SM02 Mini2 Flashcards
define basal metabolic rate
energy required by the body when lying down at complete mental & physical rest, wearing light clothing in a room, comfortably at least 12 hours after a meal
what factors influence BMR?
- thermic effect of food: food ingestion stimulates metabolism
- proportion of lean body mass: leaner muscle mass has higher BMR
- abnormal states of starvation & malnutrition: decrease BMR
- hyperactive thyroid: increases BMR
- sleep: decreases BMR by 10%
- fevers: increase BMR 7% per 1ºF
- pregnancy & lactation increase BMR
- tropical climate: increases BMR 5-20%
- physical activity: increases BMR
- dz that increase cell activity (ex. cancer) increase BMR
- growth hormone increases BMR
- cold climates increase BMR to heat body
what are the normal BMR used in calculations for males & females?
males= 1 calorie/kg/hour
females= 0.9 calorie/kg/hour
total energy requirement/output
=BMR + thermic effect of food intake (TEF) + physical activity
TEF= calories of food x 0.10 approximately 10% used to metabolize
physical activity is BMR x activty level (sedentary 20%; very light 30%; moderate 40%; heavy 50%)
the ntional academy of science recommends that what percentage of daily calories should come from carbohydrates?
55-60%
carbohydrate provide how many calories per gram?
4cal/gm
what is ketosis?
condition in which unusual products of fat breakdown ketone bodesi accumulate in the blood
caused by absence of carbohydrates in the body
why are carbohydrates important to have in the diet?
- protein-sparing
- anti-ketogenic effect (prevents ketosis)
- CNS function: brain doesn’t store glucose
- fiber source
how much carbohydrates are needed daily to avoid protein breakdown & ketosis?
100grams/day on average
why are high fiber diets becoming increasingly important?
for treatment of chronic constipation and diverticular dz of colon in diabetes, hypertension, & prevention of colonic cancers
how does a high fiber diet decrease hyperlipidemia?
- dietary fiber lead to increase secretion of bile acids
- bile acid excretion causes more cholesterol to be converted to bile acids
- thus decreasing cholesterol serum levels
how does a high fiber diet work to prevent colonic cancer?
- some colonic cancers are caused by carcinogenic secondary products of bile acids
- consuming fiber increases bile acid excretion & clearance rates
what is the daily recommended fiber intake?
20-30 grams/day
what are the essential amino acids for adults?
isoleucine
leucine
lysine
methionine
phenylalanine
threonine
tryptophan
valine
how do the essential amino acids vary for children?
adult 8 plus
arginine & histidine
what is the US reccomended daily allowance (RDA) for protein?
10-15% of total calories
protein yields 4calories/gram
what is the national academy of science’s recommendation for adequate protein intake?
0.8g/kg body weight/day
1-1.6g/kg for athletes
define maramus & list its signs and symptoms
chronic condition of semi-starvation leading to growth retardation
signs: muscular wasting, lack of subcutaneous fat
causes: failure to breastfeed, use of over diluted formula, or infection from contaminated water supply
define kwashiokor & list its signs and symptoms
deficiency dz associated w/diet high in carbohydrates & inadequate in protein (low value when available)
common in 1-4yo age group
signs: hypoalbuminemia, pitting edema, pot belly, enlarged fatty liver, muscle wasting (usually masked by edema)
protein & energy deficiency
“dz of disposed baby when next is born”
how many calories is provided per gram of fat?
9
concentrated source of energy
what is the amercian heart association reccomendation for daily fat intake?
no more than 30% of total calories in those w/no symptoms of heart dz
what are triglycerides?
dietary fats & oils
what are the functions of omega 3 fatty acids?
- reduce risk of heart dz & stroke
- lower bp & hr
- guard against plaque build-up & clot formation in arteries
- aid brain development
what are trans fatty acids?
formed when hydrogen is added to vegetable oil in order to change a liquid to a solid at room temperature
aka hydrogenation
makes unsaturated fatty acids in to saturated fats
what is the recommended daily allowance for cholesterol?
300 milligrams/day
why is vegetarianism increasing in the US?
- health
- religion
- Fad
- ecological reasons
- cost
what are the benefits to vegetarianism?
- more closely resembles guidelines of “my plate”
- high complex carbohydrates, high fiber, low fat, low sugar, low sodium
- usually follow moderate lifestyle pattern
- less alcohol, no smoking, regular exercise
- higer intake of vitamins A & C
- antioxidants decrease risk of cancers & heart dz
- reduced incidence of obesity, diabetes, HTN, hypercholesterolemia, gallstomnes, & colon cancers
1.
causes of folate deficiency
- inadequate intake: poverty, mental illness, alcoholism, chronic illness, kwasiorkor
- malabsorption: cealic dz, jejunal resection, tropic sprue
- increase requirement: pregnancy, lactation, prematurity, hemolytic dz (sickle cell, thalessemia, leukemia)
- chronic inflammatory dz: RA, TB, malaria
what is the reccomended daily allowance for folate?
400ugs/day for adults
600ugs/day for pregnant women
500ug/day for lactating women
what is the daily reccomended intake for calcium?
9-18yo: 1300mg/day
19-50yo: 1000mg/day
>51yo: 1200mg/day
risk factors for osteoporosis
- low calcium diet throughout life
- lack of adequate physical activity
- excessive alcohol intake
- family hx of osteoporosis
- premature menopause
- short stature
- cigarette smoking
nutritional considerations for alcoholics
- alcohol= 7cal/g of empty calories
- may decrease appetite
- alcohol can damage muscosal lining affecting absorption
- usually thiamine deficient leading to lactic acid acidosis
- decreases production of intrinsic factor→ B12 deficiency
- increased plasma methyl THF levels
- decreased myelin formation→ neuropathy, myleopathy, & axomal degeneration
- impared folate absorption
what is root cause analysis?
method of determining underlying factors causing negative outcome or series of incidents
brings together individuals of different training levels & departments to review an incident
purpose of change to prevent future similar incidents
what is quality gap?
difference between expected care per researched optimal care and actual care given
how does a hospital receive “top performer” status?
given by the Joint Commission for 1 of 9 “core measure sets”
- heat attack
- heart failure
- pneumonia
- sx
- children’s asthma
- inpatient psychiatric services
- stroke
- immunization
measure
act or process of ascertaining extent, dimension, or quantity of something
must be chosen w/understanding of level of system to which it relates
include where data are generated, who is responsible for collecting data, specific units
what are the challenges to measurement?
- time consuming data collection
- collecting appropriate data
- results match reality?
- unexpected answers & their consequences
what are the benefits of measurement?
- sets stage for improvement
- shows progress or change
- “sell” ideas to management
- common frame of reference
- away from anecdotes & opinions
process measure
captures basic performance of process
should be performed on variety of processes w/in system
evalulates actions that influences results
outcome measure
measure end result of process
success of system
what tool is used to assist in choosing the proper measures?
value compass
what are the faces of performace measurement?
research, judgement, improvement
not mutually exclusive
how can the faces of performance measurement be differentiated?
research: use of p-value, for hypothesis testing
judgement: for comparison (clinics, treatments, etc.)
improvement: assessing change over time
causes of variation
- living things being “non-standard”
- human factor
- environment
- data collection & recording
- margin of error
what is a run?
one or more points on a side of the median
data points on the median do not count
on a point diagram, what would indicate a special cause variation?
at least 25 data points w/8-17 runs
what is a shift?
7+ consecutive data points on one side of the median
points on the median do not count
what is a trend?
7+ consecutive data points constanly going in one direction
consecutive data point of the same value do not ruin the trend
