Quiz 2 Flashcards
Chapter 12, 17, 22
24 Hour Recall
Guided interview in which the foods and beverages consumed in a 24-hour period are described
Advantages: method is not dependent on literacy or educational level; interview occurs after food is consumed, the method does not influence dietary choices; results obtained quickly
Disadvantages: Relies on memory; underestimation and overestimation on intakes; data from single day does not represent usual intake
Skin
Acceptable Appearance :
Smooth, firm, good color
Signs of Malnutrition:
- Poor wound healing (vitamin C, zinc, PEM)
- Bruising or bleeding under skin (vitamins C and K)
- Dry, rough, lack of fat under skin (vitamin A, B vitamins, essential fatty acids, PEM,)
- Pale (iron)
Other:
- Poor skin care
- DM
- aging
- meds
Hair
Acceptable Appearance:
Shiny, firm in scalp
Signs of Mal:
- Dull, brittle, dry, loose
- Corkscrew hair (vitamin C)
- falls out (PEM)
Other:
- Hair loss from aging
- chemo
- radiation therapy
- excess chemicals
Mouth & Gums
Acceptable Appearance:
Oral tissue w/o lesions, swelling, or bleeding; red tongue; teeth w/o caries; no issues chewing or swallowing
Signs of Mal:
- Bleeding gums ( Vit C)
- Smooth or magenta tongue (B vitas)
- Poor taste sensation (zinc)
Other:
Meds, periodontal disease ( poor hygiene)
Lips
Acceptable Appearance:
Smooth
Signs of Mal:
Dry cracked, or sores in corners of lips ( angular cheilitis, stomatitis) (B vitas)
Other:
Sunburns, windburn, excess salivation from ill fitting dentures.
Anthropomorphic data
Part of nutrition screening/ assessment for unintentional weight changes, loss of muscle or subq fat
Height ( or length)
Weight 5% involuntary weight loss in one month or 10% in six month > risk for PEM
Body Mass Index (BMI) ~ Wt(kg)/ Ht (m)2 or Wt(in) x 703/ (Ht)2
Circumference of head, waist, and limbs
H W B C
Effects of Illness on Nutrition Status
Protein-energy Malnutrition (PEM)
A state of malnutrition
- Depletion of tissue proteins and energy stores
- Associated w/ micronutrient deficiencies
- 10% weight loss in six months suggest risk for PEM
Effects of Illness on Nutrition Status
Effects of illness on nutrition status (R I A)
Reduced food intake
Anorexia due to illness; nausea and vomiting; pain with eating; mouth ulcers or wounds; difficulty chewing or swallowing; depression or psychological stress; inability to feed oneself
Impaired digestion and absorption
Inflammation associated with bowel conditions; insufficient secretion of digestive enzymes or bile salts; altered structure or function of the intestinal mucosa
Altered nutrient metabolism and excretion
Elevated metab rate; muscle wasting; changes in hydration; prolonged immobilization; nutrient losses due to excessive bleeding, diarrhea, or freq urination.
Nutritional Requirements in acute stress
- Protein requirements increase
- Carbs are 50-60 % of total energy requirements
- Micronutrients increase, Vit A, B, C, zinc
Metabolic Stress
- Disruption in the body’s internal chemical environment
- uncontrolled infections
- extensive tissue damage
- Deep, penetrating wounds or multiple broken bones
- May lead to Hypermetabolism (above normal met. rate) or Wasting (loss of muscle tissue)
Hormonal Responses to Stress
Catecholamine metabolic effects
- Epinephrine and Norepinephrine
- Increase metabolic rate
- Glycogen breakdown in liver and muscle
- The release of fatty acids from adipose tissue
- Glucagon secretion from the pancreas
Cortisol metabolic effects *excess may lead to insulin resistance, contributing to hyperglycemia, suppressed immune responses, increasing susceptibility to infection.
