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Nutrition Support > Assessment > Flashcards

Assessment Flashcards

1
Q

Branch chain amino acids

A

leucine, isoleucine, and valine

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2
Q

Aromatic Amino acids

A

Phenylalanine, tyrosine, tryptophan,

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3
Q

Conditionally essential amino acids

A

Proline and Arginine. Cysteine, glutamine, glycine, tyrosine

Synthesized primarily in the order intestine And dependent on intestinal metabolism.

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4
Q

Essential amino acids

A 
Methionine
Valine
Phenylalanine 
Isoleucine 
Threonine
Tryptophan 
Histidine 
Leucine 
Lysine

histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.

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5
Q

Essential fatty acid deficiency

A

Diffuse scaly dermatitis, hair loss, anemia, and thrombocytopenia ( low platelets) hepatomegaly, fatty liver and anemia.

2-4% of total calories as fat should prevent

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6
Q

Lactated Ringer

A 
130 mEq/L
109 chloride
4 mEq/L potassium 
28 mEq/L lactate
2.7 mEq/L calcium

Most closely resembles jejunal and ileal electrolyte content (intestines have 10 to 30 mEq/l of bicarbonate as well)

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7
Q

0.9 NS

A

154 mEq/l sodium and chloride or 9 grams of salt or 3510 mg if sodium.

1 g salt (sodium chloride) = 390 mg sodium. 1 tsp salt = 6 g salt ≈ 2,400 mg sodium = 104 mmol sodium = 104 mEq sodium.May 12, 2016

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8
Q

Vitamin A supplementation for deficiency

A

25,000 IU/ day for max of 10 days

** caution in liver or renal failure and elderly

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9
Q

Thiamine deficiency

A

Wernicke’s encephalopathy

Thiamine plays a role in glucose metabolism

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10
Q

Thiamin deficiency

A

Lactitic acidosis

Thiamine used to convert pyruvate to acetyl CoA

Without thiamine pyruvate is converted to lactic acid

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11
Q

Positive acute phase protein

A

Increases during inflammation

C- reactive protein

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12
Q

Negative acute phase proteins

A

Decrease during inflammation

Albumin
Transferrin
Prealbumun

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13
Q

SIADH

A

Hyponatremia associated with SIADH

Water conserved
Urine concentrated

CNS disease
Malignancy
Lung disease

Urine sodium and osmolality elevated

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14
Q

Hypophosphatemia

A

Refeeding
DKA
Chronic alcoholism

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15
Q

Increased risk of metastatic calcification of calcium occurs when the ca & and p product is

A

Exceeds 55

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16
Q

Hyperphosphatemia can decrease

A

Calcium

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17
Q

Zinc deficiency caused by poor protein intake can cause

A

Diarrhea

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18
Q

Copper toxicity can cause

A

Nausea
Vomiting
Diarrhea
And

Wilson’s disease which is coma, hepatic necrosis, liver/renal failure

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19
Q

Copper is excreted in

A

Bile (80%)

So monitor copper in patients with liver disease

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20
Q

Zinc deficiency is common in

A

Liver disease so supplementation can improve amino acid metabolism and decrease encephalopathy

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21
Q

Aluminum toxicity can be treated with

A

Deferoxamine

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22
Q

Factors that can decrease indirect calorimetry

A

Chest tubes
Nasal oxygen
Dialysis because of loss of CO2 in dialysis coil

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23
Q

Respiratory quotient

A

0.7 fat oxidation
<0.82 underfeeding or protein oxidation
0.85 to 0.95mixed substrate
> 1 carbohydrate oxidation and overfeeding and potential lipogenesis

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24
Q

Mufflin-St. Joer

A

Best to estimate needs of obese and non obese

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25
Q

Cheilosis (cracking of corners of the mouth) is associated with deficiency of

A

Niacin
Riboflavin
Iron
Pyridoxine (B6)

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26
Q

Arginine could be beneficial for patients with

A 
Trauma
Surgery 
Compromised immunity 
*as it increases production of nitric oxide
*increases blood flow

