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Clinical Nutrition 2 > Nutritional Assessment - 1 > Flashcards

Nutritional Assessment - 1 Flashcards

1
Q

What is included in anthro?

A
  • weight
  • height
  • BMI and interpretation
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2
Q

When use adj. weight?

A

If >125% IBW or >27 kg/m2

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3
Q

What 3 weight changes should be reported?

A
  • % IBW and %UBW
  • % Weight change and direction
  • Significance of weight loss
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4
Q

What should anthro be interpreted alongside?

A

-Diet, disease state/management, biochemistry, clinical signs and symptoms

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5
Q

1-2% weight loss in 1 week =

A

Significant

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6
Q

> 2% weight loss in 1 week =

A

Severe

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7
Q

5% weight loss in one month =

A

Significant

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8
Q

> 5% weight loss in one month =

A

Severe

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9
Q

7.5% weight loss in three month =

A

Significant

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10
Q

> 7.5% weight loss in three months =

A

Severe

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11
Q

10% weight-loss in 6 months

A

Significant

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12
Q

> 10% weight-loss in 6 months

A

Severe

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13
Q

For adults with >65 years old ____ are critical in assessing the BMI

A

clinical

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14
Q

BMI<18.5

A

underweight

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15
Q

BMI 18.4-24.9 =

A

normal

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16
Q

BMI 25-29.9 =

A

Overweight

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17
Q

BMI 30-34.9 =

A

Obese Grade I

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18
Q

BMI 35-39.9 =

A

Obese Grade II

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19
Q

BMI >40 =

A

Extremely obese - Grade II

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20
Q

How can we calculate and ideal body weight range ?

A

-Use upper and lower end of health BMI (18.5 and 24.9

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21
Q

How can we calculated IBW?

A
  • Use ideal body weight range

- Use BMI midpoint of 21.7

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22
Q

When is adjusted body weight used?

A

When >125% of IBW

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23
Q

How do we incorporate amputations into our weight assessment?

A
  • Establish amount of amputations
  • Subtract the proportion from IBW
  • Continue with assessment
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24
Q

Amputation,hand?

A

0.7% of BW

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25
Q

Amputation, Lower arm and hand?

A

2.3% of BW

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26
Q

Amputation, entire arm?

A

5.0% of BW

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27
Q

Amputation, foot?

A

1.5% of BW

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28
Q

Amputation, lower leg and foot?

A

5.9% of BW

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29
Q

Amputation, entire leg?

A

16% of BW

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30
Q

A male weighs 72 kg, 180 cm tall and has a left leg amputation at the knee, what is his % IBW?

A

1) lower leg and foot = 5.9% of BW and use midpoint BMI
2) 100-5.9= 94.1%
3) 21.7 x 1.82 x 0.941 = IBW

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31
Q

Particularity about standing knee height?

A

Must be taken at 90 degree angle

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32
Q

Alternatives to standing height, adults?

A

Arm span, where measuring from tip of middle finger to middle finger OR measure from centre of sternum to tip of middle finger on RH x 2

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33
Q

Alternative to standing height, children?

A
  • Arm span

- Sitting height, at crown length

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34
Q

What is the gold standard of estimating energy needs?

A
  • Indirect calorimetry

- Measures O2 consumptions and C02 production to calculate energy expenditure over 24h

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35
Q

Harris-Benedict and MFSJ will measure weight in ___ and height in ____

A

kg

cm

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36
Q

HB, men?

A

13.75(w) + 5(ht) - 6.75 (age) + 66

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37
Q

HB, women?

A

9.56(w)+ 1.84 (ht) - 4.67 (age) + 655

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38
Q

MFSJ, men?

A

10(w) + 6.25 (ht) - 5 (age) + 5

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39
Q

MFSJ, women?

A

10 (wt) + 6.25 (ht) - 5(age) - 161

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40
Q

AF, confined to bed ?

A

1.0-1.2

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41
Q

AF, ambulatory with low activoty?

A

1.3

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42
Q

Average activity

A

1.5-1.75

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43
Q

Intense activity?

