Lesson 2/Chapter 2 Flashcards
Nutrients for homeostasis, repair and regeneration:
water, protein, carbs, fats, vitamins, minerals
Dehydration:
1% decrease in body weight due to fluid loss
Patients on air-fluidized beds require:
40-60mL of water/kg BW daily
When would a patient need a dietician referral?
swallowing difficulties, fluid restrictions, NPO more than a few days
Average amount of water per kg of body weight?
30–35 mL
- 7–3.7 l/day average
- 5L/day minimum
What is protein required for?
Collagen synthesis Granulation tissue formation Angiogenesis Remodeling Immune function
What does a protein deficiency alter?
osmotic pressure, causing edema
What percentage of protein is nitrogen?
16%
Positive nitrogen balance needed to enhance wound healing
How much of protein is need daily?
1.25–1.5 g protein/kg BW daily
Marasmus
protein deficiency though deprivation or impaired absorption, significant weight loss, caused by CA & COPD
Kwashiorkor
decreased albumin causes swelling, spares muscle, decreased immunity, infection, skin breakdown and pressure ulcers common
Marasmus Kwashiorkor-
combined- high risk of mortality & morbidity
Amount of protein needed for tissue repair?
½ body weight in pounds or 1.25-1.5g/kg of body weight for stage III & IV ulcers
Specific amino acids:
glutamine
arginine
hydroxy-methylbutyrate (HMB)
Glutamine
most abundant (20%) fuel source for small cells, primary fuel source for lymphocyte proliferation, precursor for nucleotide production in fibroblasts and macrophages, stimulates inflammatory response in wound healing, levels fall in plasma and muscle after trauma
Arginine
semi-essential amino acid, decreased production in times of stress and injury, primary component in wound healing, increases collagen deposition, fibroblastic activity, and immune function
Hydroxy-methylbutyrate (HMB)
helps support immune function, helps decrease muscle breakdown, need to give with arginine & glutamine
Carbohydrates
Primarily in the form of glucose
Provide energy for tissue repair and regeneration
Protein-sparing effect
Carbs in BW daily?
30-35kcal/kg
20-30% of total calories
What do fats do?
Provide a needed energy source when carbohydrates have been depleted
Carry fat-soluble vitamins
Assist with thermoregulation
What do free fatty acids do?
Vital components of cell membranes
Required for synthesis of new cells
What does too much fat cause?
immunosuppression
What do fat deficiencies cause?
decreased production of phospholipids which are part of the basement membrane and decrease prostaglandin production
What does omega-3 have in it?
anti-inflammatory effect, inhibit PDFG, IL-1 & TNF-alpha, may weaken wounds by impairing cross-links and collagen alignment
Fat-soluble vitamins
A,E,K
Water-soluble vitamins
C
B-complex
Vitamin A (retinol)
Maintains healthy skin and mucous membranes
Required for collagen synthesis, promotes granulation tissue formation, and facilitates epithelialization
May reverse inhibitory effects of corticosteroids
What can Vitamin A increase?
wound tensile strength
Increases inflammatory response
Increases EGF-(epidermal growth factor) increases collagen synthesis
Vitamin C (ascorbic acid)
Builds and maintains tissues
Helps body absorb iron
May help control infections and limit damaging effects of free radicals
May enhance wound healing in malnourished patients and patients with pressure ulcers
Pretreatment of irradiated skin with Vitamin C may limit skin damage
What is vitamin C essential for?
collagen synthesis
deficiency delays would healing
RDA of vitamin C
60mg/day
Vitamin K
Fat-soluble vitamin
Essential for blood clotting
Deficiency may lengthen the inflammatory phase
If on anticoagulant, do not supplement without MD clearance
B-Complex Vitamins
Group of eight vitamins
Required for normal immune function and energy metabolism
Aid in white blood cell function, antibody formation, and resistance to infection
Facilitates fibroblast function, collagen synthesis
Important co-enzymes
Vitamin B6
for protein and hemoglobin synthesis. Rec-.4mg
Vitamin B12:
Prevents anemia. Rec- 2mg
Vitamin E
Helps prevent free radical–related cellular damage
Decreases inflammatory phase of wound healing
Enhances immune function
Decreases platelet adhesion
What can vitamin E adversely affect?
wound healing and decrease collagen production, may weaken wounds
Microminerals:
iron
zinc
copper
magnesium
Macrominerals
calcium
phosphorus
selenium
How much zinc does the skin contain?
Skin contains 20% of the body’s zinc stores
What is zinc vital for?
Vital to collagen and protein synthesis, cell proliferation, epithelialization, and normal immune function
An antioxidant
What does a zinc deficiency cause?
abnormal function of lymphocytes, increased susceptibility to infection and delayed wound healing
Iron
Component of hemoglobin
Required for antibody production and normal immune functioning
Cofactor in many enzyme systems
Required for collagen and DNA synthesis
Necessary for formation of red blood cells
Transports oxygen to healing tissues
What can anemia lead to?
tissue hypoxia, decreased immune function, decreased cell replication, and decreased wound tensile strength
What is iron co-factor required for?
conversion of hydroxproline to proline in collagen maturation
What doe copper do?
Required for hemoglobin synthesis and iron absorption/transport
Increases strength of collagen cross-links
Aids in Collagen formation
Helps form RBC’s
What does a copper deficiency lead to?
poor wound healing and decreased immune function
Copper and Vitamin C relationship?
Works with vitamin C to form elastin
Recommended dosage of copper?
