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Medicine I > Nutrition Requirements and Assessment > Flashcards

Nutrition Requirements and Assessment Flashcards

1
Q

What is the nutrition screening and at which point in the hospital admission is it performed?

A

A simple & rapid first-line tool to detect px at risk of malnutrition

Within first 24-48 hrs of admission

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2
Q

What is the nutrition care process?

A
  1. Nutrition assessment
  2. Nutrition diagnosis
  3. Nutrition intervention
  4. Nutrition monitoring and evaluation
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3
Q

What are the different processes of nutritional assessment?

A
  1. Screening for malnutrition
  2. Assessing the diet, establish presence/absence of malnutrition + causes
  3. Planning & implementing
  4. Reassessing intakes
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4
Q

What are the sources of nutrition assessment data?

A

Px interview
Direct observations and measurements
Medical record review
Referring healthcare provuder

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5
Q

What are the important information to elicit in nutritional assessment?

A
  1. Dietary intake
  2. Anthropometric measurements
  3. Biochemical measurements of blood & urine
  4. Clinical examination
  5. Health hx elicitation
  6. Functional status evaluation
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6
Q

What condition is referred to deficiencies, excesses, or imbalances in a person’s intake of energy & or nutrients?

A

Malnutrition

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7
Q

What are the leading causes of malnutrition in developing countries?

A

Famine & starvation

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8
Q

What is the double burden of malnutrition?

A

Coexistence of undernutrition along w/ overweight & obesity and diet-related non-communicable diseases within individuals, households and populations throughout life.

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9
Q

What are the diff adverse outcomes assoc w/ malnutrition?

A

Poor wound healing
Compromised immune status
Impaired organ function
INC length of hospital stay
INC mortality

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10
Q

What is the GLIm Dx Scheme for screening, assessment, Dx, & grading of malnutrition?

A
  1. Risk screening
    - At risk for malnutrition: use validated screening tools
  2. Diagnostic Assessment
    - Assessment criteria:
    -> Phenotypic: weight loss, low BMI, Reduced muscle mass
    -> Etiologic: reduced food intake/assimilation, Disease burden/inflammatory condition
  3. Diagnosis
    - Meets criteria for malnutrition diagnosis: required at least 1 PHENOTYPIC CRITERION & 1 ETIOLOGIC CRITERION
  4. Severity Grading
    - Determine the severity of malnutrition: Severity determined based on the phenotypic criterion
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11
Q

What is the phenotypic criteria accdg to the GLIM Diagnostic scheme?

A

Weight loss (%)
>5% within past 6 months or
>10% beyond 6 months

Low BMI (kg/m2) (Asia)
<20 if <70yrs or <18.5 if <70 yrs or
<22 if >70 yrs <20 if >70 yrs

Reduced Muscle Mass
Reduced by validated body composition measuring techniques

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12
Q

What is the Etiologic criteria accdg to the GLIM Diagnostic scheme?

A
  1. Reduced Food Intake or Assimilation
    <50% of ER > 1 week, or any reduction for >2 wks, or any chronic GI condition that aversely inspects food assimilation or absorption
  2. Inflammation
    Acute diseases/injury
    Chronic disease-related
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13
Q

What is stage 2/severe malnutrition of phenotypic criteria accdg to the GLIM Diagnostic scheme?

A

Weight loss
>10% within the past 6 mons OR
>20% beyond 6 months

Low BMI
<18.5 if <70 yrs
<20 if >70 yrs

Reduced muscle mass
Severe deficit (per validated assessment methods)

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14
Q

How do you measure reduced muscle mass?

A
  1. Dual-energy absorptiometry = check appendicular lean mass index
  2. Body composition methods = Bioelectrical Impedance Analysis, Computed Tomography, MRI
  3. PE or std anthropometric measures = Mid-arm muscle circumference, Calf circumference
  4. Skin fold thickness & circumferences
  5. Hand-grip strength = functional assessment
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15
Q

What are the different nutritional disorders & nutrition-related conditions?

A

Malnutrition/Undernutrition
Sarcopenia and Frailty
Overweight and Obesity
Micronutrient abnormalities
Re-feeding syndrome

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16
Q

What are the different malnutrition syndromes?

