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Clinical Nutrition > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the 4 parts of the care process?

A

Assessment
Diagnosis (PES)
Intervention
Monitoring

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2
Q

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

A

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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3
Q

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

A

Determining risk of malnutrition

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

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4
Q

5 components of a nutritional assessment

A 
Screen
Health history
Med/supplement use
Social history
Diet history
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5
Q

Diet history information

A 
Allergies to food
Appetite
Necessary dietary modifications
GI issues
Who does the shopping
Physical activity
Concerns of the patient
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6
Q

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

A

24 hour recall
Food diary
Food frequency questionnaire (FFQ)

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7
Q

Static assay vs. functional assay

A

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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8
Q

Issues with biochemical assessment

A

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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9
Q

What is stool testing good for

A

Fat malabsorption
GI flora
Blood
Pathogens

-fecal occult blood test with unexplained anemia

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10
Q

What are some cytokine bio markers

A

IL-1B
TNF-a
IL-6

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11
Q

What do cytokines and eicosanoids do?

A

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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12
Q

Lab tests for anemia during inflammation

A

Lab tests for anemia are not reliable when inflammation is present

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13
Q

Positive acute phase reactants during inflammation

A 
C reactive protein
Fibrinogen
Ferritin
Ceruloplasmin
Alpha-1-antitrypsin

INCREASED

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14
Q

Negative acute phase reactants and inflammation

A
  • albumin (looks like protein deficiency)
  • transferrin
  • prealbumin
  • retinol-binding protein
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15
Q

Microcytic anemia

A

Hypochromic anemia

Iron deficiency or copper

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16
Q

Macrocyclic anemia

A

Megaloblastic anemia

Folate or B12 deficiency

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17
Q

Assess for microcytic (iron deficiency) anemia

A 
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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18
Q

Assessment to microcytic anemia

A

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

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19
Q

What is the long-term marker for blood glucose control

A

Hemoglobin A1C

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20
Q

Hemoglobin A1C

A

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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21
Q

What is normal blood glucose fasting value

A

70-99mg/dL

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22
Q

Markers of oxidative stress

A 
Antioxidants: C & E
SE
Phytochemicals (carotenoids)
AOX/enzymes 
-superoxide mutate, catalase, glutathione
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23
Q

Potential biomarkers of oxidative stress

A
  • *F2 isoprostates
  • *Myeloperoxidase (MPO)
  • MDA
  • oxidized LDL
  • MPO
  • ROS
  • serum antioxidant capacity
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24
Q

