Biochemical, physical and anthropometric assessments & energy, fluid and protein requirements

Question 1

How is potassium impacted by underfeeding or chronic starvation?

Answer 1

Upon refeeding - insulin and carbs can drive potassium into the cell which can lead to re-feeding syndrome resulting in severe hypokalemia which can lead to death

Question 2

What does a decreased Potassium level indicate?

Answer 2

Common in patients with nausea, vomiting, or diarrhea

Question 2

What do altered sodium values indicate?

Answer 2

More than likely due to hydration status rather than intake ex. dehydration can cause increased sodium concentrations

Question 2

What are causes of edema?
What can edema contribute to?

Answer 2

Protein Deficiency
low activity level
poor renal function - almost all patients with renal problems have edema
Skin breakdown

Question 2

What is Ideal Body Weight?

Answer 2

For age 19: BMI of 20-25
For age 65 and + BMI of 22-27

Question 2

What is % IBW?

Answer 2

How much of the patient’s IBW is their current weight at. IBW = current weight/IBW x 100

Question 2

How to calculate %UBW?

Answer 2

Current weight/UBW x 100

Question 2

How do you calculate BMI?

Answer 2

weight in kg / height in meters squared

Question 3

How do we interpret IBW ranges?

Answer 3

> 200 Morbid Obesity
130-199 Obese
121-129 Overweight
90-120 Normal
80-90 Mild Malnutrition
70-79 Moderate malnutriton
<69 Severe malnutrition

Question 3

What is % usual body weight?

Answer 3

Used to determine weight changes, describes your current weight as a percent of your usual body weight

Question 3

How to interpret %UBW?

Answer 3

85-95 - may indicate mild malnutrition
75-84 may indicate moderate malnutrition
<74 may indicate severe malnutrition

Question 3

What is % Weight change?

Answer 3

(UBW - Current Weight)/UBW x 100

Question 4

How do you interpret % weight change?

Answer 4

Significant weight loss:
1 week: 1-2%
1 month: 5%
3 months: 7.5%
6 months 10%
Unlimited time 10-20%

*Severe is greater than all these ranges for the time frame indicated

Question 5

What are the cutoffs for waist circumferences?

Answer 5

Males >40 inches
Females > 35 inches

Question 6

What can you tell from a tricep skinfold?

Answer 6

Can indicate fat and energy depeletion

Question 7

What are the activity factors?

Answer 7

1 - bed rest/sleep
1.2 out of bed, light activity
1.3-1.5 sedentary
1.7 Normal activity

Question 8

What are the stress factors?

Answer 8

1.0-1.2 in hospital
1.0-1.3 in cancer patients

Question 9

What are the total energy requirement recommendations for normal and obese patients?

Answer 9

25-35 kcal/kg for normal patients - increases or decreases with burns, trauma etc.

21kcal/kg for obese patients

Question 10

What are the protein requirements for healthy vs. in hospital adults?

What are they based on?

Answer 10

Healthy adults: RDA 0.8 g/kg bw/day
Hospital: minimum requirement of 1g/kg/day but most patients 1.2-1.9 (can be even higher in burn vitims)

Higher end for renal disaese, liver disease and critically ill patients in ICUs

Protein requirements are calculated based on ideal weight if bw outside the normal range

Question 11

What would be the protein requirements for liver patients?

Answer 11

Regular liver patients require 1.2g/kg/day
endstage liver failure dont make urea out of excess protein and make ammonia which could cause brain damage so need to be careful and likely lower it

Question 12

What are the fluid intake requirements?

Answer 12

19-55 years: 35ml/kg bw/day
55-75 years: 30 ml/kg/bw/day
>75 years: 25ml/kg/bw/day

Question 13

What weight should be used to calculate fluid requirements?

Answer 13

Always use actual weight

Question 14

What are the sections of the PG-SGA?

Answer 14

Weight
Food Intake
Symptoms
Activities and Function

Question 15

What are the PG-SGA Global Assessment Categories?

Answer 15

A - well nourished
B - moderate suspected malnutrtion
C - severely malnourished

Question 16

What is the purpose of nutrition screening?

Answer 16

Precedes nutrition assessment and quickly identifies groups that are at risk of malnutriton and/or may require a nutrition intervention

Question 17

What is a dietary assessment evaluation?

Answer 17

Comparing intake to Canada’s Food Guide recommended servings - gives an approximation of quality of intake

Question 18

What kinds of disorders would you see a decrease of B12 and folate in?

Answer 18

Chronic disorders such as liver disease, kidney disease, alcoholism
Malabsroption dieseases such as celiac, Crohn’s

Question 19

What disease states might Ferritin be elevated in?

Answer 19

Inflammatory Bowel Disease
Rheymatoid Arthritis
Acute & chronic infections

Question 20

What is TIBC?

Answer 20

Total iron binding capacity - surrogate marker of transferrin levels, typically elevated in IDA

Question 21

What is transferrin saturation?

Answer 21

Ratio of serum iron (free iron) / TIBC, a reflection of how well free iron binds to the transferring molecule and how sufficient or deficient free iron is present. Usually low in IDA

Less than <5% typically IDA

Question 22

What would be some signs of protein energy deficiency?

Answer 22

Dull, dry, hair
Drawn in face
Delayed wound healing, skin breakdown or ulcers
Musculoskeletal wasting and decreased strength
Edema

Question 23

What waist to hip ratios indicate increased risk for morbidity and mortality?

Answer 23

Men: > 1.0
Women: > 0.8

Question 24

What components make up a PES statement?

Answer 24

Problem
Etiology
Signs and Symptoms