A

Starvation-associated malnutrition
Chronic disease-associated malnutrition
Acute disease or injury associated malnutrition

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17
Q

What is a comprehensive nutrition assessment that assess nutritional status based on features of the bhx and PE?

A

Subjective global assessment
- includes metabolic stress of the disease component

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18
Q

What are the diff body composition considered in subjective global assessment?

A

Muscle mass
Subcutaneous fat
ECF volume
Functional status & strength & mobility

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19
Q

What is the overall SGA?

A

SGA A = well-nourished
SGA B = moderately malnourished
SGA C = severely malnourished

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20
Q

What should be asked about the body weight in nutritional assessment hx & PE?

A

Usual weight, peak weight, & deliberate weight loss

Identify significant weight loss
- 4.5kg (10lb) weight loss over 6 months
- weight loss of >10% of usual body weight
- prognostic of clinical outcomes

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21
Q

What is the formula for % weight change?

A

% weight change = [(previous weight - current weight)/(previous weight)] x 100

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22
Q

What should be taken note for weight loss?

A

Non-volitional weight loss
10% wt loss over 6 mons
30% wt loss over 6 mons = severe, life-threatening

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23
Q

What are the diff diseases w/ severe acute inflammatory response?

A

Critical illness, major infection/sepsis, ARDS, severe burns, systemic inflammatory response syndrome, major abdominal surgery, multi trauma, closed head injury

24
Q

What diseases have mild to moderate chronic inflammatory response?