- Protein degradation
- Inhibits protein synthesis
- Enhancement of glucagons action on liver glycogen
- Glucose production from amino acids
- Release fatty acids from adipose tissue
Glucagon
- Glycogen breakdown in the liver
- Glucose production from amino acids
- The release of fatty acids from adipose tissue
Aldosterone
- Sodium reabsorption in the kidneys
Antidiuretic hormone
- Water reabsorption in the kidneys
Metabolic changes in Burn patients
- Hypermetabolism
- Muscle Bone catabolism
- Negative nitrogen balance (can lead to wasting)
- Gluconeogenesis
- insulin resistance
- Loss of water and body heat
- Disrupt liver and GI function, may persist for 1 or more years
Nutrition therapy for Burn patients
- High calorie, high protein diet (1.5-2.0 g/kg)
- note overfeeding may lead to hyperglycemia, infections, fatty liver
- Achieve nitrogen balance
- Preserve lean tissue
- Maintain appropriate body weight (4-6 hrs after injury enteral feedings along with oral)
- Supplement with glutamine and arginine
- Micronutrient to add Vit A, C, zinc
- promote wound healing and immunity
- Fluid & Electrolytes monitor closely during recover (urine output & electrolyte levels)
Nutrition for Respiratory Failure
- Patient w/ lung injuries or ARDS are typically hypermetabolic and/or catabolic risk for muscle wasting
- Provide adequate energy and protein to sustain muscle tissue and lung function w/o overtaxing resp. system
- Protein for mild or mod. lung injury: 1.0 - 1.5 g /kg bw
- ARDS 1.5 to 2.0 g/kg bw
- Fluid restriction to correct pulm. edema
- Enteral over parenteral nutri.
- Provide adequate energy and protein to sustain muscle tissue and lung function w/o overtaxing resp. system
Prealbumin (Transthyretin)
10 - 40 mg/dL
- Levels may reflect illness or PEM
- Levels decrease rapidly during PEM, responds quickly to improve protein intake
- More Sensitive to short-term changes in health status than albumin or transferrin
- 2-3 days
Albumin
3.5 - 5.0 g/dL
- Levels may reflect illness or PEM
- Slow to respond to improvement or worsening of disease
- Chronic PEM individuals albumin levels remain normal for a long period; levels fall only after prolonged malnutrition
- Half-life 14-20 days
Transferrin
200-360 mg/dL
> 60 yr: 160-340 mg/dL
- Iron transport protein
- Levels may reflect illness, PEM, or iron deficiency
- Slightly more sensitive to changes in health status than albumin
- half life 8-10 days
C-Reactive Protein
68 - 8200 ng/mL
The best clinical indicator of acute phase response;
- ^ CRP levels during an inflammatory response
White blood cell
4500 - 11,000 cells/ uL
WBC number may indicate immune status, infection, or inflammation
Nutrition therapy for COPD
- Correct malnutrition (affects 60 % of COPD Pt’s)
- Encourage adequate food intake is the main focus
- NOTE Overweight COPD Pt may benefit from energy restriction and gradual weight reduction due to additional strain on resp. system
- Frequent meals spaced throughout the day rather than two or three large ones.
- lower energy content of small meals reduces the carbon dioxide load
- less abd. discomfort and dyspnea
- Adequate fluids should be encouraged to prevent secretion thickening
- For undernourished a High-energy and high-protein diet may be helpful
- NOTE excessive energy increase C02 and can increase resp. stress
Hemoglobin (Iron)
Male: 13.0 - 18.0 g/dL
Female: 12.0 - 16.0 g/dL
- Part of hgb, which carries o2 in blood
- Part of myoglobin in muscle, which makes o2 available for muscle contraction; necessary for energy metabolism
Sodium
134 - 145 mEq/L
Potassium
3.5 - 5.0 mmol/L
Calcium
2.20 - 2.55 mmol/L
Nutrition for Hypertension
- Emphasis on fruits, vegetables, and whole grains, low-fat milk products, poultry, fish, and nuts
- This plan provides more fiber, potassium, magnesium, and calcium
DASH eating plan
- Emphasizes vegetables, fruit, and whole grains; includes low-fat milk products; and limits sugars and red meats.
- works well with sodium restriction (1500 mg/day)
Nutrition for Osteoporosis
- Adequate calcium intake during growing years
- Adequate protein protects bones and reduces the likelihood of hip fractures
- Vit D needed to maintain calcium metabolism
- Vit K decreases bone turnover, protect against hip fractures
- Vit C slows bone losses
- Magnesium and Potassium maintain bone mineral density
- Vit A needed in the bone remodeling process, but too much may be associated to osteoporosis
- DIet rich in fruits, vege, and whole grains are beneficial.
- DIets contianing too much salt are associated with bone losses.