** avoid in those with septic shock **

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27
Q

Colon length

A

150 cm

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28
Q

Small bowel length

A

600 cm or 10 feet

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29
Q

Primary fuel of colonocytes

A

Short chain fatty acids

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30
Q

SCFA are

A

Acetate
Butyrate
Propionate

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31
Q

SCFA stimulate absorption of

A

Water and sodium absorption

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32
Q

Fat from oral intake is absorbed

A

In the duodenum and proximal jejunum

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33
Q

Valproic acid can induce a deficiency of

A

Carnitine

Involved in metabolism of fatty acids

Idiopathic encephalopathy can be associated with carnitine deficiency

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34
Q

Thiamin deficiency

A

Edema

Lower extremity weakness

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35
Q

Hair loss could be attributed to

A

Inadequate protein
B12
Folate

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36
Q

Brittle hair could be due to

A

Biotin deficiency

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37
Q

Hair color changes could be due to

A

Zinc deficiency

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38
Q

Dry hair could be due to what deficiency

A

Vitamin A and E

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39
Q

Easy pluckability of hair could be due to low

A

Protein
Biotin
Zinc

40
Q

Coiled or corkscrew hair could be due to

A

Deficiency of vitamins A and C

41
Q

Petechiae ( small red purple spots on skin) could be due to what deficiencies

A

Vitamins A and C

42
Q

Bitot spots are the buildup of keratin located superficially in the conjunctiva, which are oval, triangular or irregular in shape. These spots are a sign of what deficiency?

A

Vitamin A

43
Q

Xerosis (dry skin) could be due to what deficiency?

A

Vitamin A and or essential fatty acid deficiency

44
Q

Inflammation of the eyelids (angular palpebritis) could be due to what deficiency?

A

Riboflavin

45
Q

Magenta tongue is due to what deficiency

A

Riboflavin

46
Q

Glossitis is due to what deficiency?

A

Niacin
Folate
B12

47
Q

Bleeding gums could be deficiency of

A

Vitamin C

48
Q

Angular stomatitis (inflammation and small cracks in the corners of the mouth) and cheilosis ( cracks in corners of mouth)could be signs of what deficiencies?

A

B complex especially riboflavin
Iron
Protein

49
Q

Loss of lower extremity deep tendon reflexes could be due to what deficiencies?

A

Thiamin

Vitamin B12

50
Q

Calf pain could be due to what deficiency?

A

Thiamin

51
Q

Joint pain or arthralagia could be due to what deficiency?

A

Vitamin C

52
Q

High white blood cell count or leukocytosis can

A

suggest an inflammatory response 3.5 to 10.5 billion cells/L

53
Q

Nitrogen balance equation

A

Protein/6.25. - (urine urea nitrogen + 4)

54
Q

Schillings test helps identify the cause of what vitamin deficiency?

A

Vitamin B 12

55
Q

EFA deficiency is determined by checking

A

Triene:tetraene ratio and it would be more than 0.2 to 0.4

1 to 3 weeks of fat free PN

56
Q

To prevent EFA deficiency provide this much if linoleic and linolenic….

A

1 to 2 % of linoleic

and 0.5% from linolenic

57
Q

Selenium deficiency

A

Can cause cardiomyopathy

58
Q

Ileostomy output contains high amounts of

A

Sodium

59
Q

Magnesium is absorbed where?

A

Distal jejunum And ileum

60
Q

Hyperkalemia can be caused by

A

Metabolic acidosis
Which shifts potassium from intracellular to extracellular causing increased k in serum. So correct the acidosis with acetate that converts it to bicarbonate and corrects the acidosis

61
Q

Hyperglycemia is associated with what type of sodium/fluid balance?

A

Hypertonic hyponatremia. It shifts water from intra cellular to extracelluar space ( where sodium is) and dilutes sodium.

62
Q

If a pt. also has Hypokalemia also asses:

A

Assess for hypomagnesemia and if low correct magnesium first.

Mg is important in the regulation of intracellular k.

63
Q

Copper deficiency clinical signs can be similar to

A

B12 deficiency

Pancytopenia
Neuro deterioration 
Sensory ataxia
Lower limb spasticity 
Acral parthesias ( pins and needles sensation)
64
Q

Visceral proteins are

A

Albumin half life 20 days
Pre- albumin 2-3 days
Retinol binding protein 12 hours

All made n the liver
Not good to assess in liver dz except can indicate severity of the disease.