Best way to measure Vitamin D

A

Calcidiol

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25
Q

BMI severe thinnness

BMI moderate thinness

A

<16

16.0-16.9

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26
Q

BMI for mild thinness and normal range

A
  1. 0-18.49

18. 5-24.9

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27
Q

BMI for overweight and preobese

A

25+

25-29.9

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28
Q

BMI for three obese classes

A

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

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29
Q

Better indications of body weight than BMI

A

Waist circumference

waist: hip ratio

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30
Q

Waist circumference in men and women that is healthy

A

Men: under 40 inches
Women: under 35 inches

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31
Q

Wait: hip ratio in men and women that is healthy

A

Men: under 0.95
Women: under 0.8

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32
Q

Healthy wait to height recommendations for men and women

A

Men: 0.43-0.53
Women: 0.42-0.49

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33
Q

Underweight waist to height ratio for males and females

A

Under 0.35

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34
Q

Obese height to waist numbers in males and females

A

Males: 0.58-0.63
Women: 0.54-0.58

35
Q

Poor wound healing due to

A

Protein, Vitamin C or zinc

36
Q

Pressure ulcers due to

A

Protein, vitamin C, zinc deficiency

37
Q

Follicular hyperkeratosis

A

Vitamin A or EFA

38
Q

Pellagrous Dermatitis

A

Niacin or tryptophan

39
Q

Dermatitis

A

Zinc or EFA

40
Q

Pallor

A

Iron
Folate
B12

41
Q

Petechiae, ecchymoses

A

Vitamin K or C

42
Q

Spooning nails

A

Iron

Malnutrition

43
Q

Ridging/transverse nail lines

A

Protein deficiency

44
Q

Thin/dull hair/pull out easy

A

Protein or zinc deficiency

Potential eating disorders

45
Q

De-pigmentation in face or swollen

A

Protein deficiency

46
Q

Moon face

A

Protein deficiency

47
Q

Scaly/greasy with gray/yellow around nose

A

Riboflavin
Niacin
B6

48
Q

Keratomalacia

A

vitamin A

49
Q

Bitot’s spots

A

Vitamin A

50
Q

Pale conjunctiva

A

Iron
Folate
B12

51
Q

Angular palpebritis

A

Riboflavin/niacin

52
Q

Angular stomatitis (lips/mouth)

A

Riboflavin
Niacin
B6
Or dehydration

(B vitamins)

53
Q

Cheilosis of lips/mouth

A

Riboflavin/niacin

Dehydration

54
Q

Magenta tongue

A

Riboflavin

55
Q

Glossitis

A

Riboflavin, niacin, B6, B12, folate, iron

56
Q

Decreased taste/dysgeusia

A

Zinc

57
Q

Swollen/bleeding gums

A

Vitamin C

58
Q

Swollen painful joints

A

Vitamin C or D (D MC)

59
Q

Pain in calves or thighs

A

Thiamin deficiency

60
Q

Tetany

A

Ca, Mg, Na

61
Q

Hyper-reflexia

A

Hypocalcemia

62
Q

Hypoactive patellar reflex

A

Thiamin/B12

63
Q

Calculate % weight change

A

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

64
Q

Components of functional nutritional assessment

A
  1. Ingestion
    - intake and patterns
  2. Digestion
    - flora, allergies, hydration, inflammatory status, lifestyle
  3. Utilization
    - antioxidants, vitamins, oils/FA, protein utilization
65
Q

What are the effects of food on drug absorption

A
  1. Decrease iron supplement absorption by 50%
  2. OJ increases iron absorption by 85%
  3. Limit high fiber, fat, phytate, tannin, oxalate containing foods
66
Q

Effect of drugs on food absorption

A

K, Ca, Zn affect GI transit time

Change GI environment and decrease Ca, Fe, B12 absorption

Damage mucosa and cause nutrient deficiencies

67
Q

What affect do drugs have on nutrient metabolism

A

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

68
Q

Effect of drugs on nutrient excretion

A

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

69
Q

PES stand for?

A

Problem
Etiology
Symptoms

70
Q

P in PES

A

Used for coding
“Diagnostic label”

-excessive, inadequate, inappropriate nutrient intake

71
Q

E in PES

A

Etiology
Drives the intervention

-factors contributing to the cause

72
Q

S in PES

A

Symptoms
Used for monitoring

Characteristics from subjective and objective assessment

DATA

73
Q

ABC’s of behavior modification

A

Antecedent of behavior (trigger)
Behavior
Consequence

74
Q

Ex: the ABC’s of eating while watching TV

A

Watching TV
Mindless eating
Wait gain

75
Q

Stages of transtheoretical model of change

A 
Precontemplation
Contemplation
Preparation
Action
Maintenance
76
Q

How to assess patients readiness for change?

A

VAS scale

1-10

77
Q

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

A

Plant seeds of change

Identify barriers to changing

Identify behavior that might help change

78
Q

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

A

Discuss ambivalence

Reflect change talk…”I know I should be doing this but…”

Consider options and set a goal

79
Q

What do to for a patient who is ready to change

A

Set goals and plan of action

Make sure they set reasonable markers of success

80
Q

What is the righting reflex

A

Your desire as a practitioner to fix and help everyone

81
Q

Motivational interview: theory of behavior change or communication technique?

A

Communication technique

82
Q

Mottled nails

A

A and C

83
Q

Dementia

A

B1, 3, 12

84
Q

What groups should be screened for CVD risk

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

Clinical Nutrition (5 decks)

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