Nutrition Flashcards
What are some possible causes of malnutrition? (7)
Decreased appetite, GI problems, difficulty swallowing/chewing, lack of knowledge, financial status, impaired mobility, or other health problems
What are some parts of nutritional assessment?
Pt. medical hx and sx hx, overall nutrition status, IBW, hydration status, nutritional deficits, route of intake, unintentional weight loss, eating patterns, social factors, financial factors
IBW is one nutritional measure. What is considered a red flag? What loss is considered significant?
- loss of >5% over 4 weeks is considered significant
- unintentional weight loss is always a red flag
What has weight loss to below IBW been linked to?
impaired immune function, weakness, susceptibility to infection, death
What does malnutrition look like?
NOT JUST SKINNY PEOPLE! serum albumin 15%
What is the significance of losing 1g/dL of albumin?
3x increase in the odds of developing a pressure ulcer
What is the half life for albumin?
20 days
What can albumin levels be used to show, and what ranges indicate normal, mild depletion, moderate depletion, and severe depletion?
Albumin reflects prolonged protein depletion, and increases slowing with good referring. Normal= greater than 3.5g/100ml Mild depletion= 2.8-3.4 Moderate depletion= 2.1-2.7 Severe depletion= less than 2.1
What is the half life of pre albumin?
48 hours
What is prealbumin sensitive to, and what can cause it to be elevated?
- Sensitive to acute deprivation and protein deficiency (responds quickly to refeeding)
- May be elevated in use of corticosteroids or renal disease
What values represent normal, mild, moderate, and severe depletion of prealbumin levels?
normal= 16-30 mg/100ml
mild depletion= 10-15
moderate depletion= 5-9
severe depletion= less than 5
Lymphocytes fight infection, and protein calorie malnutrition reduces the number of WBCs. What is the formula for total lymphocyte count?
TLC= WBC x %lymphocytes
What TLC values represent standard value, mild, moderate, and severe depletion?
standard= 2500mm3
mild depletion= <800
Hemoglobin is responsible for oxygen transport. What does a value <12 mean? What importance does it have to wound management?
<12= anemia
important for debridement
What represents “severe” percentages for IBW and weight loss?
IBW 25%
What do you need to know in order to assess caloric needs?
activity level, injury factors, surgery, infection, degree of stress, chronic disease
Should you put an obese patient with a wound on a calorie-restricted diet? Why or why not?
NO! That would cause the patient to go into starvation mode and doesn’t provide the wound with the nutrients needed.
What are the components of a good wound healing diet?
protein (low fat meats and proteins), carbohydrates for energy, fluids to replenish losses via exudate and for skin integrity and turgor, vitamins
What vitamins are essential for a wound care diet?
multivitamin, vitamin C, vitamin A, vitamin E
How much vitamin C do you need?
500 mg/day (smokers need more)
How much vitamin A do you need in a day?
1600-2000 mg/day needed for immune-compromised patients to facilitate macrophage action
How much vitamin E do you need?
400-800 iu per day
What is the function of vit A and what may cause a deficiency?
function- collagen synthesis
deficiency- corticosteroid use
What is the function of vit C and what may happen with a deficiency?
function- collagen synthesis, membrane integrity, immune system support
deficiency- delayed healing, capillary fragility
What is the function of vit E and what may happen with a deficiency?
function- fat metabolism, collagen synthesis, membrane stabilization
deficiency- delayed healing, tissue fragility
What vitamin should you watch closely if the patient is on coumadin? What is present with a deficit?
vit K, petechiae present when deficient
What are some minerals necessary in your diet?
calcium, magnesium, iron, zinc, copper, manganese
What are important values of calcium and what is it important for?
800-1500 mg/day- bone health and protein synthesis
What are important values of magnesium and what is it important for?
320-420 mg/day- muscle and nerve function, steady heart rhythm, immune function, controls blood sugars and BP, protein synthesis, energy
What are important values of iron and what is it important for?
8mg/day- regulation of cell growth and differentiation, immune function, energy, oxygen delivery
What are important values of zinc and what is it important for?
60mg/day- needed for protein and collagen synthesis
What are important values of copper and what is it important for?
1-3 mg/day- needed for collagen production and cross-linking
What are important values of manganese and what is it important for?
5-11 mg/day- needed for collagen and ground substance
What are good food sources of protein?
dairy, meat, meat substitutes, nuts and seeds
What are good food sources of vit C?
fruits and vegetables
What are good food sources of zinc?
beef, liver and crab, smaller amounts in sunflower seeds, almonds, peanut butter, black-eyed peas, whole grain products, eggs and milk
What is arginine?
an essential amino acid needed for collagen synthesis and increases the number of total lymphocytes
What can be used as meal supplements?
Ensure, Carnation Instant Breakfast
What can be used as appetite stimulants?
Megace oral suspension, Marinol
What anabolic steroids are used as medical interventions?
Testosterone, Oxandrolone
What are some helpful interventions to be aware of to help patients get the nutrition they need?
aide for assistance with eating, financial aid, meals on wheels, adaptive devices, education for patient and family/caregiver, constant reassessment
What are some elements of a nutritional plan of care?
review patient’s dietary intake, consult MD if CHF or renal patient, educate on wound healing diet, educate on vitamin supplements, assess need for nutritional support or supplements, consider dietary consult if no healing
