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FS HN 461 > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

IBW: Men and Women

%IBW

A

Men: 106# for 5’ then 6# per additional inch
Women: 100# per 5’ then 5# per additional inch
%IBW: CBW/IBW x 100

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2
Q

%UBW

A

CBW/UBW x 100

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3
Q

% weight change

A

(UBW-CBW)/UBW x 100

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4
Q

Found to be the most accurate method to predict REE in healthy obese and non-obese people

A

Mifflin-St. Jeor equation: do NOT use adjusted body wt

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5
Q

If you have an equation that predicts BEE or REE, what do you multiply by?

A 
Multiply by stress or injury factor OR activity factor
- in this class only use one, not both
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6
Q

Special rule for obese in which formula?

What is formula?

A

Harris Benedict, use adjusted body weight:

when > 130% IBW, use adj body wt
(ABW-IBW) x 0.25 + IBW = kg

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7
Q

Special rule for calculating protein needs under stressed conditions

A

use IBW when calculating protein needs under stressed conditions

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8
Q

How many digits?
kcal, protein (g), macronutrient (%), height (cm), height (m), weight (kg or lb), IBW (kg or lb), IBW %, UBW %, weight change %, BMI, Fluid (mL)

A

whole number: kcals, all %s, fluid (mL)

tenths: protein (g), height (cm), weight (kg or lb), IBW (kg or lb), BMI
hundredths: height (m)

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9
Q

What % of protein mass is N, conversion?

A

16% of protein mass = N

6.25 g protein = 1 g N

Nitrogen balance: oldest technique to assess protein status

Correct for insensible loss: skin, sweat, gi, hair loss

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10
Q

Values for:

Albumin

Pre-Albumin

C-reactive protein

A

Albumin: 3.5-5.0 g/dL

Pre-albumin: 19-43 mg/dL

C-reactive protein: <0.8 mg/dL

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11
Q

Approximate 1/2 lives of commonly used proteins:

Albumin

Transferrin

Prealbumin

Retinol binding protein

A

Albumin: 17-21 days

Transferrin: 8-10 days

Prealbumin: 2-3 days

Retinol binding protein: 10-12 hours

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12
Q

What is the normal range for glucose

A

<100 mg/dL: standardized lab value: cannot just refer to lab print-out

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13
Q

Cholesterol classification:

Desirable
Borderline high
High

A

Desirable: or = 240 mg/dL

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14
Q

ATP III Classification of Serum Triglycerides (mg/dL)

A

500 Very high

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15
Q

Plasma LDL levels:

Optimal
Near/above optimal
Borderline high
High
Very high
A

Optimal: or = 190 mg/dL

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16
Q

HDL plasma levels

Low
High

A

Low: or = 60 mg/dL

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17
Q

LDL levels, how to calculate?

A

calculate with Freidewald equation, LDL = TC - HDL - (TG/5)

cannot use formula if TG > 300 mg/dL

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18
Q

electrolyte requirement conversions

A 
(mg/AW)*valence = mEq (Convert mg to mEq)
(mEq/valence)*AW = mg

AW is given, valence is determined by periodic table

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19
Q

Levels for classifying BMI

A

< 18.5 underweight
18.5-24.9 normal
25-29.9 overweight
30 or > obese

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20
Q

BMI for age percentiles for children interpretations

A

85th percentile overweight

>95th percentile obese

21
Q

What energy needs formula use for critically ill patients? ANy special rules with this formula?

A

Ireton Jones equations:

- spontaneously breathing patients
- ventilator dependent patients - use ABW when BMI40
22
Q

What are the protein requirements for patients based on their health status? What BW is used to calculate protein needs under stressed conditions?

A 
Healthy:						0.8-1.0 g/kg/d
Underwt or wt loss:				0.9-1.2 g/kg/d
protein depleted				1.25-2.0
fracture, infection, trauma, fever	1.5-2.0
extensive burns				1.5-3.0 g/kg/d
**rarely go over 2.0 g/kg/d
**use IBW under stressed conditions
23
Q

What are some physiological states that could increase nutrient requirements?

