodies

168
Q

positive acute phase proteins ____ during inflammation

A

INCREASE

169
Q

negative acute phase proteins

A

albumin, pre albumin, transferrin

170
Q

negative acute phase proteins _____ during inflammation

A

DECREASE

171
Q

albumin will be decreased during inflammation regardless of

A

nutrition status/malnutrition

172
Q

clinical indicators of inflammation

A

fever, UTI, wound infection, hypothermia, PNA, BSI, abscess

173
Q

chronic disease states have ______ level of inflammation

A

mild to moderate

174
Q

hematological malignancy, IBD, CVD, celiac disease, COPD, CHF, obesity, pressure wounds, chronic pancreatitis CF, dementia, RA, organ transplants and solid tumors are examples of ____ malnutrition

A

chronic (mild-moderate inflammation)

175
Q

ARDS, closed head injury, critical illness, SIRS, acute severe malnutrition, major abdominal surgery, major infection/sepsis multi level trauma and severe burns are examples of ____ malnutrition

A

severe / acute

176
Q

an approach to identify malnutrition globally with other global nutrition societies

A

Global Leadership Initiative on Malnutrition (GLIM)

177
Q

GLIM has 2 criteria ___ and ___

A

phenotypic and etiologic

178
Q

GLIM can be used in _____ settings/environments

A

all

179
Q

copper deficiency is associated with _____ anemia

A

microcytic hypochromic anemia

180
Q

because of copper deficiency, patients on long term PN have developed

A

anemia, leukopenia, neutropenia

181
Q

_____ deficiency also causes microcytic hypochromic anemia other than copper

A

iron

182
Q

B12 and Folate deficiencies cause ____ anemia

A

macrocytic

183
Q

A patient getting PN has high ileostomy output, what changes to PN is recommended

A

increase fluid

increase sodium

184
Q

When ileostomy output is over 1,000mL a day, a patient can lose up to ____ mEq/L of sodium, and if not replaced can lead to significant hyponatremia

A

120mEq/L

185
Q

Clinical characteristics of acute disease or injury related severe malnutrition are _____ fat depletion, weight loss > _____% in _____ week(s), ______ weight loss in ____ month, > ___%weight loss in ____ months, decreased energy intake _____ days, _____ muscle depletion, ____ fluid accumulation

A 
moderate fat depletion
2% in 1 week
5% in 1 month
7.5% in 3 months
<50% > 5 days
moderate muscle depletion
moderate to severe fluid accumulation
186
Q

which condition(s) are most likely to result in malnutrition of mild to moderate inflammatory response

A

cancer

187
Q

involuntary weight loss of 10% of usual body weight over 6 months is suggestive of

A

malnutrition

188
Q

Tricep skin fold thickness below the ____percentile indicates malnutrition

A

<5 percentile

189
Q

Tricep skin fold thickness to assess for malnutrition may be falsely elevated with ____ and may not be reliable in _____

A

edema

obesity

190
Q

Recent, involuntary weight loss >10% in 6 months detect risk of malnutrition in both

A

obese and non obese patients

191
Q

When conducting an NFPE, hollowing/scooping depression of the temporalis muscle indicates ____ muscle loss

A

severe

192
Q

in severe muscle depletion, the clavicle and acromion process / deltoid muscle will appear

A

square with very prominent bones

193
Q

in severe muscle loss, the interosseous muscle on the dorsal hand will appear

A

depressed between the thumb and fore finger

194
Q

in severe fat loss, the iliac crest will appear

A

prominent

195
Q

Which is common in both acute illness or injury related malnutrition and social or environmental related malnutrition

A

lipoysis

196
Q

in acute illness/injury related and social/environmental malnutrition both how catabolism of endogenous substrate, including fat stored in adipose tissue, is common in

A

both types of malnutrition

197
Q

Which nutrition tool includes evaluating subsequent fat and muscle wasting at multiple body sites to determine nutrition status

A

Subjective Global Assessment (SGA)

198
Q

hypermetabolism/hyperglycemia are characteristic of ___ related malnutrition

A

stress

199
Q

The SGA is a nutrition assessment tool using 5 historical measures including weigh history, dietary intake, GI symptoms, functional status and metabolic demand plus 3 components of the physical exam (fat depletion, muscle wasting,, nutrition related edema). With this information patients are classified as

A

well nourished
moderately malnourished
or
severely malnourished

200
Q

ASPEN and the SCCM recommend to use these screening tools for malnutrition in the ICU

A

NUTRIC/NRS 2002

201
Q

This nutrition assessment tool monitors for unintentional weight loss, BMI, disease severity, impaired general condition and age over 70

A

NRS

202
Q

This nutrition assessment tool uses the APACHE III score, SOFA score, number of comorbidities and days from hospital to ICU admit to identify malnutrition risk

A

The NUTRIC Tool

203
Q

This nutrition assessment too uses serum albumin and the ratio of current weight to usual weight to asses malnutrition risk

A

The NRI (Nutritional Risk Index) Tool

204
Q

what has been reported to be a significant independent predictor of morbidity and mortality in critically ill patients

A

albumin

205
Q

______ is a negative acute phase protein

A

alubmin

206
Q

levels of albumin decrease during stress. Hypoalbuminemia is more of a reflection of the degree of_____ , ___ and ___ rather than malnutrition

A

stress from disease, injury and inflammation

207
Q

A previously well-nourished patient with persistent fever is admitted to the hospital. Lab tests reveal an albumin of 2.1 g/dL, C-RP of 30 mg/dL, and serum calcium of 7.2 mg/dL. What is the most likely cause of hypoalbuminemia ?

A

inflammatory response

208
Q
A

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