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Mariya- PCM 3 Exam 2 > Nutritional Assessment > Flashcards

Nutritional Assessment Flashcards

1
Q

How do you calculate caloric need

A

3 components of total energy expenditure:

1) basal energy expenditure =55-65% of total calories
2) thermal effect of feeding = 10% of calories
3) activity energy expenditure = 25-33% of calories

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2
Q

In a sedentary hospitalized patient, how many kcal/kg of body weight will maintain weight?

A

30-35 kcal/kg of body weight will maintain weight

*idk what this means but it was underlined so maybe know it lol

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3
Q

In an acutely or severely ill patient (trauma, burn), how many kcal/kg of body weight will maintain weight?

A

35-40 kcal/kg

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4
Q

What are the risk factors that contribute to malnutrition and obesity?

A
  • Minority populations are at risk (76% African Americans, 80% of Mexican Americans- overweight or obese)
  • malnutrition is related to specific populations: older people who live alone, chronically ill patients, adolescents who eat and diet erratically, cancer patients undergoing chemotherapeutic or radiation protocols or other nutrient-drug interactions, alcoholics, homelessness, low SES
  • nutritional deficits: anemia
  • older adults (DETERMINE acronym)
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5
Q

Obesity vs. Overweight BMI?

A

obesity:: BMI>30; waist circumference >40” in men; >35” in women
overweight : BMI 25-29

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6
Q

What is the biggest factor related to obesity?

A

lifestyle

1% = neuroendocrine cases (rare)

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7
Q

Older adults should be screened for nutritional status using what acronym?

A 
DETERMINE
Disease
Eating poorly
Tooth loss/mouth pain
Economic hardship
Reduced social contract
Multiple medications
Involuntary weight loss
Need for assistance with self-care
Elderly years (>80)
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8
Q

Tetracyclines affect what nutrients?

A

Ca, Mg, Fe, Vitamin B12

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9
Q

Neomycin, kanamycin affect what nutrients?

A

fat-soluble vitamins, B12

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10
Q

Sulfasalazine affect what nutrients?

A

folate

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11
Q

Anticonvulsants like phenobarbital and phenytoin affect what nutrients?

A

Ca, VitD, folate, niacin

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12
Q

Hypolipidemics like cholestryramine and colestipol affect what nutrients?

A

fat and fat-soluble vitamins

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13
Q

Cytotoxic agents such as methotrexate affect what nutrients?

A

folate

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14
Q

Laxatives like mineral oil affect what nutrients?

A

water, electrolytes, fat and fat-soluble vitamins

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15
Q

Antituberculotics like isoniozid affect what nutrients?

A

Pyridoxine (B6) and Niacin (B3)

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16
Q

Anticoagulants like warfarin affect what nutrients?

A

vitamin K

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17
Q

Diuretics like thiazides + furosemide affect what nutrients?

A

K+, Mg, Ca, Zn

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18
Q

Lithium and amiodarone affect what nutrients?

A

iodine

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19
Q

What weight loss is considered significant?

A

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

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20
Q

What is the formula to calculate %weight change?

A

%weight chain = [(usual weight- current weight)/ usual weight] x 100

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21
Q

What could be some reasons/symptoms pointing to decreased caloric intake?

A

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

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22
Q

What could be some reasons/symptoms pointing towards malabsorption or maldigestion?

A

diarrhea, fatty malodorous stools, changes in bowel habits

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23
Q

What could be some signs pointing to impaired metabolism or increased requirements?

A

fever, pregnancy, chronic dz, etc.

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24
Q

What could lead to increased loss/excretion in a patient?

A

draining fistula or open wound, diarrhea, excessive vomiting

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25
Q

what does tricep skinfold thickness assess?

A

subcutaneous fat; approx 50% of body fat is subq

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26
Q

Rapid weight gain vs. weight loss is more likely related to what?

A

weight gain - fluid retention

weight loss - tissue loss

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27
Q

A patient presents with dry and scaly, cellophane appearing skin. What deficiency does this point to?

A

Protein

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28
Q

A patient presents with flaking dermatitis on their skin. What deficiency does this point to?

A

Zinc

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29
Q

A patient presents with follicular hyperkeratosis on their skin. What deficiency does this point to?

30
Q

A pt presents with pigmentation changes. What deficiency does this point to?

31
Q

A patient presents with petechiae on their skin. What deficiency does this point to?

32
Q

A patient presents with purpura on their skin. What deficiency does this point to?

A

vitamin C, vitamin K

“bloody spots”

33
Q

A patient presents with skin pallor. What deficiency does this point to?

A

iron, vitamin B12, folate

34
Q

A patient presents with night blindness. What deficiency does this point to?

35
Q

A patient presents with conjunctia pallor. What deficiency does this point to?

A

iron, vitamin B12, folate

36
Q

A patient presents with xerosis, keratomolacia, and bitot spots . What deficiency does this point to?

37
Q

A patient presents with angular stomatitis on their mouth. What deficiency does this point to?

A

riboflavin, pyridoxine, niacin

38
Q

A patient presents with cheilosis on their mouth. What deficiency does this point to?

A

riboflavin, pyridoxine, niacin

39
Q

A patient presents with glossitis. What deficiency does this point to?

A

riboflavin, niacin, B vitamins, iron, folate

**impt

40
Q

A patient presents with bleeding gums. What deficiency does this point to?

A

vitamin C, riboflavin

41
Q

If a patient presents with interosseous muscle atrophy, squaring off of shoulders, poor hand grip and leg strength (temporal, supraspinatus). What deficiency does this point to?

A

protein, calories, vitamin D

42
Q

A patient presents with tetany. What deficiency does this point to?

A

calcium, magnesium

43
Q

A patient presents with nail spooning. What deficiency does this point to?

