Exam 1: Biochemical, Physical, and Functional Assessment

Question 1

What is the importance of biochemical and laboratory data in performing a nutritional assessment

Answer 1

• objective data
• used to diagnose nutrient deficiencies and toxicities

Question 2

What is the importance of physical attributes in performing a nutritional assessment?

Question 3

What is the importance of functional status in performing a nutritional assessment?

Question 4

Identify types of laboratory specimens

Answer 4

• Whole blood (glucose, hemoglobin…)
• Serum (no clotting factors)
• Plasma (yes clotting factors)
• Blood cells
  ⚬ Erythrocytes
  ⚬ Leukocytes
• Blood spots (babies- genetic metabolic disorders)
• Other tissues
• Urine
• Feces
• Breath tests (SIBO small intestinal bacteria overgrowth, or intolerances)
• Hair/nails (micronutrients)
• Saliva
• Sweat (cystic fibrosis)

Question 5

Identify types of Chemistry panels (laboratory tests)

Answer 5

• Basic metabolic panel (BMP)
• Comprehensive Metabolic Panel (CMP)
• Complete Blood Count (CBC)
• Stool testing
• Urinalysis

Question 6

Whats included in BMP?

Answer 6

• BUN
• Calcium
• Chloride
• CO2
• Creatinine
• Glucose
• Potassium
• Sodium

Question 7

Whats included in CMP?

Answer 7

BMP plus
* Albumin
* ALP- Alkaline Phosphatase
* ALT- Alanine Tranaminase
* AST- Aspartate Aminotransferase
* Bilirubin
* Total protein

Question 8

Whats included in CBC?

Answer 8

RBCs
⚬ Hg Hemogloblin
⚬ Hct Hematcrit- % of packed red blood cell in blood
⚬ MCV mean corpuscular value (mean avg cell size)
⚬ MCH mean corpuscular hemoglobin
⚬ MCHC mean corpuscular hemoglobin concentration
⚬ WBCs white blood cells

Question 9

Whats included in stool testing?

Answer 9

• Blood
  ⚬ Pathogens
  ⚬ Gut flora
  ⚬ Fat

Question 10

Whats included in Urinalysis?

Answer 10

pH
⚬ Protein
⚬ Glucose
⚬ Ketones

Question 11

What is hydration status

Answer 11

water regulation is vital for electrolyte balance
assess for dehydration and edema

Question 12

Dehydration is

Answer 12

excessive loss of water and electrolytes from

Question 13

What are the causes dehydration

Answer 13

vomiting; diarrhea; excessive laxative abuse; diuretics; fistulas; GI suction; polyuria; fever; excessive sweating; or decreased intake caused by anorexia, nausea, depression, or limited access to fluids.

Question 14

What are the symptoms of dehydration?

Answer 14

rapid weight loss, decreased skin turgor, dry mucous membranes, dry and furrowed tongue, postural hypotension, a weak and rapid pulse, slow capillary refill, a decrease in body temperature

Question 15

What is edema

Answer 15

an increase in the extracellular fluid volume
- inc albumin level

Question 16

What are the causes edema

Answer 16

an increase in capillary hydrostatic pressure or capillary permeability or a decrease in colloid osmotic pressure. It often is associated with renal failure, chronic heart failure, cirrhosis of the liver, Cushing’s syndrome, excess use of sodium-con- taining intravenous fluids, and excessive intake of sodium-containing food or medications

Question 17

What are the symptoms of edema

Answer 17

rapid weight gain, periph- eral edema, distended neck veins, slow emptying of peripheral veins, a bounding and full pulse, rales in the lungs, polyuria, ascites, and pleu- ral effusion

Question 18

Hydration status tests

Answer 18

Serum sodium
Blood urea nitrogen
Serum osmolality

Question 19

What is inflammation

Answer 19

a protective response by the immune system to infection, acute illness, trauma, toxins, many chronic diseases, and physical stress.