A

2.0

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44
Q

Which predictive equations are not recommended by AND for critically ill patient?

A
  • Swinamer

- Ireton-Jones

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45
Q

Which predictive equations are recommended by AND?

A

-Penn state

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46
Q

What does the Penn state equation include?

A
  • Mifflin SJ
  • Temperature
  • Ventilation support
  • Constant from regression equation
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47
Q

What’s important to consider about AF?

A

MUST rationalize use of one over another

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48
Q

What do sedatives cause in the ICU?

A

Sometimes will decrease their REE

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49
Q

What’s important to consider about weight loss?

A
  • Is it intentional?
  • When was the period of the most rapid weight-loss?
  • Interpret this
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50
Q

What may we do if we don’t know height?

A

May do volume feeds only, or use metabolic cart in ICU to assess peoples needs

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51
Q

Underweight rule of thumb?

A

35 kcal/kg of ABW

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52
Q

Normal weight rule of thumb?

A

30 kcal/kg of ABW

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53
Q

Overweight rule of thumb?

A

25 kcal/kg of ABW

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54
Q

Obese rule of thumb?

A

11-14 kcal/kg of ABW

22-25 kcal/kgof IBW

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55
Q

If the IBW is close to ABW, which weight do we use?

A

ABW

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56
Q

If underweight (<90% of IBW), what weight to we use?

A

1) Use ABW and add energy when ready to gain weight (ABW + 500 kcal/day)
2) Use IBW in equation to accommodate recovery

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57
Q

if overweight and >125% of IBW, what weight to use?

A

Adj. weight

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58
Q

Adj. weight =

A

[(ABW-IBW) x 0.25] + IBW

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59
Q

When is Adj. weight important for?

A

Proper fluid requirements, where LBM demands fluids

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60
Q

If overweight, and BMI <27-30, which weight to use?

A

ABW

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61
Q

If overweight, and BMI >30, which weight to use?

A
  • IBW

- Adjusted

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62
Q

Which E equations should ABW be used?

A

-MFSJ and Ireton Jones

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63
Q

Which E equations should HB be used?

A

-Adjusted

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64
Q

Protein, basic?

A

0.8-1.0

65
Q

Protein, Elderly, no stress

A

1..0-1.5

66
Q

Protein, Metabolic stress, mild

A

1.2-1.5

67
Q

Protein, metabolic stress, moderate

A

1.5-1.8

68
Q

Protein, metabolic stress, severe

A

1.7-2.0

69
Q

Protein, stroke

A

1.0-1.25

70
Q

Protein, burns

A

1.7-2.5

71
Q

Protein, abnormal protein losses (wounds, fistulas)

A

2.0-2.5

72
Q

Weight <125% IBW, fluid. req for 18-55 y/o?

A

35 ml/kg

73
Q

Weight <125% IBW, fluid re. for 56-75 y/o?

A

30 ml/kg

74
Q

Weight <125% IBW, fluid req. for >75 y/o?

A

25 ml/kg

75
Q

Weight <125% IBW, fluid req. for those with fluid restriction?

A

<25 ml/kg

76
Q

Fluid requirements when weight is >125% IBW AND in people with obesity?

A
  • Use Adj. body weight

- Avoid fluid overload, as fat is 25% metabolically demanding, and LBM demands water

77
Q

ECF consists of what?

A
  • Intravascular (plasma, serum)
  • Lymph
  • Interstitial
78
Q

ECF consists of ___ of TBW

A

1/3

79
Q

ICF consists of ___ of TBW

A

23

80
Q

What is normal within the context of biochemistry?

A

Obtained from 95% of health population sample

81
Q

4 example of what may impact labs

A
  • Age, sex, ethnicity, genetics
  • Adherence to diet
  • Fasted/fed
  • Exercise
82
Q

What is prolonged fasting?

A

fasting >24 hours

83
Q

Which lab values do exercise increase? (LAC)

A
  • Lactate dehydrogenase
  • AST/SGOT
  • Creatine kinase
84
Q

When someone is in shock, there is often an ____ of proteins

A

exacerbation

85
Q

What is mean by “normal is not always good” within the context of lab values?

