Module 3 part 1 Flashcards
Nutrition
planned weight loss goal
500 caloric def. daily
Will lose 1 lb per week
Unplanned parameters
whats moderate?
whats severe?
- 5% in a month
- 10% in 6 months
- 11-19% moderate protein-calorie
- 20%+ severe
What is overnutrition
- eat more calories than burn.
- 500 per day excess will gain 1 lb in a week
how many calories is 1 lb of fat
3,500 calories
Define malnutrition
undernutrition (stunting, wasting, underweight, micronut def) and overnutrition (overweight/obese).
Individuals at risk for undernutrition
- Alcoholics
- Behavioral/mental health issues
- Children
-
Chronically/acutely ill individuals
* Decreased cognitive function - Elderly
- Illiterate individuals
- Individuals with disabilities
- Individuals who lack financial means
** Traumatic brain injury** - Substance abusers
a diagnosis of malnutrition:
- Low energy intake.
- Weight loss.
- Loss of muscle mass.
- Loss of subcutaneous fat.
- Fluid accumulation.
- Diminished hand grip strength.
If the individual has at least two of the five criteria, a diagnosis of malnutrition can be made
If you have malnutrition, what happens to your body?
higher risk for disease/illness, delayed healing, poorer functional status, recovery, and a lower survival rate.
-you have less energy reserves so this makes sense
What test is ordered when someone has caloric deficit?
CBC to test for anemia, lipid disorders and nutritional status
RBC refresher:
What is hematocrit, MCV, MCH, RDW, platelet count, RBC count, hemoglobin?
- hematocrit is #/100 (%) proportion of blood that is rbcs
- MCV is size of rbc - low if not much hemoglobin or iron to fill the rbc up, or some kind of spleen chomping it issue
- MCH is avg hemoglobin in the average red cell. not the AMOUNT of hemoglobin.
- RDW is how diverse the sizes of rbc are
- platelet count (thrombocytes)
- RBC count is the AMOUNT of RBCs
what vitamen is folate
FOLATE = green folgate
B9
where is folate absorbed
Intestine and liver
Where is ferritin made
- liver, spleen, bone marrow
- storage should be equal to circulation
Prealbumin is what? What is serum albumin significance
- prealbumin is produced by the liver. used to assess protein def.
- Serum albumin measures protein found in the blood LONG TERM
What program can deliver meals
Meals on Wheels
cushings disease process
high cortisol
gain a lot of fat/weight in the belly and upper back
Anorexia, Ageusia, Dysgeusia definitions
- Anorexia is a decreased appetite.
- Ageusia is the absence of taste.
- Dysgeusia refers to the presence of a metallic, rancid, or foul taste in the mouth.
What are the most common food allergies
nuts, fish, milk, eggs, soy products, and wheat.
Whats the most common intolerance
lactose
is gluten free an allergy or intolerance
intolerance
no wheat, barley, or rye
Explain The Malnutrition Screening Tool (MST)
a brief screening by a nurse. if positive, notify MD for dietician referral
Have you lost weight without trying? How much? Decreased appetite?
0 or 1 no risk but repeat weekly
2+ at risk and immediately intervere w/ nutritionist consult
Nutrition history, vs 24 hr recall, vs 3 d diary
- 3 d diary is more accurate
- 24 h recall sometimes hard to rememeber
*24 h recall is subject to recall bias whereas the 3 d diary is recorded right after they eat
assessment through direct observation
- Observe the patient eating during mealtime.
- Note if the patient is having any difficulty swallowing or feeding himself or herself.
- Document the percentage (0 through 100 percent) of the meal eaten.
normal is 75% of food eaten or more!
can BMI be a health indicator alone?
no. must take diet, physical activity, and family history
what is a stadiometer
measures height
what is a normal BMI
18.5 to 24.9
obese bmi?
overweight bmi?
underweight bmi?
BMI < 18.5: Underweight range.
BMI ≥ 25 to 29.9: Overweight range.
BMI ≥ 30: Obese range.