Question 20

describe the inflammatory process

Answer 20

• Release of pro-inflammatory cytokines and eicosanoids
  ⚬ ↓ hepatic protein synthesis, ↑ muscle protein breakdown
  ⚬ Redistribution of albumin
  ⚬ Iron stores shift from hemoglobin to ferritin

Question 21

What are the triggers of inflammation

Answer 21

⚬ Infection
⚬ Illness

⚬ Chronic disease
⚬ Physical stress

⚬ Trauma
⚬ Toxins

Question 22

What are acute reactatns

Answer 22

indicators for inflammation

Question 23

What are the positive acute phase reactants with inflammation

Answer 23

positives increase in response to inflammation
- C reactive protein
- ferritin

Question 24

• C reactive protein

Answer 24

sensitive measure of chronic inflammation seen in patients with atherosclerosis and other chronic diseases (Wang et al, 2017). Although the exact function of CRP is unclear, it increases in the initial stages of acute stress—usually within 4 to 6hours of sur- gery or other trauma. Furthermore, its level can increase as much as

Answer 25

synthesis of ferritin increases in the presence of inflammation. Ferritin is not a reliable indicator of iron stores in patients with acute inflammation, uremia, metastatic cancer, or alcoholic-related liver diseases. Cytokines and other inflammatory mediators can increase ferritin synthesis, fer- ritin leakage from cells, or both. Elevations in ferritin occur 1 to 2 days after the onset of the acute illness and peak at 3 to 5 days.

Question 26

What are the negative acute phase reactants with inflammation

Answer 26

Decreasing values when there’s inflammation in the body
-Albumin: half-life 18-21 days, affected by hydration
-prealbumin (PAB): half-life 2 days, affected by zinc status

Question 27

What do you look for in anthropometric measurements

Answer 27

Height/length
* Weight
* Body composition
* Girth measurements
⚬ Head
⚬ Midarm
⚬ Waist
￭ Risk factor:
⚬ Waist-to-hip ratio
⚬ Waist-to-height ratio

Question 28

body composition methods

Answer 28

skin fold test
DXA (gold standard)
Bod Pod
Hydrostatic weighing

Question 29

Wasit risk factors for men and woman

Answer 29

men >40
woman > 35 in

Question 30

Significant weight loss by month

Answer 30

5% month 1
7.5% month 3
10% month 6

Question 31

NFPE techniques

Answer 31

Inspection
⚬ Palpation
⚬ Percussion
⚬ Auscultation

Question 32

NFPE examination areas

Answer 32

• subcutaneous fat loss
• muscle loss
• presence of edema

Question 33

areas - subcutaneous fat loss

Answer 33

eyes
triceps
ribs

Question 34

areas of muscle loss

Answer 34

temples
jaws
clavicles
scapulae
interosseous

Question 35

edema areas

Answer 35

ankles and hands

Question 36

clinical characteristics of adult malnutrition

Answer 36

A minimum of two of the six characteristics below is recommended for diagnosis of malnutrition

Question 37

if calcium levels are low, what lab do you check for?

Answer 37

Albumin level in CMP and do a corrected calcium level

Question 38

serum Sodium level is indicator for

Answer 38

hydration status

Question 39

Serum potassium status is assess for patient with

Answer 39

renal disease or heart failure

Question 40

CO2 level is assess for patient with

Answer 40

respiratory problems

Question 41

BUN and creatine level are indicators for

Answer 41

kidney function

Question 42

Albumin and total protein levels are indicators for

Answer 42

protein status

Question 43

ALP, ALT, ASP, Bilirubin level are indicators for

Answer 43

liver status

Question 44

When is BMP ordered?

Answer 44

blood glucose level, electrolyte and fluid balance, and kidney function

Question 45

When is CMP ordered

Answer 45

blood glucose level, electrolyte and fluid balance, kidney function, protein status, and liver function

Question 46

malnutrition type if there is no presence of inflammation

Answer 46

starvation related malnutrition

Question 47

malnutrition type if there is presence of inflammation mild to moderate degree

Answer 47

chronic disease or injury-related malnutrition

Question 48

malnutrition type if there is presence of high inflammation degree

Answer 48

acute disease or injury-related malnutrition (ICU)

Question 49

6 Characteristics of malnutrition

Answer 49

edema or fluid overload
significant weight loss
muscle wasting
fat wasting
decreased energy intake
reduced grip strength