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Clinical nutrition > Nutrition assessment 2 > Flashcards

Nutrition assessment 2 Flashcards

1
Q

Meaning of biochemical assessment

A

measurement of nutritional markers in blood, urine and other fluids and tissues

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2
Q

what does biochemical assessment detect

A

detects subclinical nutrient deficiencies

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3
Q

with the biochemicals exams what can we examine

A

visceral and somatic proteins
hematological assessment
lipid profile
micronutrient assessment
immunocompetent assessment

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4
Q

Protein status assessment

A

visceral protein status is reflected by serum proteins, red blood cells and white blood cells

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5
Q

malnutrition

A

decreases organ mass and substrate supply
that will decrease synthesis of serum proteins

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6
Q

what are some of serum proteins

A

Albumin (3500-5000 mg/dL)
fibronectin (220-400 mg/dL)
transferrin (215-380 mg/dL)
prealbumin (16-35 mg/dL)
retinol (2.1-6.4 mg/dL)

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7
Q

how is serum proteins influenced by

A

low protein intake
altered metabolism and synthesis
inflammation
hydration
medications
pregnancy
exercise

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8
Q

what is half life in serum proteins

A

is how much time it takes to replace half of the pool
albumin is 17-21 days
transferring is 8-10 days
prealbumin is 2-3 days
rbp is 10-12h

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9
Q

when you have a high albumin it could mean

A

dehydration, corticosteroids

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10
Q

when you have a high transferrin

A

it can means iron deficiency and pregnancy

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11
Q

when you have a high transthyretin it can mean

A

renal failure or hodgkins disease

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12
Q

when you have a retinol binding protein

A

renal failure

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13
Q

when serum proteins are low it means

A

inflammation

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14
Q

what are the proteins that are negative acute phase. What does it mean

A

albumin, transferrin, TTR and RBP. Their levels decrease by 25% during inflammation, illness or metabolic stress

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15
Q

what are the proteins that are negative acute phase? What does it mean

A

C reactive protein (CRP). It is used to detect mild or acute inflammation

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16
Q

what does it means if you have a high CRP and a low albumin

A

it could be due to an inflammation or low protein intake

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17
Q

What is the cutoffs for albumin for a mild deficit in proteins

A

35 g/L

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18
Q

Nitrogen balances

A

total protein retention or losses

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19
Q

what is positive nitrogen balance + examples

A

anabolism > catabolism (more retention)
- pregnancy, growth, recovery

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20
Q

what is negative nitrogen balance
+ examples

A

anabolism < catabolism (more loss)
starvation, trauma, surgery, inadequate protein intake

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21
Q

Nitrogen balance limitations

A
  • time consuming (24h)
  • prone to errors : protein intake estimated vs measured, missed or incomplete urine collection, does not account for losses due to diarrhea, vomiting, wound leaks…
  • errors always favor a more + balance
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22
Q

Urinary Creatinine excretion is proportional to what

A

skeletal muscle mass

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23
Q

urinary creatinine excretion is higher and lower depening of what

A

higher : exercise, meat, menstruation, infection, fever, trauma
lower: renal failure and age

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24
Q

what is anemia

A

reduction in the quantity of hemoglobin or in the number of RBC in the blood
decrease oxygen capacity

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25
Q

what is the complete blood count

A

erythrocytes ( number, size, shape, color) to diagnose anemia

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26
Q

what is the classification of anemia

A

color: hypochromic, normochromic, hyperchromic

size: microcytic, normocytic, macrocytic

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27
Q

anemias may be due to deficiencies of

A

iron, folate, vit B12, other micronutrient and chronic diseases

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28
Q

lab tests for anemia
- what is the deficit in women and men for hemoglobin.

A

<120 g/L women
< 140 men

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29
Q

when can hemoglobin be less

A

protein energy malnutrition, hemorrhage and other anemias

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30
Q

what is the hematocrit

A

% of red blood cells in total blood volume

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31
Q

hematocrit is high and low when

A

high : dehydration
low : hemorrhage

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32
Q

mean corpuscular volume MCV

A

rbc size: microcytic (<76) vs macrocytic (>100)

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33
Q

mean corpuscular hemoglobin

A

Hb concentration in RBC
hypochromic (<21) vs hyperchromic (>38)

34
Q

what is the order of iron status deficiency

A

1) storage iron (liver, bone marrow)
2) transport iron saturated
3) essential iron

