Exam 1 Flashcards
What are the 4 parts of the care process?
Assessment
Diagnosis (PES)
Intervention
Monitoring
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)
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
5 components of a nutritional assessment
Screen Health history Med/supplement use Social history Diet history
Diet history information
Allergies to food Appetite Necessary dietary modifications GI issues Who does the shopping Physical activity Concerns of the patient
What are 3 ways you can get a nutrient intake from a patient
24 hour recall
Food diary
Food frequency questionnaire (FFQ)
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
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
What is stool testing good for
Fat malabsorption
GI flora
Blood
Pathogens
-fecal occult blood test with unexplained anemia
What are some cytokine bio markers
IL-1B
TNF-a
IL-6
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
Lab tests for anemia during inflammation
Lab tests for anemia are not reliable when inflammation is present
Positive acute phase reactants during inflammation
C reactive protein Fibrinogen Ferritin Ceruloplasmin Alpha-1-antitrypsin
INCREASED
Negative acute phase reactants and inflammation
- albumin (looks like protein deficiency)
- transferrin
- prealbumin
- retinol-binding protein
Microcytic anemia
Hypochromic anemia
Iron deficiency or copper
Macrocyclic anemia
Megaloblastic anemia
Folate or B12 deficiency
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)
Assessment to microcytic anemia
Folate
B12
Methylmalonic acid (MMA) —differentiates between B12/folate deficiency. Best for b12
Serum homocysteine
What is the long-term marker for blood glucose control
Hemoglobin A1C
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
What is normal blood glucose fasting value
70-99mg/dL
Markers of oxidative stress
Antioxidants: C & E SE Phytochemicals (carotenoids) AOX/enzymes -superoxide mutate, catalase, glutathione
Potential biomarkers of oxidative stress
- *F2 isoprostates
- *Myeloperoxidase (MPO)
- MDA
- oxidized LDL
- MPO
- ROS
- serum antioxidant capacity
Best way to measure Vitamin D
Calcidiol
BMI severe thinnness
BMI moderate thinness
<16
16.0-16.9
BMI for mild thinness and normal range
- 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
- Ingestion
- intake and patterns - Digestion
- flora, allergies, hydration, inflammatory status, lifestyle - Utilization
- antioxidants, vitamins, oils/FA, protein utilization
What are the effects of food on drug absorption
- Decrease iron supplement absorption by 50%
- OJ increases iron absorption by 85%
- 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
