Exam 2 Flashcards
What is MAC
midarm circumference
how is a MAC measurement performed
measure between acromion process and olecranon process, measure circumference in cm
how is TSF measurement performed
on the right side of the body, measure midpoint between acromion process and olecranon process. Grab about 1cm to 1/2 inch, close tip of caliper and read approximately 4 seconds after pressure from hand is released. Take two measurements. Measure triceps skinfold in mm at the marked point and biceps skinfold at marked point.
What is MAMC
Midarm muscle circumference
How is MAMC measured
estimated by creatinine/height index and midarm muscle circumference, [(C - piT)^2] / 4pi where C is cirumference in cm and T is triceps skinfold in millimeters.
what are the benefits of MAMC
Indirect determination of arm muscle area and arm fat area, determines lean body mass and skeletal protein reserves
how to determine bone free AMA in female and males
AMA-10 for males, AMA-6.5 for females.
What is DEXA
Dual-Energy X-Ray Absorptiometry takes energy beam from x-ray tube and measure energy loss depending on type of tissue the beam passes through.
What does DEXA scan measure
bone mineral density by measuring fat and boneless lean tissue
What are the benefits of DEXA scan
measures mineral, fat, and lean tissue compartments, easy, low levels of radiation, avaliable in most hospitals.
What are the limitations of DEXA scan
patient must remain still, which is difficult for those in chronic pain. Hydration status and bone/calcified soft tissue can cause inaccurate readings.
Identify significant %WL for 1 week, 1 month, 3 months, and 6 months
1-2%,
5%,
7.5%,
10%
Identify severe %WL for 1 week, 1 month, 3 months, and 6 months
> 1-2%,
5%,
7.5%,
10%
Calculate BMI
weight (kg)/height (m^2)
Calculate IBW for women and men
100 for first 5 ft then add 5(x inches over 5ft) for women
106 for first 5ft then add 6(xinches over 5ft) for men
Calculate %UBW
% UBW = (Actual weight / UBW)* 100
What is inflammation
the protective response against infection, illness, trauma, chronic disease, and physical stress
what is chronic inflammation
inflammation where body continues to synthesize inflammatory mediates during normal physiological processes. loss of barrier function, response to normally benign stimuli, overproduction of oxidants, cytokines, and chemokines.
Calculate %WL
[UBW-CBW] / UBW
What are the signs of acute inflammation
redness, swelling, heat, loss of function, pain
how do you convert lbs to kg
divide by 2.2
how do you convert inches to cm
multiply by 2.54
what is acute inflammation
short term inflammation mediated by negative feedback mechanisms and where mediators have short life and are quickly degraded.
inflammation causes a(n) _______ in positive acute phase proteins
increase
inflammation causes a(n) _______ in negative actute phase proteins
decrease
C-reactive protein
positive acute-phase reactants
a-1 antichymotryspin
positive acute-phase reactants
a1-antitrypsin
positive acute-phase reactants
haptoglobins
positive acute-phase reactants
ceruloplasmin
positive acute-phase reactants
serum amyloid A
positive acute-phase reactants
fibrinogen
positive acute-phase reactants
ferritin
positive acute-phase reactants
complement and components of C3 and C4
positive acute-phase reactants
orosomucoid
positive acute-phase reactants
albumin
negative acute-phase reactants
transferrin
negative acute-phase reactants
prealbumin/transthyretin
negative acute-phase reactants
retinol-binding protein
negative acute-phase reactants
Declining values of negative acute phase protein indicate
inflammatory processes and severity of tissue injury
Can you use lab test to predict nutritional anemia risk
NO
what does C-reactive proteins measure
reflect any type of systematic inflammation, sensitive marker for bacterial diseases. Associated with trauma, CV, neoplastic proliferation.
what is a normal oral glucose levels
<200 in 1 hr and <140 in 2 hrs
what does creatinine measure
used with BUN to assess kidney function, also assess somatic muscle protein status. Creatine should be greater or equal to DRI, low levels in diabetes mellitus.