A
  • Depends on the patient and diease context

- Diabetes, hypercholesterolemia

86
Q

What is the concept of critical differences?

A

Each lab value has a certain % (the critical difference). When this certain % is reached, whether through increase/decrease signals an abnormality. For example, CRP has to double for it to be considered abnormal, whereas an increase of 8% in albumin is considered abnormal

87
Q

Albumin is low at admission, and decreases after surgery in an elderly person, What is your impression?

A
  • Lower albumin may be OK in the elderly, lower threshold for normal
  • After sx, indicative of inflammation ad not nutritional status
88
Q

What are other factors to consider when interpreting lab values?

A
  • Med interaction
  • Caffeine, alcohol and nicotine
  • IV
89
Q

Explain how IV could influence lab values

A

1) Contamination, or dilution of collection

2) Dextrose may inflate glucose levels

90
Q

When someone is critically-ill, what is one of the first interventions?

A

Make hemodynamically stable by pushing IV fluids (isotonic), which will stabilize BP

91
Q

In emergency medicine, there is often different ____

A

lab reference ranges

92
Q

What is different about the lab reference range in critical medicine?

A
  • Critical low and critical high

- More generous that the reference range

93
Q

Sodium reference range

A

137-145

94
Q

Sodium critical low

A

<125

95
Q

Sodium critical high

A

> 155

96
Q

Potassium reference

A

3.8-4.8

97
Q

Potassium critical low

A

<2.5

98
Q

Potassium critical high

A

> 6.0

99
Q

Bicarbonate reference

A

22-32

100
Q

Bicarbonate, critical low

A

<10.0

101
Q

Bicarbonate, critical high

A

> 45

102
Q

Glucose reference

A

3.8-5.5

103
Q

Glucose, critical low

A

<2.0

104
Q

Glucose, critical high

A

> 30

105
Q

Calcium, reference

A

2.10-2.55

106
Q

Calcium, critical low

A

<1.5

107
Q

Calcium, critical high

A

2.55

108
Q

Magnesium, reference

A

0.70-0.90

109
Q

Magnesium, critical low

A

<0.3

110
Q

Magnesium, critical high

A

> 2.5

111
Q

In a health state, which electrolytes are not tightly regulated by hormones? Does nutritional intake have an impact on these paramenters?

A
  • Na, glucose

- NO

112
Q

What are important contributors to abnormal lab results? Does dietary intake have an effect?

A
  • Medications and disease state

- Yes, but less effect

113
Q

When should a dietitian intervene to assess lab value?

A

When the patient is hemodynamically stable

114
Q

In emergency medicine, lab values are often inflated by pushing fluids, creating ___ which will in turn ___ lab value

A
  • hypovolemia

- dilute

115
Q

Stress and lab results within the context of hormones?

A

Stress will cause an increase in neurotransmitters, such as serotonin and cathecholamine which will elicit and increase in pulse BP, and blood glucose.
-Cortisol causes hyperglycaemic effect, and insulin resistance

116
Q

Stress and lab results in the context of plasma volume increase?

A

Will dilute plasma proteins, causing them to appear lower than they actually are

117
Q

Stress and lab results in the context of inflammation?

A
  • Increase in cytokines and decrease in interleukins, albumin and transferring will cause the production of platelets and uptake of cholesterol
  • Cholesterol is likely to decrease
  • IL-6 increase thanks to cortisol, which will elicit an immune response
118
Q

Discuss plasma cholesterol during a severe infection, surgery or after an MI

A

Can DECREASE up to 40%

recall the inflammation process, where cholesterol uptake increases

119
Q

Mental stress an cholesterol?

A

Can cause HDL cholesterol to decrease by 15%

120
Q

What does a CBC include?

A
  • Number of RBC and WBC
  • HMG
  • Hematocrit
  • MCV
  • Platelet count
121
Q

What is the fraction fo blood composed of RBCs?

A

Hematocrit

122
Q

What is the size of red blood cells?

A

MCV

123
Q

What does the platelet count usually indicate?

A

Stress, response to medical therapies

-often interpreted if a patient is on glucocorticoids

124
Q

When is CBC calculations useful?

