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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
How do you adjust energy needs for patients with a fever
add 7% of BEE/RMR for each degree F above normal temperature (98.6 F)
26
What are the two methods for calculating fluid needs?
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
How is the information from a biochemical assessment test used?
- 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
Define: Somatic and Visceral
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
Define: Precision and accuracy
Precision: ability to reproduce a value (reliability) Accuracy: closeness of a reported value to the actual value (validity)
30
What tissues are sampled for a biochemical data test?
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
What is the Creatinine Height Index (CHI) and what does it indicate?
- 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
What does a positive or negative nitrogen balance indicate?
negative: starvation, PEM, stress, trauma positive: growth (children), pregnancy, weight gain, recovery from illness or injury
33
When assessing protein-energy status, what are the negative and positive acute phase proteins?
Negative acute phase proteins: - albumin - transferrin - transthyretin (TTHY) (prealbumin) - retinol-binding protein (RBP) Positive acute-phase proteins: - C-reactive proteins (CRP) - fibrinogen
34
What are the functions, advantages, and limitations of assessing Albumin?
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
What are the functions, advantages,and limitations of assessing Transferrin?
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
What are the functions, advantages, and limitations to using Transthyretin (prealbumin) for assessment of protein energy status?
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
What is the function, advantages, and limitations to assessing C-reactive protein status?
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
What is the function, advantages, and limitations to assessing retinol-binding protein status?
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
What values are included in a basic metabolic panel?
- 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
What are the classic renal indicators?
- BUN, Cr, PO4, and K+ Normal CR values - women = 0.5-1.1 mg/dL - men = 0.6 - 1.2 mg/dL
41
What are the causes of anemia?
- iron deficiency - infection - chronic disease - folate and B12 deficiencies
42
What is happening in the 3 stages of Fe deficiency and what are the indicators?
1. depleted iron stores, ferritin decreases 2. deficiency without anemia, transferrin decreases, protoporphyrin increases 3. hemoglobin increases, mean corpuscular volume decreases
43
What is anemia of chronic disease?
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
What is ferritin?
- 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
what is transferrin?
- transport iron in blood - serum Fe is Fe bound to transferrin - each molecule can bind 2 Fe but normally only 30% saturated
46
What is the total iron binding capacity (TIBC)?
- depends on the # of free binding sites on transferrin - decreases with decreased Fe stores - decreases with Fe overload and inflammation
47
What is hemoglobin?
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
What is hematocrit?
- 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
What is the mean corpuscular volume (MCV)?
- 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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