A

pregnancy, lactation, metabolic stress, wound healing

* for these cases DRI may not be adequate

24
Q

What are the interpretations for waist to hip ratios?

A

Men > 1.0
Women > 0.8
= increased risk of CVD, T2DM, breast CA

25
Q

How do you adjust energy needs for patients with a fever

A

add 7% of BEE/RMR for each degree F above normal temperature (98.6 F)

26
Q

What are the two methods for calculating fluid needs?

A

1) 1 mL/kcal
2) Holiday Segar method
1. 100 mL/ first 10 kg = 1000 mL
2. 50 mL/next 10 kg = 500 mL
3. 20 mL/kg for rest
* could also start with 1500 mL then subtract 20 kg from CBW and go to step 3

27
Q

How is the information from a biochemical assessment test used?

A
  • protein energy status assessed from albumin and pre albumin
  • hydration status could falsely elevate levels
  • diagnosis/prognosis (BUN, Cr, K, PO4 = renal disease)
  • metabolic issues (glc, insulin, T4, K)
  • micronutrient status (Fe, B6, B12 = anemia)
  • response to nutritional status (pO2, pCO2)
28
Q

Define: Somatic and Visceral

A

Somatic: reflects skeletal muscle

  • anthropometrics (MAMA, MAC)
  • biochemical tests (creatinine height index, Nbal)

Visceral: non-skeletal protein stores (organs, structural components, erythrocytes, granulocytes, lymphocytes)
- biochemical measures that assess the proteins made by the organs (primarily the liver)

29
Q

Define: Precision and accuracy

A

Precision: ability to reproduce a value (reliability)

Accuracy: closeness of a reported value to the actual value (validity)

30
Q

What tissues are sampled for a biochemical data test?

A
  1. Plasma- fluid remaining after centrifugation, RBC & WBC removed, clotting factors still present
  2. Serum- whole blood allowed to clot, clot removed (RBC, WBC, clotting factors)
  3. erythrocytes
  4. leukocytes
  5. urine
  6. fecal matter
31
Q

What is the Creatinine Height Index (CHI) and what does it indicate?

A
  • formed from muscle CrP and excreted by kidney
  • daily urine output of creatinine correlated with total muscle mass

(24 hr urine creatinine in mg)/(expected 24 hr urine creatinine in cm) x 100 = CHI

60-80% of standard = mild skeletal muscle depletion
40-59% = moderate skeletal muscle depletion
<40% = severe loss of skeletal muscle

32
Q

What does a positive or negative nitrogen balance indicate?

A

negative: starvation, PEM, stress, trauma
positive: growth (children), pregnancy, weight gain, recovery from illness or injury

33
Q

When assessing protein-energy status, what are the negative and positive acute phase proteins?

A

Negative acute phase proteins:

  • albumin
  • transferrin
  • transthyretin (TTHY) (prealbumin)
  • retinol-binding protein (RBP)

Positive acute-phase proteins:

  • C-reactive proteins (CRP)
  • fibrinogen
34
Q

What are the functions, advantages, and limitations of assessing Albumin?

A

Function:

  • most abundant plasma protein (55-65%)
  • maintains colloidal oncotic pressure
  • transport protein

Advantage: lab value easily obtained

Limitations:

  • influenced by hydration state
  • long half life
  • not reflective of protein intake
35
Q

What are the functions, advantages,and limitations of assessing Transferrin?

A

Function: transport protein of iron
- plasma level controlled by iron storage pool (depleted iron = transferrin synthesis increases)

Advantage:

  • shorter half life
  • responsive to dietary protein and energy

Limitations:

  • influenced by hydration state
  • although responsive to diet, response not rapid enough to be used in acute care
36
Q

What are the functions, advantages, and limitations to using Transthyretin (prealbumin) for assessment of protein energy status?