what does albumin measure
Major purpose is to maintain colloid osmotic pressure. Transports major blood constituents, hormones, minerals, medications, fatty acids, ions.
what does prealbumin (PAB) /transthyretin (TTHY) measure
USED FOR PROTEIN STATUS AND INFLAMMATION, MALIGNANCY. can indicate protein wasting in intestines and kidneys. complex of retinol-binding protein and vitamin A. Transports thyroid hormone. Related to zinc deficiency.
what does retinol-binding protein measure
sensitive protein-energy balance indicator, low levels indicate presence of inflammatory stress, trasnport vitamin A metabolite, rapidly responds tonutrition intervention
what does transferrin measure
transprot of iron to bone marrow of hemoglobin production, low levels indicate actue inflammatory reaction, malignancies, collagen vascular disease, liver disease.
what does ferritin measure
Fe storage in proteins, best lab to determine IRON DEFICIENCY or toxicity
what is the half life for C-reactive proteins
short, 5-7 hours
what is the half life of prealbumin/transthyretin
long, 2 days
what is retinol-binding protein’s half life
12 hours
what is transferin half life
long, 8 days
Microcytic anemia is associated with
iron deficiency
Macrocytic anemia is associated with
B12 or folate deficiency
Pernicious anemia is associated with
malabsorption of B12
What is TIBC
total iron binding capacity
What does TIBC measure
transferrin concentration
What is MCV
Mean red blood cell volume
What does MCV indicate
low levels mean iron deficiency, renal failure. high levels mean B12 or folate deficiency
What is MCH
Mean corpuscular hemoglobin
what does MCH indicate
low levels mean iron deficiency, renal failure. high levels mean B12 or folate deficiency
what does MCHC indicate
low levels in those with iron deficiency
what does ferritin indicate
parallels with iron stores
what does transferrin measure
responds to the binding of iron
what does hemoglobin test measure
blood hemoglobin concentration
what does hematocrit measure
% RBC in whole blood
what does homocysteine measure
risk factor for CVD, related to B12 and folate
what does C-reactive protein labs indicate for
inflammation, CVD, infection
What does LDL test indicate
positive risk factor for CVD
what are normal LDL levels?
desireable: <100mg/dL
borderline: 130-159 mg/dL
high risk: >160mg/dL
what does HDL test indicate
protective against artherosclerotic vascular developement or negative risk factors
what is desirable HDL levels
women: >50mg/dL
men: 40mg/dL
what does triglyceride test show for
association with CHD, increase blood viscocity
what are normal triglyceride leves
normal: <150mg/dL
borderline: 150-199
high: 200-399
Very high: >500mg/dl
what is normal serum glucose range
70-90mg/dL
what does A1C indicate
differences between short term hyperglycemia and myocardial infarction
what is a normal range for A1C
4-6%
what does oral glucose tolerance indicate
establish how effective glucose uptake is
what is normal fasting oral glucose tolerance level
70-100 mg/dl
hr: <200 mg/dL
what is ceruloplasmin
a copper-carrying protein in the blood, also in iron metabolism
what does ceruloplasmin levels tell us?
increase levels from stress, low levels indicate copper deficiency or malnurition
What are the components of the urinalysis
examine appearance, find results of chemically impregnated reagent strips, and microscopic examination of urine sediment
what are the analytes of the urinalysis
specific gracity, pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocyte esterase
Why do we measure specific gravity in urine
Linked to dehydration/overhydration. monitor dilution ability of kidney, hydration status. Low levels indicate diabetes insipidus, high levels indicate fever, adrenal insufficiency, hepatic disease, heart failure
why do we measure pH of urine
acidic measurements show in high protein diets, acidosis (starvation), kidney stones. Alkaline associated with urinary tract infection, drugs, and kidney stones
why do we measure protein in urine
low levels in those with renal disease or urinary tract disorders. High levels with nephrotic syndro,e, congestive heart failure.
why do we measure glucose in urine
positive levels in those with uncontrolled DM
why do we measure ketones in urine
positive in those with uncontrolled DM
why do we measure blood in urine
blood in urine indicates UTI, neoplasm, trauma, traumatic muscle injuries, hemolytic anemia.
