Exam 1 Flashcards by Maddy Meyer

What are the 4 parts of the care process?

Assessment
Diagnosis (PES)
Intervention
Monitoring

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What are some risk factors that would affect a patients nutritional intake

Food/nutrient intake (inadequate intake, GI issues)

Physical (overweight, age, CA, neurologic impairment)

Psychological/social factors (low income, depression, addictions)

Biochemical/meds (abnormal lab work, chronic med use/poly pharmacy)

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What is the MUST tool used for? And PG-SGA?

Determining risk of malnutrition

0- routine care
1- observe
2 or more is high risk- treat

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5 components of a nutritional assessment

Screen
Health history
Med/supplement use
Social history
Diet history

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Diet history information

Allergies to food
Appetite
Necessary dietary modifications
GI issues
Who does the shopping
Physical activity
Concerns of the patient

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What are 3 ways you can get a nutrient intake from a patient

24 hour recall
Food diary
Food frequency questionnaire (FFQ)

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Static assay vs. functional assay

Static: measurement of nutrient in blood, urine or tissue. Ex: vitamin A

Functional: measurement of a process requiring specific nutrients ex: bone density scans for calcium/vitamin D

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Issues with biochemical assessment

Assessment can be influenced by non-nutritional factors ex: environment, disease

No test thats sufficient for monitoring nutritional status

Some non-specific

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What is stool testing good for

Fat malabsorption
GI flora
Blood
Pathogens

-fecal occult blood test with unexplained anemia

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What are some cytokine bio markers

IL-1B
TNF-a
IL-6

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What do cytokines and eicosanoids do?

Increase muscle breakdown and cause redistribution of plasma protein that leads to edema

decrease production of RBS

Pull iron away from hemoglobin to ferritin

Inhibits transferrin

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Lab tests for anemia during inflammation

Lab tests for anemia are not reliable when inflammation is present

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Positive acute phase reactants during inflammation

C reactive protein
Fibrinogen
Ferritin
Ceruloplasmin
Alpha-1-antitrypsin

INCREASED

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Negative acute phase reactants and inflammation

albumin (looks like protein deficiency)
transferrin
prealbumin
retinol-binding protein

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Microcytic anemia

Hypochromic anemia

Iron deficiency or copper

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Macrocyclic anemia

Megaloblastic anemia

Folate or B12 deficiency

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Assess for microcytic (iron deficiency) anemia

Hematocrit (% RBC in blood)
Hemoglobin
Ferritin (iron storage in liver)
Serum iron
Total iron binding capacity
Transferrin saturation (iron availability to tissues)

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Assessment to microcytic anemia

Folate
B12
Methylmalonic acid (MMA) —differentiates between B12/folate deficiency. Best for b12
Serum homocysteine

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What is the long-term marker for blood glucose control

Hemoglobin A1C

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Hemoglobin A1C

Long-term blood sugar control. Averages the last 2-3 months.

Abnormal >6.4%
Each 1% increase = increase of 35mg/dl in blood sugar

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What is normal blood glucose fasting value

70-99mg/dL

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Markers of oxidative stress

Antioxidants: C &amp; E
SE
Phytochemicals (carotenoids)
AOX/enzymes 
-superoxide mutate, catalase, glutathione

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Potential biomarkers of oxidative stress

*F2 isoprostates
*Myeloperoxidase (MPO)
MDA
oxidized LDL
MPO
ROS
serum antioxidant capacity

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Best way to measure Vitamin D

Calcidiol

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BMI severe thinnness | BMI moderate thinness

