Nutrition Flashcards by Taryn Douglas

Calories needed to maintain weight in sedentary hospitalized patient

30-35 kcal/kg

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

35-40 kcal/kg

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Specific populations that are at risk for malnutrition (6)

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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What populations are at risk for obesity

Minorities

76% African Americans
80% Mexican Americans are obese

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Definition of obesity

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

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

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Acronym for screening older adults nutritional status

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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Example of drug classes that affect nutritional status (8)

antibiotics
anticonvulsants
hypolipidemics
cytotoxic agents
laxatives
antituberculotics
anticoagulants
diuretics

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tetracycline effect on nutritional status

calcium, magnesium, iron, vitamin B12

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neomycin/kanamycin effect on nutritional status

fat-soluble vitamins, B12

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sulfasalazine effect on nutritional status

folate

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phenobarbital, phenytoin effect on nutritional status

calcium, vitamin D, folate, niacin

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cholestryamine, colestipol effect on nutritional status

fat and fat-soluble vitamins

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methotrexate effect on nutritional status

folate

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mineral oil effect on nutritional status

water, electrolytes, fat and fat-soluble vitamines

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isoniazid effect on nutritional status

pyridoxine (B6), niacin (B3)

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warfarin effect on nutritional status

vitamin K

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thiazide, furosemide effect on nutritional status

potassium, magnesium, calcium, zinc

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lithium, amiodarone effect on nutritional status

iodine

What is considered significant weight loss?

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

Common issues leading to weight loss (4)

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

Causes of decreased caloric intake

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

causes of malabsorption and maldigestion

diarrhea
fatty malodorous stools
change in bowel habits

causes of impaired metabolism or increased caloric requirements

fever
pregnancy
chronic disease

causes of increased losses or excretion

- draining fistula or open wounds - diarrhea - excessive vomiting

3 physical exam findings that provide clues to nutritional status

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)

PEx findings with protein deficiency

- dry, scaly skin with cellophane appearance - interosseous muscle atrophy - poor hand grip/leg strength - parotid enlargement

PEx findings with Zinc deficiency

flaking dermatitis

PEx findings with Vitamin A deficiency

- follicular hyperkeratosis - night blindness - xerosis, keratomalacia, bitot spots

PEx findings with niacin deficiency

- pigmentation changes - angular stomatitis - cheilosis - glossitis

PEx findings with vitamin C deficiency

- petechiae - purpura - bleeding gums - corkscrew hairs

PEx findings with vitamin K deficiency

- purpura

PEx findings with iron deficiency

- skin pallor - conjunctival pallor - glossitis - spooning nails

PEx findings with folate deficiency

- skin pallor - conjunctival pallor - glossitis

PEx findings with riboflavin deficiency

- angular stomatitis - cheilosis - glossitis - bleeding gums

PEx findings with pyridoxine deficiency

- angular stomatitis | - cheilosis

PEx findings with protein/calorie/vitamin D deficiency

- interosseous muscle atrophy - squaring off of shoulders - poor hand grip and leg strength

PEx findings with calcium/magnesium deficiency

tetany

PEx findings with iodine deficiency

goiter

What physical exam maneuvers can provide information about nutritional status?

1) appearance | 2) muscle strength

What labs are helpful in identifying nutritional deficiencies?

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

Scurvy summary

Vitamin C deficiency. the "four H's" - hemorrhagic signs - hyperkeratosis of hair follicles - hypochondriasis - hematologic abnormalities

Pellegra summary

Niacin deficiency (vitamin B3). The "three Ds" - dermatitis (photosensitivity) - diarrhea - dementia

Rickets summary

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

B12 deficiency summary

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