why do we measure bilirubin in urine
increased levels in those with liver disease, gallstones
why do we measure urobilinogen in urine
increased levels in those with hemolytic conditions, distinguish different hepatic diseases
why do we measure nitrite
should be negative value, index of bacteriuria
why do we measure leukocyte esterase
it is an indirect test of bacteriuria and detects leukocytes
What is a functional nutrition assessment
wholistic, patient focused, evidence based practice that focuses on how environment influences the metabolic processess, GI health, absorption, etc. Will assess physical reserves of micronutrients
what are the components of a functional nutrition assessment
food/nutrition history, client history, NFPE, physical measurements, lab and medical test
what are the factors identified in a functional nutrition assessment
pattern recognition, under and over nutrition, reduction of toxin exposure, antecedents or events in history that act as a trigger for a response beginning a disease process
what is ausculation
use of the naked ear or a stethoscope to listen to body sounds (heart, bowl, lung, blood vessel)
what is inspection
general observation that progresses to a more focused observation using the senses of sight, smell, and hearing; most frequently used
what are some examples of inspection
patient’s appearance, behavior, or movements like facial expression, mood, body habitus, conditioning, skin color, etc.
what is palpation
tactile exam to feel pulsations and vibrations; assess body structures, including texture, size, temperature, tenderness, and mobility
what is percussion
assessment of sounds to determine body organ borders, shape, and position; not alwayed used in NFPE
what are the signs of hypertonic dehydration
loss of more water than salt, high serum Na levels, low extracellular volume, high serum osmolaity
what are some signs of hypotonic dehydration
loss of more salt than water, low serum Na, low extracellular volume, low serum osmolarity
what are some signs of isotonic dehydration
salt and water loss equal, normal serum Na, low extracellular volume, normal serum osmolarity,
how much water loss can cause death, how much may damage body systems?
20% death, 10% damage
what labs do you look for in hypertonic dehydration
high serum osmolality, high serum Na, high albumin, high H/H, high BUN, high urine specific gravity
which labs do you look for in hypotonic dehydration
low serum osmolality, low serum Na, high albumin, high H/H, high BUN, High urine specific gracvity
what are labs to look for in isotonic dehydration
high albumin, high H/H, high BUN, high urine specific gracity
what clinical findings do you see with dehydration (NFPE only)
dry mucous membranes, dry tongue, sunken eyes, poor skin turgor, pallor, sweating, clammy or flushed skin
what are the clinical findings of dehydration
BP - hypotension, unplanned weight loss, fever, fatigue, faintness, increased thirst, peripheral or pulmonary edema
what are some causes of overhydration
heart, lung, or kidney disease
what does BUN stand for
blood urea nitrogen
what does H/H stand for
hemoglobin and hematocrit
what are the biochemical findings for hypertonic overhydration
high serum osmolality, high serum Na, low albumin, low BUN, low H/H
what are the biochemical findings for hypotonic overhydration
low serum osmolality, low serum sodium, low albumin, low BUN, low H/H
what are the NFPE clinical findings for overhydration
low urine volume, increase thirst, unstable BP/cardiac overload, insterstitial edema, dyspnea, unplanned weight gain
what is insterstitial fluid
fluid space between tissue cells, about 16% body weight
what is intracellular fluid
fluid within the tissue cells, about 30-40% body weight
what is extracellular fluid
interstitial fluid and plasma, consist of about 20% of body weight
what are electrolytes
substances that dissocaiate into positively and negatively charged ions when dissolved in water
what are the major extracellular electrolytes
sodium, calcium, chloride, bicarbonate
what are the major intracellular electrolytes
potassium, magnesium, phosphate
what are some rich sources of potassium
avocados, bananas, artichokes, chili, coconut, beet greens, corn,
what are some food sources of calcium
dairy products, green vegetables, nuts, canned fish.