A

Sometimes in LTC

125
Q

What can we derive from CBC calculations?

A
  • Mean corpuscular hemoglobin (MCH)
  • Mean corpuscular hemoglobin concentration (MCHC)
  • Differential on WBC
126
Q

How do we obtain our differential on WBC ?

A

Lymphocytes x 10^9 /L = (#WBC x % lymphocytes) / 100

127
Q

What does differential mean?

A

Will allow us to calculate our % of each type of WBC in our blood

128
Q

What does TLC allow us to interpret?

A

Malnutrition and weight loss

129
Q

What is an issue with TLC?

A

Is non-specific and has low-sensitivity in early malnutrition

130
Q

How can we calculate TLC?

A

TLC x 10^9/L

131
Q

TLC, mild malnutrition?

A

1.200-1.800

132
Q

TLC, moderate depletion?

A

0.800 - 1.199

133
Q

TLC, Severe malnutrition?

A

<0.800

134
Q

When are TLC values reduced?

A
  • Viral infection
  • Chemotherapy
  • Radiation
  • Steroids
  • Penicillin
  • Sulfonamides
  • Some diuretics
135
Q

When are TLC values elevated?

A
  • Tissue necrosis

- Infections

136
Q

What lab value is used to interpret aids?

A

CD4 cell count

137
Q

> 800 CD4?

A

Normal (goal)

138
Q

<500 CD4?

A

Initiate antiretroviral drug therapy

139
Q

<200 CD4?

A

Prophylaxis for opportunistic pathogens

140
Q

Basic mechnaism of HIB?

A

The HIV virus will use CD4 cells to propagate, thus as CD4 cells decline, the management of opportunistic infections and HIV-related malignancies will begin

141
Q

What is particular about liver enzymes ?

A

Are also found in other organs, thus patterns of elevation may help us diagnose disease and injury processes

142
Q

SGOT =

A

AST

143
Q

SGPT =

A

ALT

144
Q

Which liver enzymes will elevate in acute liver injury (1-2 days), but will not stay elevated if extensive liver damage?

A

ASt and ALT

145
Q

What is the issue with interpreting liver enzymes?

A
  • General enzymes which are impacted by so many things

- They change quick, hard to evaluate over long-term

146
Q

In viral hepatitis, liver enzymes often ____ and don’t ____

A

go up

come down

147
Q

Within the context of liver enzymes, what should be considered in nutritional management?

A

The stage of the liver disease

148
Q

All types of ____ rise as liver function declines

A

-Bilirubin

149
Q

What is bilirubin?

A

Bilirubin is part of the normal breakdown of the heme within the RBC, where is bound to albumin, then conjugated in the liver for excretion.

150
Q

When albumin is low, why may it lead to jaundice?

A

Hard to get bilirubin out of tissues, cannot be transported with albumin to liver for conjugation, thus will cause build-up

151
Q

What is unconjugated/indirect bilirubin more likely to be associated with

A

Liver dsyfunction, cannot conjugate glucuronic acid

  • Albumin normal, but liver cannot conjugate
  • Hemolysis
152
Q

When is jaundice common?

A

In newborn iwth immature livers

153
Q

What is conjugated/direct bilirubin more likely to be associated with?

A
  • Hypoalbuminemia
  • Excretion issue owing to disease
  • Stress of injury/ state
154
Q

Which meds may increase levels of unconjugated/indirect bilirubin?

A

Novobiocin or gentamicin

155
Q

_____ bilirubin is more toxic

A

unconjugated

156
Q

As the liver heals, what trends in bilirubin can we expect?

A

-Total bilirubin will fall very slowly

157
Q

What sensitive marker of liver function will decrease with recover of function?

A

Conjugated/Direct Bilirubin

158
Q

When will total/direct bilirubin rise?

A

-Prolonged TPN
-Biliary atresia
Both due to imapred excretion

159
Q

Key concept with liver and visceral proteins?

A

The liver manufactures proteins, thus liver insufficiency will reduce levels

Clinical Nutrition 2 (21 decks)

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