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Nutrition > Malnutrition- Exam 1 > Flashcards

Malnutrition- Exam 1 Flashcards

1
Q

______ general state of inadequate nutrient and/or energy intake and absorption to meet metabolic demands.

A

malnutrition

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2
Q

malnutrition can be defined as ?????

A

“Not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat

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3
Q

What are the causes of malnutrition?

A

poor intake
poor absorption
increased metabolic needs

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4
Q

___ of deaths in children worldwide under 5 years of age have been linked to undernutrition

A

45%

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5
Q

What are some impacts of malnutrition?

A

low mood
weight loss
low energy
muscle wasting
increased risk of fractures
increased risk of hospital admissions
confusion
infections
reduced independence
increased risk of falls
reduced mobility

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6
Q

About ___ of households had “low” or “very low” food security
Jumps to ____ when looking only at households with children

A

13%

17%

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7
Q

Estimated that up to ____ of US adults do not consume adequate amounts of the nutrients that they need, on a regular basis, to support optimal health

A

85%

specially fiber, vitamins, minerals, omega 3 FA

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8
Q

What are some screening tools that screen for malnutrition?

A

Subjective Global Assessment (SGA)
Malnutrition Universal Screening Tool (MUST)
Malnutrition Screening Tool (MST)

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9
Q

Types of screening tools: ______: combines hx, ROS, and PE findings
Categorizes pts as well-nourished, mild-moderately malnourished, or severely malnourished

A

Subjective Global Assessment (SGA)

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10
Q

Types of screening tools: ______: Utilizes BMI, unintentional weight loss, and effects of acute disease to determine risk for malnutrition
Offers recommendations based on risk level

A

Malnutrition Universal Screening Tool (MUST)

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11
Q

Types of screening tools: ______: Simple, 2-question screen to determine risk of malnutrition

A

Malnutrition Screening Tool (MST)

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12
Q

Name some H&P findings that can help reflect nutritional status

A

Nutritional habits and intake (“picky eaters”)
Social questions - to determine food security
Psych history
Baseline “usual” weight compared to current
Percent usual weight - (actual weight ➗ usual weight) x 100

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13
Q

How do you screen young children for malnutrition?

A

body length and head circumference

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14
Q

**Cell with ???? are better ways to check for malnutrition. Give some examples

A

rapid turnover rate or high metabolism

Integumentary - skin, hair, nails, mucosal membranes

Hematopoiesis - immunosuppression, anemia, bleeding or bruising

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15
Q

What are some physical screening processes that you can do to test for malnutrition?

A

skinfold thickness

midarm muscle circumference

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16
Q

In men, what does the triceps skinfold thickness need to be? in women?

A

thickness < 12.5 mm = malnutrition, > 20 mm = overnutrition

thickness < 16.5 mm = malnutrition, > 25 mm = overnutrition

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17
Q

In midarm muscle circumference, the value needs to be ??? in order to be considered malnutrition?

A

less than 15th percentile

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18
Q

How do you assess underweight in children?

A

growth charts or failure to thrive

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19
Q

____ is considered low height for age

____ is considered low weight for age

A

stunting: height

wasting: weight

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20
Q

T/F: Every malnourished pt is underweight

A

FALSE!! Not every malnourished patient is underweight

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21
Q

______ is considered the gold standard imaging tool for malnutrition. Not used very often

A

DEXA scan

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22
Q

With labs associated with screening for malnutrition need to assess for ___ and _____

A

somatic and visceral proteins

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23
Q

Somatic proteins assess ?????. What is a way to test for it?

A

relative state of skeletal muscle mass

24 hour urinary creatinine excretion

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24
Q

Name 4 visceral proteins

A

albumin, transferrin, prealbumin, retinol-binding protein

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25
Q

_____ is the most commonly used visceral protein. What is the 1/2 life?

A

albumin

20 days

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26
Q

Name some clinical scenarios in which albumin might be low?

A

low in acute sepsis and liver disease

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27
Q

_____ is more useful in a very acute malnourishment. What is the 1/2 life?

A

prealbumin

also depressed in acute stress states

2 days

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28
Q

_____ is elevated in iron deficiency states. What is the 1/2 life?

A

transferrin

8-10 days

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29
Q

What labs would you want to order?

A

CBC, CRP, ESR
Urinalysis +/- Urine culture

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30
Q

order ____ to screen for anemia, chronic infection, inflammation, cancer

A

CBC, CRP, ESR

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31
Q

order _____ to evaluate for kidney disease and chronic UTI

A

Urinalysis +/- Urine culture

32
Q

Order ____ to test for amylase, lipase, +/- C peptide

A

pancreatic testing

33
Q

_____ nutrient reference values developed by the Institute of Medicine to quantify recommended levels of a given nutrient necessary for optimal health based on a patient’s individual characteristics (e.g. height, gender, activity level)

A

Dietary reference Intake (DRI)

34
Q

_____ average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals in a particular life stage and gender group

A

Recommended Dietary Allowance (RDA)

35
Q

_____ recommended average daily intake level based on approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate

A

Adequate Intake (AI)

36
Q

use _____ with an RDA cannot be determined

A

Adequate Intake

37
Q

_______ average daily nutrient intake level estimated to meet the requirement of half (50%) the healthy individuals for a particular life stage and biologic sex

A

Estimated Average Requirement (EAR)

38
Q

______ EAR specifically used for energy - average dietary intake predicted to maintain energy balance in healthy individuals of a given age, gender, weight, height, and physical activity level consistent with good health

A

Estimated Energy Requirement (EER)

39
Q

EER includes extra metabolic needs during ?????