what are some food sources of sodium
table salt, protein foods have naturally existing sodium. Flavor enhancers, preservatives, convenience foods
how does hydration status influence sodium electrolytes
measured by serum osmolality test. regulates extracellular and plasma volume. SIADH results in CNS, pulmonary disorders, tumors. high sodium intake associated with high urinary calcium excretion
what are some food sources of magnesium
green leafy vegetables, legumes, and whole grains
what are some food sources of phosphorous
animal products (meats and milk) and beans
how does magnesium electrolytes influence hydration status
High intake can lead to high alkaline status and enhance mineral-water consumption.
how does phosphorous electrolytes influence hydration status
act as buffer in acid-base balance
how does potassium electrolytes influence hydration status
osmotic equilibrium
what does anuric mean
no urine production
what does oliguria mean
decrease or scant urine production
what body systems are involved in fluid balance
GI tract, kidney, brain (specifically pituitary and hypothalamus)
what are the hormones that control fluid balance
vasopressin (antidiuretic hormone) and renin (stimulates thirst)
what are the thirst mechanisms for fluid balance
renin and Na blood levels are stimulated
hormonal regulation of fluid balance
baroreceptors in CNS regulate antidiuretic vasopressin, increase serum osmolality/decrease blood volume conserves water, baroreceptrors are stimulated to decrease ECF volume, kidneys release renin to produce angiotensin II that then stimulates vasoconstriction and thirst increases.
what is the fluid needs for adults
1ml/Kcal
what is the fluid needs for infants
1.5mL/kcal
how can stool samples inform on an individual’s risk for anemia
fecal occult blood test is done to look for pathogenic bacteria and presence of blood
how can stool test inform on an individual’s absorption efficiency
gut flora test to find pathogenic flora or imbalance of physiologic flora that influences absorption
what is a normal blood pressure reading
<120/<80
what is the range for prehypertension
120-139/80-90
what is the range for hypertension I
140-159/90-99
what is the range for hypertension II
> 160/>100
what is considered hypertension crisis
> 180/>110
what are the signs and symptoms of prediabetes
excessive hunger, excessive thirst, fatigue, frequent urination, weight gain, impaired glucose homeostasis, hemoglobin A1C of 5.7 to 6.4%
what are the signs and symptoms of type I diabetes
hyperglycemia, excessive thirst, frequent urination, significant weight loss, electrolyte disturbances, weakness, fatigue, irritability, insulin deficiency
what are the signs and symptoms of type II diabetes
hyperglycemia, fatigue, excessive thirst, frequent urination, obesity, history of gestational diabetes, physical inactivity, excessive kcal intake
what are the signs and symptoms of gestational diabetes mellitus
hyperglycemia, fatigue, excessive thirst, frequent urination, genetic predisposition, obesity, physical inactivity, excessive calorie intake
what is a normal fasting (8hr) glucose range
70-100mg
what is a normal casual blood glucose range
<200mg/dL
what is a normal non-diabetic adult A1C value
2.2-4.8%
what lab values classify an individual as having CVD and related MS
HDL <40mg/dL in males and <50mg/dL in females. Triglycerides>150 mg/dL, blood glucose >100mg/dL
what are the signs and symptoms of CVD and related MS
large WC, high triglyceride level, low HDL, high BP, high fasting blood sugar, shortness of breath, weakness, dizziness, discomfort in chest, jaw, throat, arm, pounding in chest.
what are the lab values found on the complete blood count
RBC, hemoglobin concentration, hematocrit, MCV, MCH, MCHC, WBC
what are the two types of metabolic panels
basic metabolic panel and comprehenisve metabolic panel
what is a basic metabolic panel (what tests)
basic screening of eight test: glucose, calcium, sodium, potassium, CO2, chlorid, BUN, and creatine
what is the comprehensive metabolic panel (CMP)
BMP plus 6 more test including albumin, total protein, ALP, ALT, AST, and bilirubin
what is a functional assay
quantitatively measure biochemical or physiological activity that depends on the nutrient of interest
what is a static assay
measures the actual level of the nutrient in a specifimen
what is normal bp
<120/<80
