Exam 1: Biochemical, Physical, and Functional Assessment Flashcards
What is the importance of biochemical and laboratory data in performing a nutritional assessment
- objective data
- used to diagnose nutrient deficiencies and toxicities
What is the importance of physical attributes in performing a nutritional assessment?
What is the importance of functional status in performing a nutritional assessment?
Identify types of laboratory specimens
- 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)
Identify types of Chemistry panels (laboratory tests)
- Basic metabolic panel (BMP)
- Comprehensive Metabolic Panel (CMP)
- Complete Blood Count (CBC)
- Stool testing
- Urinalysis
Whats included in BMP?
- BUN
- Calcium
- Chloride
- CO2
- Creatinine
- Glucose
- Potassium
- Sodium
Whats included in CMP?
BMP plus
* Albumin
* ALP- Alkaline Phosphatase
* ALT- Alanine Tranaminase
* AST- Aspartate Aminotransferase
* Bilirubin
* Total protein
Whats included in CBC?
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
Whats included in stool testing?
- Blood
⚬ Pathogens
⚬ Gut flora
⚬ Fat
Whats included in Urinalysis?
pH
⚬ Protein
⚬ Glucose
⚬ Ketones
What is hydration status
water regulation is vital for electrolyte balance
assess for dehydration and edema
Dehydration is
excessive loss of water and electrolytes from
What are the causes dehydration
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.
What are the symptoms of dehydration?
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
What is edema
an increase in the extracellular fluid volume
- inc albumin level
What are the causes edema
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
What are the symptoms of edema
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
Hydration status tests
Serum sodium
Blood urea nitrogen
Serum osmolality
What is inflammation
a protective response by the immune system to infection, acute illness, trauma, toxins, many chronic diseases, and physical stress.
describe the inflammatory process
- Release of pro-inflammatory cytokines and eicosanoids
⚬ ↓ hepatic protein synthesis, ↑ muscle protein breakdown
⚬ Redistribution of albumin
⚬ Iron stores shift from hemoglobin to ferritin
What are the triggers of inflammation
⚬ Infection
⚬ Illness
⚬ Chronic disease
⚬ Physical stress
⚬ Trauma
⚬ Toxins
What are acute reactatns
indicators for inflammation
What are the positive acute phase reactants with inflammation
positives increase in response to inflammation
- C reactive protein
- ferritin
- C reactive protein
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
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.
What are the negative acute phase reactants with inflammation
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
What do you look for in anthropometric measurements
Height/length
* Weight
* Body composition
* Girth measurements
⚬ Head
⚬ Midarm
⚬ Waist
￭ Risk factor:
⚬ Waist-to-hip ratio
⚬ Waist-to-height ratio
body composition methods
skin fold test
DXA (gold standard)
Bod Pod
Hydrostatic weighing
Wasit risk factors for men and woman
men >40
woman > 35 in
Significant weight loss by month
5% month 1
7.5% month 3
10% month 6
NFPE techniques
Inspection
⚬ Palpation
⚬ Percussion
⚬ Auscultation
NFPE examination areas
- subcutaneous fat loss
- muscle loss
- presence of edema
areas - subcutaneous fat loss
eyes
triceps
ribs
areas of muscle loss
temples
jaws
clavicles
scapulae
interosseous
edema areas
ankles and hands
clinical characteristics of adult malnutrition
A minimum of two of the six characteristics below is recommended for diagnosis of malnutrition
if calcium levels are low, what lab do you check for?
Albumin level in CMP and do a corrected calcium level
serum Sodium level is indicator for
hydration status
Serum potassium status is assess for patient with
renal disease or heart failure
CO2 level is assess for patient with
respiratory problems
BUN and creatine level are indicators for
kidney function
Albumin and total protein levels are indicators for
protein status
ALP, ALT, ASP, Bilirubin level are indicators for
liver status
When is BMP ordered?
blood glucose level, electrolyte and fluid balance, and kidney function
When is CMP ordered
blood glucose level, electrolyte and fluid balance, kidney function, protein status, and liver function
malnutrition type if there is no presence of inflammation
starvation related malnutrition
malnutrition type if there is presence of inflammation mild to moderate degree
chronic disease or injury-related malnutrition
malnutrition type if there is presence of high inflammation degree
acute disease or injury-related malnutrition (ICU)
6 Characteristics of malnutrition
edema or fluid overload
significant weight loss
muscle wasting
fat wasting
decreased energy intake
reduced grip strength
