Nutrition Assessment Overview Flashcards
What compromises the reliability of urinary urea nitrogen to calculate nitrogen balance
creatinine clearance <50mL/min
What micronutrient has been shown to decrease plasma homocysteine concentrations
folic acid
hyperhomocysteinemia concentrations has been associated with an increased risk of
atherosclerosis
which three micronutrients can be supplemented to decrease homocysteine levels in plasma to decrease the risk of atherosclerosis
folic acid, vitamin B12 and vitamin B6
what is the most appropriate fluid requirement for a healthy 78 year old adults
25mL/kg/day
what is the recommended fluid requirement for healthy adults between the ages of 18-55
35mL/kg/day
what is the recommended fluid requirement for adults between the ages of 55 and 75 years old
30mL/kg/day
what is the recommended fluid requirement for adults with fluid restriction such as CHF
25mL/kg/day
What enzyme initiates the digestive process of carbohydrates in the mouth
salivary amylase
Lipase is an enzyme released by the pancreas that helps the digestion of
fat
Lactase and Maltase are enzymes located in the ______ of the small intestine to aid in intraluminal carbohydrate digestion
brush border
Iron is primarily absorbed in the __________ and ________ in the _______ state. Gastric ____ is very important in maintaining dietary iron in the _____ state
duodenum and jejunum
ferrous
acid
ferrous
What amino acid is most crucial in small intestine structure and function
glutamine
In persons with phenylketonuria (PKU), tyrosine becomes an essential amino acid due to a deficiency of
the phenylalanine hydroxylase enzyme
Phenylalanine Hydroxylase catalyzes the hydroxylation of phenylalanine to _______, so phenylalanine levels become _____ and _____ levels are decreased
tyrosine
elevated
tyrosine
Conditionally essential amino acids are synthesized from other amino acids under normal conditions but require increased needs from dietary sources during ________. For example, arginine becomes conditionally essential for _______ and _____ during trauma
stress
wound healing
glutamine
glutamine becomes conditionally essential during
trauma
arginine becomes conditionally essential during
wound healing
What are the conditionally essential amino acids
arginine, cysteine, glutamine, glycerin, proline, tyrosine
An NPO post operative patient has been on 2 in 1 PN for 3 weeks. He develops hair loss, diffuse scaly dermatitis, anemia and thrombocytopenia. What is the probable cause
he has not been getting ILE for 3 weeks
Provision of fat free PN for ____ weeks has resulted in essential fatty acid deficiency
3 weeks
Essential Fatty Acid deficiency usually results after ___ weeks of fat free PN, although signs and symptoms of deficiency can be as early as ___ to ____ days
10-20 days
what are the signs and symptoms of EFAD
alopecia, scaly dermatitis, impaired wound healing, anemia, thrombocytopenia
Provide __ to ___% total calories from ____ or ____ ILE to prevent EFAD
4-10% total calories
soy of safflower oil ILE
Which IV fluid most closely resembles jejunal and ileal electrolyte content
lactated ringers
Fluids and electrolytes of the jejunum contains ____ mEq of sodium, ___ mEq of potassium, ___ mEq of chloride and ____ mEq of bicarb
95-120 mEq of sodium
5-15 mEq of potassium
80-130 mEq of chloride
10-20 mEq of bicarb
Fluids and electrolytes of the ileum contains ____ mEq of sodium, ___mEq of potassium, ___ mEq of chloride and ___ mEq of bicarb
110-130 mEq of sodium
10-20 mEq of potassium
90-110 mEq of chloride
20-30 mEq of bicarb
Lactated Ringers IV solution contains ___ mEq/L of sodium, ___ mEq/L of potassium ____ mEq/L of chloride, ____ mEq/L of lactate and ___ mEq/L of calcium
130 mEq/L of sodium 4 mEq/L of potassium 109 mEq of chloride 28 mEq/L of lactate 2.7 mEq/L of calcium
Normal saline contains ___ mEq/L of sodium, ____mEq/L of chloride
154 mEq/L sodium
154 mEq/L chloride
Half Normal saline contains ___ mEq/L of sodium and ____ mEq/L of chloride
77 mEq/L sodium
77 mEq/L chloride
Dextrose and half normal saline contains ____ g/L of glucose, ___ mEq/L of sodium and ____ mEq/L of chloride
50 g/L dextrose
77 mEq/L sodium
77 mEq/L chloride
What are the clinical symptoms of inappropriate diuretic hormone (SIADH)
increased urinary sodium
hyponatremia
increased urinary osmolality
a disorder of sodium and water balance caused by inappropriate release of anti-diuretic hormone which causes increased total body water which causes dilution hyponatremia
SIADH
In SIADH, increased sodium and osmolality of the urine is due to
excessive water retention/re-absorption
In SIADH to compensate for the expansion of the extracellular fluid, aldosterone secretion is inhibited to maintain
euvolemia
A 45 year old patient with chronic corticosteroid use has suspected vitamin A deficiency. Supplementation of vitamin A (3,000 to 5,000 IU) should be given at a max of ____ days
7 days
what are the main functions of vitamin A