A

Function: transport protein that binds retinol binding protein (RBP) and thyroxin

Advantages:

  • correlates with short term changes in PEM status
  • short half life makes it useful in monitoring improvements in PEM status

Limitations:

  • influenced by hydration state
  • zinc deficiency affects synthesis and secretion (therefore inflammation and zinc status need to be considered when interpreting PA levels)
37
Q

What is the function, advantages, and limitations to assessing C-reactive protein status?

A

Function: unclear, synthesized in liver

Advantages:

  • objective serum marker of the acute phase
  • positive acute phase protein (when serum levels begin to decrease inflammatory response is subsiding, more intense nutrition intervention can then begin)

Limitations:

  • influenced by hydration state
  • do not know exact function
38
Q

What is the function, advantages, and limitations to assessing retinol-binding protein status?

A

Function: binds and transports retinol

Advantages:

  • short 1/2 life
  • concentration correlates with protein energy status

Limitations:

  • Vit A status complicates interpretation of RBP as a marker of PEM status
  • cannot be used to assess PEM in renal patients
  • influenced by hydration state
39
Q

What values are included in a basic metabolic panel?

A
  • electrolytes (Na, K, Cl, HCO3)
  • glucose
  • creatinine, BUN
  • Albumin
  • Serum enzymes (ALT, AST)
  • Bilirubin
  • total calcium, phosphorous
  • TC, TG

** obtaining lipids is “extra” and not on the basic panel

40
Q

What are the classic renal indicators?

A
  • BUN, Cr, PO4, and K+

Normal CR values

  • women = 0.5-1.1 mg/dL
  • men = 0.6 - 1.2 mg/dL
41
Q

What are the causes of anemia?

A
  • iron deficiency
  • infection
  • chronic disease
  • folate and B12 deficiencies
42
Q

What is happening in the 3 stages of Fe deficiency and what are the indicators?

A
  1. depleted iron stores, ferritin decreases
  2. deficiency without anemia, transferrin decreases, protoporphyrin increases
  3. hemoglobin increases, mean corpuscular volume decreases
43
Q

What is anemia of chronic disease?

A

nutritional anemia due to insufficient Fe is hardly seen in hospitals

  • result of infection, inflammation, neoplastic disorders
  • ferritin fails to correlate with iron stores
  • important to distinguish so inappropriate Fe supplementation is not started
44
Q

What is ferritin?

A
  • primary storage form of iron
  • as iron stores decrease, ferritin decreases
  • most sensitive test to detect iron deficiency
  • can be falsely increased through inflammation, infection, trauma, iron overload
45
Q

what is transferrin?

A
  • transport iron in blood
  • serum Fe is Fe bound to transferrin
  • each molecule can bind 2 Fe but normally only 30% saturated
46
Q

What is the total iron binding capacity (TIBC)?

A
  • depends on the # of free binding sites on transferrin
  • decreases with decreased Fe stores
  • decreases with Fe overload and inflammation
47
Q

What is hemoglobin?

A

Fe containing molecule that carries O2, found in RBC
- most widely used screening test for Fe def anemia (not affected until 3rd stage of deficiency)

Normal values:

  • women: 12-16 g/dL
  • men: 14-18 g/dL
    • 5-10 g/dL less for African Americans
    • hemodilution during pregnancy decreases Hb
48
Q

What is hematocrit?

A
  • packed cell volume
    -% of RBC making up entire volume of whole blood
  • dependent upon the size and # of RBC
  • Normal values:
    Women: 37-47%
    Men: 40-54%
49
Q

What is the mean corpuscular volume (MCV)?

A
  • volume of average RBC size
  • Hct / [RBC]
  • normal range 80-100 fL
  • macrocytic (increased MCV) caused by:
    - Folate, B12 deficiency
    - chronic liver disease, alcoholism
    - cytotoxic chemotherapy
  • microcytic (decreased MCV) caused by:
    - iron deficiency
    - lead poisoning

FS HN 461 (6 decks)

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