<16 | 16.0-16.9

BMI for mild thinness and normal range

17. 0-18.49 | 18. 5-24.9

BMI for overweight and preobese

25+ | 25-29.9

BMI for three obese classes

1: 30-34.9 2: 35-39.9 3: 40+

Better indications of body weight than BMI

Waist circumference | waist: hip ratio

Waist circumference in men and women that is healthy

Men: under 40 inches Women: under 35 inches

Wait: hip ratio in men and women that is healthy

Men: under 0.95 Women: under 0.8

Healthy wait to height recommendations for men and women

Men: 0.43-0.53 Women: 0.42-0.49

Underweight waist to height ratio for males and females

Under 0.35

Obese height to waist numbers in males and females

Males: 0.58-0.63 Women: 0.54-0.58

Poor wound healing due to

Protein, Vitamin C or zinc

Pressure ulcers due to

Protein, vitamin C, zinc deficiency

Follicular hyperkeratosis

Vitamin A or EFA

Pellagrous Dermatitis

Niacin or tryptophan

Dermatitis

Zinc or EFA

Pallor

Iron Folate B12

Petechiae, ecchymoses

Vitamin K or C

Spooning nails

Iron | Malnutrition

Ridging/transverse nail lines

Protein deficiency

Thin/dull hair/pull out easy

Protein or zinc deficiency | Potential eating disorders

De-pigmentation in face or swollen

Protein deficiency

Moon face

Protein deficiency

Scaly/greasy with gray/yellow around nose

Riboflavin Niacin B6

Keratomalacia

vitamin A

Bitot’s spots

Vitamin A

Pale conjunctiva

Iron Folate B12

Angular palpebritis

Riboflavin/niacin

Angular stomatitis (lips/mouth)

Riboflavin Niacin B6 Or dehydration (B vitamins)

Cheilosis of lips/mouth

Riboflavin/niacin | Dehydration

Magenta tongue

Riboflavin

Glossitis

Riboflavin, niacin, B6, B12, folate, iron

Decreased taste/dysgeusia

Zinc

Swollen/bleeding gums

Vitamin C

Swollen painful joints

Vitamin C or D (D MC)

Pain in calves or thighs

Thiamin deficiency

Tetany

Ca, Mg, Na

Hyper-reflexia

Hypocalcemia

Hypoactive patellar reflex

Thiamin/B12

Calculate % weight change

(Usual body weight-present weight) / usual body weight X100

Components of functional nutritional assessment

1. Ingestion - intake and patterns 2. Digestion - flora, allergies, hydration, inflammatory status, lifestyle 3. Utilization - antioxidants, vitamins, oils/FA, protein utilization

What are the effects of food on drug absorption

1. Decrease iron supplement absorption by 50% 2. OJ increases iron absorption by 85% 3. Limit high fiber, fat, phytate, tannin, oxalate containing foods

Effect of drugs on food absorption

K, Ca, Zn affect GI transit time Change GI environment and decrease Ca, Fe, B12 absorption Damage mucosa and cause nutrient deficiencies

What affect do drugs have on nutrient metabolism

May cause nutrient depletion’s due to increased requirement for metabolism Ex: tegretol increases met. Of Vit D, folate, biotin Methotrexate depletes folate Statins deplete CoQ10

Effect of drugs on nutrient excretion

Diuretics cause e-lyte imbalance (K,Mg, Cl, Na, Ca) ACE inhibitors decrease K excretion Corticosteroids decrease Na excretion and increase K and Ca excretion

PES stand for?

Problem Etiology Symptoms

P in PES

Used for coding “Diagnostic label” -excessive, inadequate, inappropriate nutrient intake

E in PES

Etiology Drives the intervention -factors contributing to the cause

S in PES

Symptoms Used for monitoring Characteristics from subjective and objective assessment DATA

ABC’s of behavior modification

Antecedent of behavior (trigger) Behavior Consequence

Ex: the ABC’s of eating while watching TV

Watching TV Mindless eating Wait gain

Stages of transtheoretical model of change

``` Precontemplation Contemplation Preparation Action Maintenance ```

How to assess patients readiness for change?

VAS scale | 1-10

What can you do if a patient isn’t ready to change (1-3)

Plant seeds of change Identify barriers to changing Identify behavior that might help change

What to do for a patient that is unsure about chance (4-7)

Discuss ambivalence Reflect change talk...”I know I should be doing this but...” Consider options and set a goal

What do to for a patient who is ready to change

Set goals and plan of action Make sure they set reasonable markers of success

What is the righting reflex

Your desire as a practitioner to fix and help everyone

Motivational interview: theory of behavior change or communication technique?

Communication technique

Mottled nails

A and C

Dementia

B1, 3, 12

What groups should be screened for CVD risk

- atherosclerotic individuals - 45-75 with LDL 70-189 or have 7.5% 10 year risk - LDL > 190