44
Q

A patient presents with a goiter (enlarged thyroid) on their neck. What deficiency does this point to?

45
Q

A patient presents with parotid enlargement. What deficiency does this point to?

46
Q

A patient presents with corkscrew hairs. What deficiency does this point to?

47
Q

What physical exam maneuvers can provide info about nutritional status?

A

Appearance: muscle mass, hair texture, nail health, skin texture

Muscle strength: grip strength (ask pt to squeeze index and middle fingers for 10 seconds); ambulation(walk across room and back); LE strength against resistance

48
Q

What labs are helpful in identifying inflammation?

A

CRP, elevated WBC and albumin

albumin <3.5 g/dL= mild systemic inflammatory response; <2.4 = severe systemic inflammatory response

49
Q

A CBC can determine which potential nutrition deficiency?

A

iron, B12, folate

50
Q

TSH can determine what potential nutritional deficiency?

51
Q

A total protein, albumin can determine what potential nutritional deficiency?

A

protein calorie malnutrition

52
Q

one of the LOs is where can i find the reliable nutrition info for patients…

A

Academy of Nutrition and Dietetics: www. Eatright.org

more on the DSA…but i dont think this is worth a question lol, happy studying!

53
Q

What are clinical features of scurvy?

A

vitamin C deficiency

four Hs: hemorrhagic signs, hyperkeratosis of hair follicles (keratotic plugging–> “CORKSCREW hairs” = good visual clue), hypochondriasis and hematologic abnormalities

characteristic cutaneous finding: perifollicular petechiae

bleeding gums, poor healing

collagen problems!! so energy go down and everything go down–> fatigue, depression, widespread CT abnormalities

54
Q

What are clinical features of pellegra?

A

niacin deficiency (B3)

3 Ds: Diarrhea, dermatitis (photosensitivity), dementia

dermatologic findings are SUN exposed areas

-glossitis, stomatitis, vertigo and BURNING parasthesias

55
Q

What are clinical features of rickets?

A

result of deficient mineralization of osteoid matrix before closure of the epiphyseal plate causing softening and weakening of bones in infants and children

  • mineralization impairment may be secondary to abnormal calcium, phosphorous, or vitamin D metabolism –> accumulation of osteoid before epiphyseal closure, compromising bone stability at sites of rapid bone growth
  • in adulthood: osteomalacia
56
Q

B12 deficiency clinical features:

A

glossitis, hyperpigmentation, and canities = main dermatologic manifestations

  • bright red tongue, sore , and atrophic
  • creases and flexures mostly (seen on hand)
  • pigmented nails
  • premature gray hair (canities)
  • often present with megaloblastic anemia

seen in VEGETARIANS (bc its NOT in plants)

57
Q

What is the recommendation for an adult for vegetables/fruits per day?

A

6-9 fruits + vegetables

58
Q

What is the recommended amount for protein foods in a 2000 calorie diet?

A

5.5 oz-eq/day

59
Q

What is a Mediterranean diet?

A

• Based on the eating habits of Greece and southern Italy in the early
1960’s
• Plant based: fruits, vegetables, nuts, grains, seeds, beans and olive oil
• Eggs, dairy, poultry and fish are eaten several times/week, but the
portions are small
• Minimal intake of red meat, refined sugar, flour, butter and fats
(except for olive oil)
• Includes: 1-2 glasses of red wine/d*

60
Q

What is the current recommendation for salt intake? average consumption?

A

<2300 mg/day

average: 3400 mg/day

salt is directly related to blood pressure and fluid retention

61
Q

salt is directly related to what?

A

blood pressure and fluid retention

lower salt improves blood pressure

62
Q

A strict vegetarian or vegan diet can result in what deficiency?

63
Q

Food label laws include what?

A

ingredient lists: descending order of predominance (mc–>lc)

mandatory labeling of major allergens: milk, eggs, peanuts

64
Q

BE able to read a nutrition label.

A

she said hint hint

serving size, total calories
notice vitamin D, potassium, calcium, and iron = required; vit A + C = optional

65
Q

What is the difference between all the types of salt/sodium content?

A

-Salt/Sodium-Free = less than 5 mg of sodium per serving.
• Very Low Sodium = less 35 mg of sodium or less per serving.
• Low sodium = 140 mg of sodium or less per serving.
• Reduced Sodium = at least 25% less sodium than in the original
product. (**)
• Light in Sodium or Lightly Salted = at least 50% less sodium
than the regular product.
• No-Salt-Added or Unsalted = that no salt is added during
processing. It does not mean that there is no sodium in the product

66
Q

What is the difference between all the types of fat labelling content?

A

-Fat-free means the food has less than 0.5 grams (g) of fat per serving.
• Low-fat = 3 g of fat or less per serving.
• Reduced fat or less fat = the food has at least 25% less fat than the
regular product.
• Trans fat free = the food has less than 0.5 g trans fat per serving. Even
though a food says “trans fat free,” it may still contain 0.49 g trans fat. Eating
many servings of a food with small amounts of trans fat per serving can add
up. (NOT FAT FREE)

67
Q

What disease processes could lead to vitamin A deficiency

A

Crohns dz, celiac dz, chronic mineral oil use for constipation, bariatric surgery

68
Q

What are some risk factors for vitamin D deficiency?

A

elderly nursing home resident, treatment for seizure disorders, dark-skinned pts living in northern climates, pts with milk allergies

69
Q

With a strict vegan diet, what lab could you see?

A

Megaloblastic anemia from vitamin B12 deficiency

70
Q

Vitamin A deficiencies affect what mostly?

A

the epithelium

71
Q

What can cause gingival dz/bleeding of gums?

A

vitamin C deficiency

Mariya- PCM 3 Exam 2 (2 decks)

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