A

CVS, CHF, CF, Neuromuscular dis, solid tumors, DM, etc

25
What are the diff indications or approach to BMI?
<18.5 = screen for malnutrition <15 = INC mortality >25 = INC body fat <20 - DEC MM & Body fat 11-13 = incompatible w/ life 17 = Protein energy malnutrition
26
What is the normal BMI from WHO & Asia-Pacific?
WHO: 18.5-24.9 Asia-Pacific: 18.5-22.9
27
How do you measure height of a frail olde rperson?
Measuring knee height using a caliper device
28
What is the formula for estimating height from knee height?
Female: Ht in cm = 84.88 - (0.24 x age) + (1.83 x knee ht) Male: Ht in cm = 64.19 - (0.04 x age) + (2.02 x knee ht)
29
What are 2 other methods to estimate a px's height?
Ulna length - measure betw the point of the elbow (olecranon process) and the midpoint of the prominent bone of the write (styloid process) -> L side Demispan (DABEST) - measure distance from the middle of the sternal notch to the tip of the middle finger (L arm)
30
What is the formula for estimating ht from demispan?
Female Ht in cm = (1.35 x demispan (cm)) + 60.1 Male Ht in cm = (1.40 demispan (cm)) + 57.8
31
What are the 8 PE seen to assess nutritional disorders?
Temporal muscle wasting Subcutaneous fat loss Muscle wasting @ clavicular area Mid-upper arm circumference Skinfold thickness Mid-arm muscle circumference Waist & hip circumference Calf circumference
32
How do you measure the mid-upper arm circumference?
1. bend the L arm 2. Find the mark with a pen the acromion process & olecranon process 3. mark the midpoint betw these 2 marks 4. with the arm hanging straight down, wrap a tape measure around the midpoint 5. measure the nearest 1cm
33
What are the major determinants of mid-upper circumference?
Muscle & subcutaneous fat
34
What are the 4 sites used to measure skinfold thickness?
1. Biceps skinfold - front side of the middle upper arm 2. Suprailiac skinfold - above the upper bone of the hip 3. Subscapular skinfold - under the lowest point of the shoulder blade 4. Triceps skinfold - back-side of the middle upper arm
35
How many times should skinfold thickness be measure?
3 times
36
What is the formula of the mid-arm muscle circumference?
MAMC (cm) = MUAC (cm) - [3.14 x TSF (cm)]
37
What are the std adult values of mid-arm muscle circumference?
Triceps skinfold in mm Male: 12.5 Female: 16.5 MUAC (cm) M: 29.3 F: 28.5 MAMC (cm) M: 25.3 F: 23.2
38
What is used to measure risk for meatbolic complications? What is the measurement site?
Waist & Hip circumference Site: circumference around the hips and butt - highest pt of iliac crest
39
What are the WHO cut-off points & risk of metabolic complications?
Waist circumference M: >94cm F: >80cm Increased risk of metabolic complications Waist circumference M: >102 cm F >88 cm Substantial INC of metabolic complications Waist-hip ratio M: >0.90cm F: 0.85cm Substantial increased risk of metab complications
40
What are the cut-off points of WHC of Europoids, South Asians, Chinese & Japanese?
Europoids M: >94cm F: >80cm SA, Ch, Japs M: >90cm F: 80cm
41
How do you measure calf circumference? What popu is this used commonly?
To measure the ht from the heel up to below the knee To get the widest point to measure calf circumference
42
What is used to measure weakness/loss of strength?
Hand grip dynamometer - used to measure hand grip strength
43
What condition is indicated if there is lower extremity deficiency?
Thiamine deficiency
44
What is the grading of pitting edema?
+1 = <2mm; slightly pitting; disappears rapidly +2 = 2-4mm, somewhat deeper pit; disappears after 15 secs +3 = 4-6mm, pit is noticeably deep; may last for >30sec +4 = 6-8mm, v deep pit; >60 sec rebound
45
What are the diff hair findings & its corresponding nutrient deficiency?
Hair loss = CHON, Vit B12, Folate Brittle hair = Folate Color change = Zinc Dry hair = Vit A&E Easy pluckability = CHON, Biotin, Zinc Coiled, corkscrew = Vit A&C
46
What are the clin manifestation of Biotin deficiency?
Dermatitis & Alopecia
47
What are the diff skin findings & its nutrient deficient?
Desquamation = Riboflavin Petechiae = Vit A & C Perifollicular hemorrhage = Vit C Ecchymosis = Vit C & K Xerosis, Bran-like desquamation = Essential FA Pigmentation, Cracking, Crusting = Niacin Acneiform lesions, Follicular keratosis, Xerosis = Vit A Acro-orificial dermatitis, Erythematous, Vesiculobullous, and Pustular = Zinc
48
What are the ocular findings and its corresponding nutrient deficiencies?
Bitot's spots, Xerosis, Difficulties with night vision/Night blindness = Vit A Angular palpebritis = Riboflavin
49
What is Bitot's sports?
white, foamy area of keratinizing squamous metaplasia of bulbar conjunctiva, seen in vit A def
50
What are diff perioral findings and nutrient deficiencies?
Angular stomatitis = B complex, Iron, Protein Glossitis = Niacin, Folate, Vit B12 Magenta tongue = Riboflavin Bleeding gums, Gingivitis, Tooth loss = Vit C Riboflavin def = Cheilosis, Angular stomatitis, Glossitis, Seborrheic dermatitis Scurvy = Vit C def, impaired wound healing
51
What are the extremity findings and its corresponding nutrient deficiencies?
Arthralgia = B complex, Iron, & CHON Calf pain = Thiamine
52
What are the MSE findings and its corresponding nutrient deficiencies?
Opthalmoplegia & foot drop = Thiamine Paresthesia = Thiamine, Vit B12, Biotin Depressed vibratory & position senses = Vit B12 Bleeding gums, gingivitis, tooth loss = Vit C Anxiety, Depression & Hallucinations = Niacin Memory disturbance = Vit B12 Hyporeflexia, loss of lower extremity DTRs = Thiamine, Vit B12 Wernicke-Korsakoff syndrome = Severe thiamine def
53
What are the different thiamine deficiency?
Non-specific symptoms: Anorexia, Weight loss, Mental changes, Muscle weakness Severe def: Wet beriberi = Cardiac failure and edema Dry beriberi = Neurological changes & muscle weakness Wenicke-Korsakoff syndrome w/ delirium = Ophthalmoplegia including Nutrition coma & possible death
54
What are the diff functional assessment?
Gait Chair stands Stair steps Balance Neurological status, coordination, and strength Time gait, chair stands and stair
55
What is SOAP?
Subjective Objective Assessment Plan

Medicine I (8 decks)

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