Pediatrics Flashcards
what is assessed in pediatric malnutrition
food/nutrient intake, energy/protein needs, growth parameters, weight gain velocity, mid upper arm circumference, hand grip strength
when using z scores you can meet _____ number of criteria for malnutrition in pediatrics
1
categories of pediatric malnutrition using z scores
weight/height, BMI, length for height/age, MUAC
Mild Malnutrition Criteria (peds) Z scores
- 1 to -1.9 height/weight
- 1 to -1.9 BMI
- 1 to -1.9 MUAC
Moderate Malnutrition Criteria (PEDS) z scores
- 2 to -2.9 height/weight
- 2 to -2.9 BMI
- 2 to -2.9 MUAC
Severe Malnutrition Criteria (PEDS) z scores
- 3 or less height /weight
- 3 or less BMI
- 3 or less length/ht and length/age
- 3 or less MUAC
Mild Malnutrition Criteria PEDS (2+ needed)
weight gain velocity <75% of normal
5% loss of UBW
decline in 1 standard deviation of weight for length/weight for height z score
51%-75% EEN/EPN
Moderate Malnutrition Criteria PEDS (2+ needed)
weight gain velocity <50% of normal
7.5% loss of UBW
decline in 2 std deviations for weight for length/weight for height z score
26-50% EEN/EPN
Severe Malnutrition Criteria PEDS (2+ needed)
weight gain velocity <25% of normal
10% loss of UBW or greater
at least 3 standard deviations below wt/lenght and wt/ht z score
<25% EEN/EPN
phenotypic malnutrition criteria (weight) in GLIM
> 5% in = 6 months
>10% in > 6 months
phenotypic malnutrition criteria (BMI) in GLIM
<20 if >70 years old
<22 if 77 years old
<18.5 Asians <70 years old
<20 Asians >70 years old
phenotypic malnutrition criteria (Muscle mass)
decreased muscle mass
etiologic GLIM criteria
50% < food intake >1 week
any reduction > 2 weeks for any chronic GI absorption that impacts food assimilation
acute/chronic disease related inflammation
well defined, easy to palpate, slightly seen clavicle in females, curved shoulders, scapular bones not prominent describes ______ upper body muscle
normal
muscles around the knee visible but well rounded, patella not prominent, gastrocnemius is developed and rounded describes ____ lower body muscle
normal
temporalis muscle slightly depressed, decreased pectoralis major muscle moderately visible, clavicle present in females and males, shoulder blade/acromion process is more visible with a hollow trapezius, there is somewhat prominent scapular bones describes ______ upper body muscle
mild/moderate depletion
patella slightly prominent but rounded, inner thigh with concave gap when pressed together, gastrocnemius is less developed describes____ lower body muscle
mild/moderate depletion
depressed/hollow temporalis muscle, prominent facial bones, sharply protruded clavicle, minimal prese pectoralis muscle, scapula/ acromion process are sharply angular and there is deep concave interosseous muscle describes ___ upper body muscle
severe depletion
patella is sharply prominent, there is concaved shape between thighs with a large gam and the quadriceps lack definition indicates _____ lower body muscle
severe depletion
fat pads protrude slightly or are flat indicate, the skinfold underneath the triceps with ample fat tissue, iliac crest doesn’t protrude and ribs are visible indicates ____ fat assessment
normal fat assessment
faint, dark circles with a moderately concave eye area, skin fold pinch with some fat tissue but less space between the fingers, iliac crest visible and ribs are visible but without marked depressions between them indicates _____fat assessment
mild to moderate fat depletion
visible, dark circles, extremely concave eye socket, skin is loose, skin fold pinch yields fingers touching, little to no fat tissue present, iliac crest is protruding, ribs are protruding with sharp depressions in-between them indicate ___ fat assessment
severe fat depletion
the incidence of aspiration is directly caused by EN is _______ to be determined due to the lack of clinical research. There is no standard definition of aspiration
difficult
Critically ill children have decreased strength and coordination of pharyngeal muscles and a weak cough reflex making ___ more likely
aspiration
what is considered appropriate use of powdered infant formula in healthcare facilities?
only use when alternative, sterile liquid products are not available or when clinically necessary
powdered formulas are or are not sterile
are NOT!
use extra caution when providing powdered formulas to ______ children as they have a higher risk of bacterial contamination
immunocompromised chidren
in the hospital, what is the hang time for expressed human milk when used for continuous feedings?
4 hours
human milk is _____ sterile due to normal skin flora that is present. Never re use ___, ___ or _____ to reduce the chance of contamination
never sterile
bags, syringes, or tubing
A 1 month old has acute onset of diarrhea for 48 hours. The parents noticed that he hasn’t been wetting as many diapers and mucous membranes are slightly dry. It is anterior fontanel is soft and not sunken. He normally ingests milk based formula ad lib. What is the most appropriate intervention?
oral rehydration therapy. the infant is likely dehydrated from diarrhea/viral gastroenteritis and then return to age appropriate diet as tolerated and continue with milk
sunken eyes, sunken fontanel, poor skin turgor, dry mucous membranes and decreased numbers of wet diapers indicates
dehydration
what osmolarity is considered to be an upper limit for the osmolarity of infant formulas to avoid tolerance issues
460mOsm/kg
Osmolality of standard infant formulas has a caloric density of ______ kcal/oz with and osmolarity of _______ to ____ mOsm/kg
20 kcal/oz
200-380mOsm/kg