A

pregnancy, lactation or childhood

40
Q

T/F: There is no upper intake level (UL) or recommended dietary allowance (RDA) for energy

A

True

41
Q

_____ highest average daily nutrient intake level likely to pose no risk of adverse health effects to almost all individuals in the general population

A

Tolerable Upper Intake Level (UL)

42
Q

_____ energy expenditure needed to sustain the metabolic activities of cells and tissues, blood circulation, respiration, GI and renal processing, and staying awake. How is it determined?

A

Basal Metabolic Rate (BMR)

subject reclining after a 12 hour fast

43
Q

What is the difference between BMR and BEE?

A

Basal energy expenditure (BEE) - BMR extrapolated to 24 hours

44
Q

______ Similar to BMR; accounts for energy expenditure increases due to recent food intake or recently completed physical activity

A

Resting Metabolic Rate (RMR)

45
Q

The RMR is ______ than BMR on average

A

10-20% higher

46
Q

What is the difference between RMR and REE?

A

Resting energy expenditure (REE) - RMR extrapolated to 24 hours

47
Q

What is the clinical presentation of malnutrition?

A

iron deficiency, folate, vit D, B vitamins, Vit A, Iodine deficiency

48
Q

Malnutrition in underdeveloped countries tends to show up as ____ and _____

A

Vit A and iodine deficiencies

49
Q

_____ is the most common deficiency in the US

A

folate deficiencies

50
Q

_____ state of protein and total energy malnutrition body’s requirements for calories are not met by intake

A

Marasmus

51
Q

**Relatively large head with large, staring eyes
Emaciated, weak appearance
Thin, dry skin with thin, sparse hair that is easily plucked
Shrunken arms, thighs, and buttocks with redundant skin folds
Bradycardia, hypotension, hypothermia
Irritable, fretful demeanor

What am I?

A

marasmus

52
Q

_____ protein malnutrition in the presence of caloric intake. Classically seen in babies weaned from the breast in low-income countries

A

Kwashiorkor

53
Q

Growth retardation
Changes in skin and hair pigmentation, and thin, dry, peeling skin
Low serum albumin
Bradycardia, hypotension, and hypothermia
Distended abdomen with dilated intestinal loops
May see hepatomegaly from fatty liver infiltrates
Lethargic, apathetic, irritable
Classic edematous appearance

What am I?

A

Kwashiorkor

54
Q

________: multifactorial wasting syndrome defined by continuous loss of skeletal muscle mass, with or without loss of fat mass

A

Cachexia

55
Q

Can cachexia be fully reversed?

A

Cannot be fully reversed by conventional nutritional support

56
Q

Cachexia affects ____ of cancer patients

A

50-80% of cancer patients

57
Q

Cachexia is thought to be tied to ______

A

mitochondrial dysfunction

58
Q

Mitochondrial dysfunction _____ ATP and protein synthesis. ______ oxidative stress in the body. _____ inflammatory markers

A

Decreases

Increases

Elevated

59
Q

Enteral feeding includes _____ and _____ tubes. Give some examples

A

oral and feeding

NG tubes

PEG tubes

60
Q

How is parenteral nutrition usually delivered? When is it indicated?

A

usually delivered through a central line

only indicated if the gut is not working

61
Q

What does parenteral nutrition carry a higher risk of ??

A

bacteremia and sepsis, poorer weight gain

62
Q

_____ : fever, HSM, and coagulopathy due to fat sludging

A

Fat overload syndrome

63
Q

_____ is associated with bone metabolism disease in children with long-term use

A

parenteral nutrition

64
Q

What are some helpful principles of low appetite/anorexic patients?

A

Frequent spacing of small meals

Prioritize energy-dense foods

Avoid distractions during mealtime

Powdered or liquid nutritional supplementation

Pediasure, Ensure, protein powders

Adding calories and nutrition to preferred foods

65
Q

T/F: All dietitians recommend powdered or liquid nutritional supplementation to help anorexic patients?

A

False: Controversial - not always shown to reduce hospitalizations, survival, QOL

66
Q

_____ sweating, flushing, dizziness, and tachycardia caused by large amounts of foods (especially high intake of simple sugars) moving rapidly from the stomach into the bowel. How do you prevent it?

A

Dumping syndrome

Slow infusion rate and amount of feeding given at one time

67
Q

_____ synthetic progestin which has been found to promote appetite

A

Megestrol acetate (Megace)

68
Q

_____ is used in anorexic/ cachexia associated with AIDS and cancer related cachexia (off label)

A

Megestrol acetate (Megace)

69
Q

_____ 1st generation Antihistamine. Commonly given to pediatric patients.

A

Cyproheptadine (Periactin)

70
Q

MAOI therapy; urinary or gastric obstruction (BPH, stenosis, etc.); acute angle-closure glaucoma; gastric ulcer. premature infants, neonates, pregnant or breastfeeding women, elderly or debilitated patients

These are the CI for _____

A

Cyproheptadine (Periactin)

71
Q

______ Cannabinoid-derived agent (THC); can suppress N/V and promote appetite
Used mostly in patients AIDS and patients on chemotherapy
Controlled - Schedule III

A

Dronabinol (Marinol)

72
Q

use of disulfiram or metronidazole in last 14 d; allergy to alcohol or sesame oil.

These are the CI to ______

A

Dronabinol (Marinol)

73
Q

GI upset, headache, insomnia, rash

SE of _____

A

Megestrol acetate (Megace)

74
Q

dizziness, drowsiness, anticholinergic

These are the SE of _____

A

Cyproheptadine (Periactin)

75
Q

euphoria, GI upset, dizziness, drowsiness, AMS

These are the SE of _____

A

Dronabinol (Marinol)

76
Q

**What is the major CI to Dronabinol (Marinol)?

A

allergy to alcohol or sesame oil

77
Q
A

Nutrition (11 decks)

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