Basic Fluid and Electrolyte Balance
- Balance of two-thirds of body fluids inside the cell and one-third outside is vital to cell life
- In an electrolyte solution, water molecules are attracted to both anions and ca+ions
- Electrolytes attract water
- K, Mg, P, S Primarily inside cell
- Na, Cl, Ca primarily outside cell
(Both can be found inside and outside of cell, but each can be found mostly on one side of the other.)
- Water follows electrolytes
- Crosses membrane towards more concentrated solutes (Osmosis)
- Cell membrane selectively permeable
Osmosis
Aldosterone
- Hormone released from adrenal glands
- Signals kidneys to excrete potassium and to retain more sodium
- Water follows salt
- lncreases BP
Antidiuretic Hormone
- A hormone produced by the pituitary gland
- In response to dehydration (or sodium concentration in blood)
- Stimulates kidneys to reabsorb more water and therefore to excrete less
- Elevates BP (Vasopressin)
Factors that Increase Water Needs
- Very young
- Very old
- Certain diseases…diabetes
- Prolonged diarrhea, vomiting
- Fever
- Alcohol
- Caffeine
- High protein diets
- Medications
- Surgery
- Blood loss
- Burns
- Exercise
Fluid lossess
Normal
- 2400 mL
Fever
- 3400 mL
Exercise
- 6700 mL
Water Recommendations
Needs will vary
- Diet
- Physical activity
- Environmental temperature
- Humidity
- Forced-air environments
- 3 Hour airplane flight = loss of 1.5 L
- High altitude
- 5000 ft and above
- ^ breathing rate and depth
- Lower humidity air
- increases water loss
Dehydration
sxs & tx
Causes Symptoms
- Vomiting Dry & warm skin
- diarrhea Poor skin turgor
- diuresis Dark & odorous urine
- decreased intake Low BP
- decreased IV replacement Weight loss
Care
- Hydrate
- daily weights
- skin care
Sodium
Upper sodium limits (adults) 2300 mg
Salt sensitive no more than 1,500 mg
Avg intake in US 3400 mg
Salt (sodium chloride) is 40% sodium
- 1 tsp sale contributes about 2300 mg sodium
Foods high in sodium
and its influence on BP
1 tbsp Soy Sauce = 1029 mg sodium
1 Container instant lunch = 1330 mg sodium
- Reduces blood flow through arteries
- Elevation of BP in response to high salt diet over the years is progressive and damage caused to blood vessels is irreversible
Potassium-rich foods and conditions that may require potassium-rich diets
Fresh foods are richest sources
- AI 4700 mg/day
Potatoes, avocados, bananas, cantaloupes, carrots, spinach, strawberries, tomatoes, fish, mushrooms, oranges, pork, beef, and veal.
Deficiency:
Increase BP; Salt sensitivity; Kidney stones; Bone turnover; Irregular heartbeats; Muscle weakness; Glucose intolerance
Calcium Rich foods
Most abundant mineral in the body
Milk products, Bok choy, Kale, Brocolli, Sardines w/ bones, Almonds, Fortified juices and foods
Calciums relationship to the development of Osteoporosis
Low blood calcium signals the parathyroid glands to secrete a parathyroid hormone into the blood ⇒ stimulates calcium reabsorption from the kidneys into the blood ⇒ enhances calcium absorption in the intestines ⇒ Stimulates osteoclast cells to break down bone (pulls from bone)
Risk factors for Osteoporosis
Kidney Failure (ESKD) Diet Recommendations
Also known as Stage 5 CKD
Nutritional therapy is to maintain appropriate fluid status, BP, and Blood chemistries
- High protein
- Low phosphorus, Low potassium, Low sodium (2 to 4 g/day) fluid-restricted diet
Protein intake increases once on dialysis
- Fifty percent of protein intake should come from biologic sources ( egg, milk, meat, fish, poultry, soy)
- Restrict phos ( high protein leads to increase phos intake; included in protein products)
- Add calcium supplements.
Nutrition for Pernicious Anemia
&
Iron-deficiency Anemia
Pernicious Anemia (Most common form of vitamin B12 deficiency)
- Natural sources of Vit B12
- Fish, meat, poultry, eggs, milk (vegans need supplemental B12)
Iron-deficiency Anemia (Most common nutritional disorder in the world)
- Sources of Iron
- Meat, fish, poultry, tofu, dried peas and beans, whole grains, dried fruit, iron-fortified food
- Vita C facilitates absorption of iron (promote consumption!)
- Meat, fish, poultry, tofu, dried peas and beans, whole grains, dried fruit, iron-fortified food