Classes of obestiy
Class 1: BMI of 30 to < 35.
Class 2: BMI of 35 to < 40.
Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity
Name a few anthropometric measurements
height, weight, BMI, abdominal circumference, waist to hip ratio, mid upper arm circumference
abdominal circumference procedure steps
- Stand in front of the patient and palpate the right hip (right ilium) at the top of the right iliac crest to identify the greatest diameter of the abdomen.
- Place the tape measure around the bare abdomen at the level of the iliac crest, which should also be close to the level of the navel (Fig. 4-5).
- Pull the tape measure snugly around the abdomen.
- Take the measurement after the patient breathes normally out
(end of expiration). - Document the measurement.
normal and abnormal abdominal circumference for males and females
Normal is
Males: 40 inches or less
Females 35 inches or less
danger of abdominal fat?
CVD risk factor in adults because it indicates fat deposition on the organs (visceral fat)
Waist to hip ratio procedure steps
- Place tape measure around the narrowest area of the waist between the hips and the 11th rib (Fig. 4-6).
- Take measurement after a normal breath at the end of expiration.
- Record the measurement in inches or centimeters.
- Place the tape measure around the widest point of the hips (Fig.
4-6). - Record the measurement in inches or centimeters.
- Calculate the waist-to-hip measurement by dividing the waist
measurement by the hip measurement.
waist is over hip
also measures central distribution of fat
this goes one step further than abdominal circumference. it gets the ratio to the hip as well.
normal and abnormal findings for waist to hip ratio
NORMAL FINDINGS
Men: Waist ≤ 40 inches (102 cm), WHR ≤ 0.95. cant be more than this
Women: Waist ≤ 35 inches (88 cm), WHR ≤ 0.80. cant be more than this
whats better, pear shape, or apple shape?
pear. pear indicates gluteal femoral obesity.
apple indicates abdominal obesity. more indicative of CVD risk
Mid upper arm circumference procedure
- Place the patient in an upright sitting or standing position.
If the patient is unable to sit or stand, the MUAC may be
taken in the laying position. - Remove clothing from the nondominant arm.
- Ask the patient to bend the nondominant arm.
- Using the measuring tape, measure from the top of the shoulder
(acromion process) to the tip of the elbow (olecranon process)
(Fig. 4-9A). - Identify the mid-point of measurement and mark the arm at this
point. - Ask the patient to allow his or her arm to hang by his or her side.
Measure the arm at the mid-point mark making sure the tape
measure is snug but not tight (Fig. 4-9B). - Document the measurement in centimeters (cm).
What is the point of measuring arm circumference and what are normal findings
its an alternative to other measurements if the patient is too immobile or ill. Its used to measure skeletal muscle mass and 50% of protein in the body.
- 50 percent of the protein stores are in the muscle tissue.
*indicator of nutritional status
*can be taken laying down
Can the patient still eat food that their culture likes
yes
try to tailor the diet around it
Myplate vs Healthy eating plate
healthy eating plate was dev. by harvord school of public health. expands on myplate.
myplate was from USDA (US dept of agriculte)
proportion of weight due to water?
60%
A higher specific gravity indicates…
….more concentrated urine…
and the body is holding onto water so its thirsty.
Which electrolytes are imbalanced when someone is dehydrated? and lab values
BUN elevated
Na, Cl, K abnormal
CBC
hematocrit elevated
One liter is how many kg? How many lbs?
1 L = 1 kg
1 L = 2.2 lbs
1 kg = 2.2 lbs
A
Symptoms of dehydration
- Dry mouth and mucous membranes Irritability or confusion (brain needs water)
- Headache
- Dizziness (not enough blood circulation to reach brain)
- Decreased urine output
- Darker urine color
- ** Fever** (body can’t cool down)
Besides the obvious patient education, what about exercise?
- Strength training: Do strength training exercises for all major muscle groups at least two times a week.
- Aerobic activity: Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. The guidelines suggest that you spread out this exercise during the course of a week.