wound healing, cell differentiation, and collagen synthesis
what is the typical dose for vitamin A supplementation
3,000 to 5,000 IU for 7 days
when should vitamin A be supplemented
to enhance wound healing with corticoid steroid therapy
Corticosteroid therapy has been shown to decrease vitamin ______
vitamin A
A patient with alcoholism is admitted with a small bowel obstruction and is started on PN. The PN provides 400 grams of dextrose, If after 3 days, the patient develops mental status changes, it is most likely due to a deficiency of
thiamine
alcohol related thiamine deficiency presents as
Wernicke’s Encephalopathy
Symptoms of Wernicke’s Encephalopathy are
mental status changes, confusion, nystagmus, gait ataxia
The glucose load in PN is associated with PN increases metabolic demand for ____ which is essential for glucose metabolism
thiamine
Lactic acidosis can be a result of which vitamin deficiency
thiamine
Thiamine is required for ____ metabolism. When Pyruvate is converted to acetyl CoA. If thiamine is not present, pyruvate will convert to production of _____ fermentation
glucose
lactic acid fermentation
In addition to aggressive refeeding, what else places patients at high risk for hypophosphatemia
DKA
Which patients are at the highest risk for hypophosphatemia
malnourished, DKA, chronic alcoholism, respiratory and metabolic acidosis, critical illness
Insulin is an anabolic hormone that drives potassium and phosphorous into the cells causing serum _____ of these electrolytes
depletion
in DKA, large amounts of ____ is lost in urine from the osmotic diuresis resulted from hyperglycemia
phosphorous
The risk of metastatic calcification in soft tissues begins to increase when the product of serum calcium and phosphorous exceeds
55 mEq
Hyperphoshpatemia can cause which issues
soft tissue and vascular calcification
hyperparathyroidism
renal osteodystorphy
Zinc deficiency is most commonly associated with
diarrhea
what are the functions of zinc
catalytic reactions
structural function
regulatory functions
When is additional zinc provision recommended
thermal injury (burns)
excessive GI loss from diarrhea
decubitus ulcers
high output fistulas
Copper toxicity is associated with ___ disease
liver
what are the signs of copper toxicity
severe nausea, diarrhea
Copper toxicity can cause
Wilson's disease Coma Hepatic Necrosis Liver Failure Renal Failure Death
80% of copper is excreted via
bile
a patient with liver disease should be monitored and supplemented or be
decreased or eliminated
Hemolysis increases copper
loss
Enteral zinc supplementation can compete with ____ for absorption
copper
Hepatic encephalopathy is most likely to be improved by which trace element
zinc
Liver disease can cause altered ____ metabolism leading to decreased serum ____ levels. ____ supplementation has been shown to help in hepatic encephalopathy
zinc
zinc
zinc
In hepatic encephalopathy zinc should be supplemented in doses of ____ mg/day for 3 months
150 mg per day
What is the function of aluminum in PN solutions
Aluminum has NO KNOWN BIOLOGICAL function
Aluminum is only present in PN as
a contaminant
What can result in an invalid indirect calorimetry measurement
air leak chest tube leak extracorperoal membrane oxygenation hemodialysis FiO2 >60% in mechanically ventilated patients/spontaneously breathing patients reliance on supplementation oxygen unable to cooperate claustrophobia anxiety
How should a critically ill patient’s energy delivery be modified in response to resting energy expenditure measured by indirect calorimetry
use the caloric target WITHOUT adding a stress or activity factor
in calculating energy delivery, should a stress or activity factor be added
no, it can result in overfeeding
A respiratory quotient of 0.87 most likely suggests
mixed substrate utilization
RQ measures CO2 _____ divided by O2 _____
CO2 produced
O2 consumed
An RQ 0.7 or less likely indicates and >1 likely indicates
hyperventilation , hypoventilation
An RQ of 0.71 indicates primarily ____ oxidation
fat
An RQ of 0.82 indicates primarily ____ oxidation
protein
An RQ of 0.85 indicates _____ oxidation
mixed substrate
An RQ of 1.0 indicates primarily ____ oxidation
carbohydrate
which predictive equation has demonstrated the greatest accuracy in estimating actual resting metabolic rate in healthy obese and non-obese adults
Mifflin St. Jeor
Cheilosis is a physical symptom associated with a deficiency of _____, which can include hyperemia, edema of the oral mucosa, angular stomatitis, or glossitis
riboflavin
Malnutrition is most common in which form of IBD due to its involvement in the small intestine where micronutrients are absorbed
Chron’s Disease
A patient with end stage liver disease with refractory ascites awaiting liver transplantation is on PN due to intolerance to tube feeding. Sodium is 123 mEq/L. In addition to fluid restriction, what changes to his PN prescription is most appropriate?
