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PCM III > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Calories needed to maintain weight in sedentary hospitalized patient

A

30-35 kcal/kg

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2
Q

Calories needed to maintain weight in acutely or severely ill patients (trauma/burns/etc)

A

35-40 kcal/kg

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3
Q

Specific populations that are at risk for malnutrition (6)

A

1) older persons who live alone
2) chronically ill patients
3) adolescents who eat and diet erratically
4) cancer patients undergoing chemo or radiation
5) alcoholics
6) homelessness, low SES

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4
Q

What populations are at risk for obesity

A

Minorities

  • 76% African Americans
  • 80% Mexican Americans are obese
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5
Q

Definition of obesity

A
  • BMI >30
  • waist circumference >40” in males and >35” women
  • circumference is measured at uppermost lateral border of iliac crest during normal (minimal) respiration
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6
Q

Nutritional deficits with weight loss are common. What is one exception to this?

A

anemia secondary to strict vegetarian or vegan diets may have b12 deficiency (fortification of folate in food is protective)

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7
Q

Acronym for screening older adults nutritional status

A 
D- Disease
E- Eating poorly
T- tooth loss or mouth pain 
E- economic hardship
R- reduced social contact
M- multiple medications
I- involuntary weight loss
N- need for assistance with self-care
E- elderly years: > 80 y/o = elderly
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8
Q

Example of drug classes that affect nutritional status (8)

A
  • antibiotics
  • anticonvulsants
  • hypolipidemics
  • cytotoxic agents
  • laxatives
  • antituberculotics
  • anticoagulants
  • diuretics
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9
Q

tetracycline effect on nutritional status

A

calcium, magnesium, iron, vitamin B12

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10
Q

neomycin/kanamycin effect on nutritional status

A

fat-soluble vitamins, B12

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11
Q

sulfasalazine effect on nutritional status

A

folate

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12
Q

phenobarbital, phenytoin effect on nutritional status

A

calcium, vitamin D, folate, niacin

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13
Q

cholestryamine, colestipol effect on nutritional status

A

fat and fat-soluble vitamins

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14
Q

methotrexate effect on nutritional status

A

folate

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15
Q

mineral oil effect on nutritional status

A

water, electrolytes, fat and fat-soluble vitamines

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16
Q

isoniazid effect on nutritional status

A

pyridoxine (B6), niacin (B3)

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17
Q

warfarin effect on nutritional status

A

vitamin K

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18
Q

thiazide, furosemide effect on nutritional status

A

potassium, magnesium, calcium, zinc

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19
Q

lithium, amiodarone effect on nutritional status

A

iodine

20
Q

What is considered significant weight loss?

A

unintentional weight loss of 5% over 6 months or 10% over one year

21
Q

Common issues leading to weight loss (4)

A

1) decreased caloric intake
2) malabsorption and maldigestion
3) impaired metabolism or increased requirements
4) increased losses or excretion

22
Q

Causes of decreased caloric intake

A
  • anorexia
  • early satiety
  • difficulty chewing or swallowing
  • inability to feed self or obtain food
  • social isolation or depression
23
Q

causes of malabsorption and maldigestion

A
  • diarrhea
  • fatty malodorous stools
  • change in bowel habits
24
Q

causes of impaired metabolism or increased caloric requirements

A
  • fever
  • pregnancy
  • chronic disease
25
Q

causes of increased losses or excretion

A
  • draining fistula or open wounds
  • diarrhea
  • excessive vomiting
26
Q

3 physical exam findings that provide clues to nutritional status

A

1) vital signs (height, weight, BMI)
2) tricep skinfold thickness (assesses subq fat)
3) rapid weight gain/loss (gain likely fluid retention, loss likely tissue loss)

27
Q

PEx findings with protein deficiency

A
  • dry, scaly skin with cellophane appearance
  • interosseous muscle atrophy
  • poor hand grip/leg strength
  • parotid enlargement
28
Q

PEx findings with Zinc deficiency

A

flaking dermatitis

29
Q

PEx findings with Vitamin A deficiency

A
  • follicular hyperkeratosis
  • night blindness
  • xerosis, keratomalacia, bitot spots
30
Q

PEx findings with niacin deficiency

A
  • pigmentation changes
  • angular stomatitis
  • cheilosis
  • glossitis
31
Q

PEx findings with vitamin C deficiency

A
  • petechiae
  • purpura
  • bleeding gums
  • corkscrew hairs
32
Q

PEx findings with vitamin K deficiency

A
  • purpura
33
Q

PEx findings with iron deficiency

A
  • skin pallor
  • conjunctival pallor
  • glossitis
  • spooning nails
34
Q

PEx findings with folate deficiency

A
  • skin pallor
  • conjunctival pallor
  • glossitis
35
Q

PEx findings with riboflavin deficiency

A
  • angular stomatitis
  • cheilosis
  • glossitis
  • bleeding gums
36
Q

PEx findings with pyridoxine deficiency

A
  • angular stomatitis

- cheilosis

37
Q

PEx findings with protein/calorie/vitamin D deficiency

A
  • interosseous muscle atrophy
  • squaring off of shoulders
  • poor hand grip and leg strength
38
Q

PEx findings with calcium/magnesium deficiency

A

tetany

39
Q

PEx findings with iodine deficiency

A

goiter

40
Q

What physical exam maneuvers can provide information about nutritional status?

A

1) appearance

2) muscle strength

41
Q

What labs are helpful in identifying nutritional deficiencies?

A

1) CBC (iron, B12, folate)
2) TSH (iodine)
3) total protein, albumin (protein calorie malnutrition)

42
Q

Scurvy summary

A

Vitamin C deficiency. the “four H’s”

  • hemorrhagic signs
  • hyperkeratosis of hair follicles
  • hypochondriasis
  • hematologic abnormalities
43
Q

Pellegra summary

A

Niacin deficiency (vitamin B3). The “three Ds”

  • dermatitis (photosensitivity)
  • diarrhea
  • dementia
44
Q

Rickets summary

A

Vitamin D deficiency. Rickets is result of deficient mineralization of osteoid matrix before closure of the epiphyseal plate causing softening and weakening of bones in infants and children

45
Q

B12 deficiency summary

A
  • glossitis: bright, red, sore, atrophic tongue
  • hyperpigmentation: on exposed areas (face/hands) and palmar/flexor creases
  • canities: premature gray hair
  • megaloblastic anemia
  • neuro findings

PCM III (3 decks)

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