65
Q

Lactic acidosis can be the result of what vitamin deficiency

A

Thiamin

66
Q

Vitamin D deficiency can be shown as

A

Less than 20 no/mL
Muscle weakness
Increased production of parathyroid hormone ( reduced excretion)
Increased serum lipids
Hypertension due to increased renin activity

67
Q

Parkinson’s pt on levodopa needs to avoid what vitamin or foods with high amounts of this vitamin?

A 
B6 or pyridoxine
Beef liver
Organ meats
Starchy vegetables
Potatoes
Fortified cereals
Non citrus fruits
68
Q

Sarcopenia

A

Loss of lean body mass and strength

69
Q

Marasmus

A

Loss of somatic muscle
Gradual wasting of body fat
Preservation of visceral proteins

70
Q

Kwashiorkor

A

Visceral protein wasting (decreased albumin)

Preservation of fat and somatic muscle

71
Q

Elderly

A

Increased fat oxidation

Lower glucose oxidation

72
Q

Acute phase response effect on iron and transferrin is

A

Decrease iron

Increase ferritin

73
Q

Folate is resorbed by

A

Enterohepatic circulation: liver to the bile, followed by entry into the small intestine, absorption by the enterocyte and transport back to the liver.

74
Q

Acute phase response does what to iron and ferritin?

A

Decrease iron

Increase ferritin

75
Q

Folate is resorbed via

A

Enterohepatic circulation

76
Q

Stress and trauma increases

A

Cortisol
Epinephrine
Growth hormone
Glucagon

Increase liver glucose production
Increased protein breakdown from muscle
Increased fatty acid oxidation

77
Q

Ileal brake

A

Dietary fiber in distal ileum causes delayed gastric emptying

78
Q

Half life of transferrin

A

8 to 10 days

Iron transport protein
The saturation can indicate iron deficiency

79
Q

Body is ? Water

A

2/3

Three compartments if total body water
Intracellular ...2/3
Extra cellular ...1/3 of this 
                  1/4 is intravascular and 3/4 interstitial 
Trans cellular only 3%

Intravascular means fluid in veins
Interstitial means fluid between veins and cells

80
Q

Vitamin b 12 is absorbed in the

A

Distal ileum

81
Q

Folic acid is absorbed in the

A

Proximal small intestines via carrier mediated process.

82
Q

Parietal cell secrete

A

Intrinsic factor to bind to b12 which is absorbed in the distal ileum

83
Q

Primary intracellular osmole is

A

Potassium

84
Q

Primary extra cellular osmole is

A

Sodium

85
Q

Hypotonic fluids move water

A

2/3 move to ICF and 1/3 ECF then

1/4 intravascular area in the vessels

3/4 interstitial which is area around a cell

86
Q

Hypertonic fluids move

A

Movement of water out of cells

87
Q

Isotonic fluids

A

All goes to ECF and then divides to interstitial and intravascular

88
Q

Avoid dextrose solutions when treating Hypokalemia

A

As dextrose prompts insulin which will promotes an intracellular shift of potassium.

89
Q

Magnesium absorption

A

Distal jejunum and ileum

90
Q

Corrected total calcium equation

A

[Measured calcium in mg/dL ]+ 0.8 x [4-alb in g/dL]

91
Q

Metabolic alkalosis can do what to ionized calcium?

A

Decrease

An increase in phosphorus can decrease ionized calcium too

92
Q

Body fluid normal pH

A

6.8 to 7.8

93
Q

Regarding acid base balance in the body only the kidneys can

A

Regulate Alkaline substances in the blood and eliminate metabolic acids from the body.

94
Q

Kwashiorkor is characterized by

A

Edema, ascites, easy hair pluckability as well as well nourished appearance

95
Q

Which vitamins can reduce plasma homocysteine concentration which indication increased risk for CAD?

A

Folate
B6
B12

96
Q

Iron is absorbed in ferric or ferrous state?

A

Ferrous state in the proximal jejunum. Gastric acid is important in maintaining iron in the ferrous state.

97
Q

In PKU what amino acid is in the special formulas?

A

Tyrosine as there isn’t the phenylalanine enzyme hydroxylase to convert phenylalanine to tyrosine

Nutrition Support (7 decks)

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