restrict sodium
give 1.5 g/kg/day of protein
What is the dietary recommendations for patients on ascites
fluid and sodium restriction 1-1.5 g/kg/day of protein with cirrhosis
_______ nutrition formula should be used with patients who have ascites from ESLF to avoid further sodium and fluid overload
concentrated
Arginine supplementation should be used most cautiously in patients with
septic shock
arginine increases the production of ______ which causes vasodilation. Providing arginine during septic shock would further exacerbate ______
nitrous oxide
hemodynamic instability
the normal length of the small intestine in adults is about
300-600 cm long
when the small bowel is less than _____ cm, to an end jejunostomy/ileostomy, PN and hydration will likely be needed
120 cm
The presence of an ileocecal valve and colon significantly improves _____ , ______ and _____ absorption. If the ileocecal valve is left intact, a patient may NOT need PN with as little as 60 cm left of the small bowel
fluid, electrolytes, and short chain fatty acids
What is the primary fuel of colonocytes
short chain fatty acids
the three primary short chain fatty acids are
butyrate, acetate and propionate
short chain fatty acids can provide up to ______ kcals in short bowel syndrome
1,000 kcals
Dietary fat is predominantly absorbed in what part of the GI tract
duodenum and proximal jejunum
Gastrectomy patients are at risk for a deficiency of which vitamin
B12
___ is the total or partial removal of the stomach
gastrectomy
the _____ cells of the stomach produce intrinsic factor
parietal cells
Intrinsic factor aids in the absorption of ___ in the small bowel
vitamin B12
When the stomach is resected, there is no longer adequate intrinsic factor to bind is B12 and may result in
deficiency
what areas of the GI tract has the the LEAST impact on nutrient absorption and intestinal adaptation following significant intestinal resection?
jejunum
resecting the proximal bowel (duodenum & upper jejunum) is usually _____ tolerated than ilelal resection
BETTER tolerated because the ileum is good at adaptation of absorption of nutrients
the jejunum _____ adapt well when the ileum is resected
doesn’t
preservation of the ____ is important as it slows intestinal transit allowing for better absorption of nutrients
ileocecal valve
The colon is critical for ___ and ____ absorption. patients without a colon are at increased risk for _____ but can salvage calories through _____________
water & nutrient absorption
dehydration
anaerobic bacterial fermentation of undigested carbohydrates into short chain fatty acids
During fasting, fuel oxidation shifts from carbs to mainly ____ oxidation
lipid
During fasting lipolysis will _____, glycogenesis will ____, gluconeogenesis and glucose oxidation will ______
Increase
decrease
decrease. The body increases lipid oxidation to provide the body with fatty acids for energy
how much fluid per day is required to maintain fluid balance in an average healthy adult
25-35mL/kg/day
Valproic acid has been shown to induce a deficiency of ______
carnitine
Valproic acid is a ____ drug and can cause a deficiency in carnitine
anti epileptic drug
Carnitine plays a role in fatty acid metabolism and is an essential cofactor in the elimination of ___ and ___ from the body
valproic acid and ammonia
carnitine supplementation should be considered for patients
in a coma, with elevated ammonia, have liver disease or with valproic acid medications >450mg/day
methotrexate acts by interfering with the normal intracellular metabolism of which of the following nutrients
folate
Methotrexate is a ____ drug and ______ analogue, so that it’s binding sites are commentative
chemotherapeutic drug
folate
Methotrexate competes with folate for absorption to catalyze the function of the enzyme dihydrofolate reductase, which converts dihydrofolate to tetrahydrofolate, a cofactor for the production of purine synthesis making up ______
DNA
what vitamin absorption is most likely to be impaired with chronic use of proton pump inhibitors
B12