Rec-1.5-3mg
Magnesium:
Cofactor in over 300 enzyme systems
Important for bone/protein synthesis
Inadequate stores lead to hypertension and vasoconstriction
Who is a magnesium deficit found in?
often found in patients with diabetes, alcoholism, chronic diarrhea, or dehydration
Calcium:
Bone formation, remodeling Muscle contraction Fibrin synthesis Important for blood clotting Neurotransmitter
Phosphorous
Bone formation
Needed for normal metabolism
Essential component of many enzyme systems
What does selenium do?
Assists with normal immune function
Required to make up to 30 proteins
What is folic acid necessary for?
RBC production
What is thiamin necessary for?
to obtain energy from food. Rec - 2
What does a nutritional screening entail?
patient characteristics
recent dietary hx
wound characteristics
patient comorbidities
BMI less than 16
underweight
severe protein-energy malnutrition
BMI 16-16.9
underweight
moderate protein-energy malnutrition
BMI 17-18.4
underweight
mild protein-energy malnutrition
BMI 18.5-24.9
normal
BMI 25-29.9
overweight
BMI 30-34.9
Obese
Class I
BMI 35-39.9
Obese
Class II
BMI greater than 40
Obese
Class III
Clinical manifestation of water deficiency:
dry skin, hair and mucous membranes poor skin turgor increased HR and respirations orthostatic hypotension confusion sunken eyeballs
Clinical manifestation of protein deficiency:
dull, dry hair
pallor
peripheral edema
pressure ulcers, especially multiple or repeat ulcerations
Clinical manifestation of carbs/energy deficiency:
decline in body weight
pallor
extremely poor denition
Clinical manifestation of fats deficiency:
emaciated
epidermal flaking
fissuring of the skin
large flakes of dandruff
Clinical manifestation of Vitamin A deficiency:
night blindness difficulty adapting to changes in light intensity scleral changes and dry eyes gingivitis pigment changes dry skin
Clinical manifestation of Vitamin C deficiency:
swollen gums that bleed readily
transparent skin quality
weakness
delayed wound healing
Clinical manifestation of Vitamin K deficiency:
petechiae
wound bleeds readily
Clinical manifestation of B complex vitamins deficiency:
pallar pale eye membranes hyperpigmentation redness or swelling of the mouth mouth sores purple discoloration tongue w/loss of villi confusion muscle cramps anemia
Clinical manifestation of zinc deficiency:
decreased sense of taste
dull, dry or thinning hair
seborrhea-like dryness and redness of the face
Clinical manifestation of iron deficiency:
pallor yellow discoloration of the skin soft, spoon-shaped nails easily fatigued dyspnea anemia
Clinical manifestation of copper deficiency:
thinning of hair
may have pigmentation changes
Clinical manifestation of magnesium deficiency:
dehydration
neuromuscular hyperexcitability
confusion
Clinical manifestation of calcium deficiency:
acute: neuromuscular hyperexcitability, dyrhythmias skeletal deformities bone pain dry scaling skin and hair brittle nails
Clinical manifestation of phosphorus deficiency:
skeletal deformities
bone pain
idiopathic fractures
Clinical manifestation of selenium deficiency:
muscle pain/wasting
decreased ability to fight infection
Creatine
Measure of kidney function and protein status
Malnutrition decreases creatine levels
Normal levels are 0.8–1.5 mg/dL
Serum Albumin
Plasma protein produced by liver
Normal levels are at least 3.5 mg/dL
What do low levels of serum albumin correlate with?
pressure ulcer severity
Decreased levels lead to edema
Dehydration will increase levels
How long does it take to determine effectiveness of albumin?
21 days
Prealbumin
Major transport protein
Normal values 16–40 mg/dL
Mortality risk increases as levels drop
How soon is a pre-albumin change observable?
observable in 42-78 hours. Not affected by hydration. Affected by renal failure. Pre-albumin < 17 mg/dL = malnutrition
Serum Transferrin
Sensitive indicator of protein status
Levels less than 170 mg/dL indicate malnutrition
C-reactive protien-CRP-
associated with systemic inflammation
Serum Cholesterol
< 160mg/dL with poor intake and weight loss- at risk for pressure ulcers
Hemoglobin
< 12mg/dL and hematocrit < 33% = anemia/pressure ulcer risk
Serum Osmolality
> 29 mOsm/L
Blood Urea Nitrogen (BUN)
Urea is a by-product of protein metabolism and
is excreted by the kidney
Indicator of renal function
Normal levels are 5–25 mg/dL
Elevated levels are associated with decreased
wound healing
BUN/Creatinine ratio
> 10-:1-skin tugor, urine output, and weight fluctuation indicators of dehydration
Total Lymphocyte Count (TLC)
Indirect measure of nutritional status and immune function
TLC is a marker for HIV
Normal TLC count:
3000-3500 cells/ l
What are elevated TLC levels associated with?
infection, leukemia
What are decreased TLC levels associated with?
associated with delayed wound healing and increased mortality
<1500- immunocompromised
<1200- protein deficiency
Severe- < 900
Increased blood glucose levels are associated with?
associated with risk of ulceration and impaired wound healing
>180 neutrophils cannot chemotax to infection,
>200 affects neutrophils ability to carryout oxidative bursts with phagosomes
Main causes of malnutrition:
Lack of knowledge, poverty, health problems
Proper nutritional guidelines
30–35 calories/kg BW
1.25–1.5 g protein/kg BW
Changes in body weight:
1% decrease in a week
5% decrease in a month
7.5% in 3 months
10% in 6 months