35
Q

true or false
ferritin deficit is low in early deficiency

A

true

36
Q

transferrin saturation (<30%)

A

decreases with diminished transport iron

37
Q

serum folate deficiency

A

4.5-45 nmol/L

38
Q

vit b12 deficiency

A

120-500 pmol/L
low in progressing deficiency state

39
Q

in iron requirement which group needs more

A

pre menopausal women and pregnancy

40
Q

what are some excellent sources of heme iron (>3.5 mg)

A

clams, oysters, liver

41
Q

what are some excellent sources of non heme iron (>3.5 mg)

A

cooked legumes, seeds, tofu etc

42
Q

risk factors for poor iron status

A
  • diet low in meat, fish, poultry
  • diet low in vit c
  • drink a lot of coffee with meals
  • excessive menstrual losses ( menorrhagia)
  • 3 or more blood donation
  • pregnancy, multiple gestation
  • regular use of aspirin
43
Q

how do we maximize iron supplementation absorption

A
  • take with empty stomach with liquid (orange juice to decrease the pain)
  • if you cant take a snack before or with
44
Q

clinical assessment

A
  • includes the patient’s medical, social and psychological history
  • physical examination for clinical signs and symptoms of nutritional deficiencies through visual inspection and palpation
45
Q

what needs to be examined/asked in the patient history

A
  • primary and secondary diagnosis
  • past medical history
  • weight history
  • factors affecting nutrient intake
  • social history (religion socioeconomic, shopping, cooking, family)
46
Q

what are some physical signs of malnutrition
- hair
- face
- eyes
- lips
- tongue
- gums and teeth
- skin
- nails
- musculoskeletal
- neurological
- abdomen

A

hair : dry, dull, brittle, early graying
(def in protein, zinc, copper, etc)

face: fullness, puffy (def: protein, energy)

eyes: dryness, pallor (def: vit a, iron, b vit)

lips: angular stomatitis, cheilosis (def: niacin, iron)

tongue: magenta, painful, edema (b vit, zinc, iron)

gums and teeth : caries, stomatitis ( vit c, folate, b12, proteins)

skin: dryenes, scaliness, wound healing (def: vit a, zinc, it c)

nails: spoon nails, egg shell nails (def: iron, vit a)

musculoskeletal: bone pain, weakness (def: protein, energy, thiamin, etc)

neurological: sensory loss, confusion, dementia (def: thiamin, B12, protein)

abdomen: distention, flats (def: protein, energy, lactose, etc)

47
Q

what are the 5 dietary assessment methods

A

24h recall
food record or diary
food frequency questionnaire
direct observation
technology based methods

48
Q

the choices of dietary assessment methods depends on what

A

individual vs group
nutrients of interest

49
Q

explain the 24h recall

A

ask about intake during the previous 24h
multiple ones required to assess usual intake

50
Q

advantage of 24h recall

A
  • quick and inexpensive
  • element of surprise
  • low patient burden
  • literacy independent
51
Q

disadvantages of 24h recall

A
  • memory dependent
  • overstimation/underestimation
  • high inter interviewer variability
52
Q

Explain food record

A

recorded or weighed for a given time period (3-7 days)
assesses actual or usual intake

53
Q

advantage of food record

A
  • greater precision
  • not memory dependant
  • considered actual intake
54
Q

disadvantages of food record

A
  • time consuming
  • may not reflect “normal” eating patterns, may change behaviour
  • must be literate and motivated
55
Q

explain food frequency questionnaire

A

survey of intake over specified time
include food list, consumption frequency

56
Q

what is the advantages of the food frequency questionnaire?

A
  • quick, inexpensive
  • can examine specific nutrients
  • can be used in large studies
  • considered usual intake
57
Q

disadvantages of food frequency questionnaire

A
  • qualitative information and less accurate
  • memory dependant
  • diff since not meal based
  • must be literate and motivated
58
Q

explain direct observation

A

used in controlled setting
does not represent usual intake

59
Q

advantage of direct observation

A
  • more precise
  • not memory or literacy dependent
  • patient unaware of assessment
60
Q

disadvantage of direct observation

A
  • high staff burden
  • intrusive
  • diff to attain and interpret
61
Q

what do we need to know in the environmental assessment of a patient

A
  • socio-economic status, food security/access to food
  • education, food and nutrition literacy
  • ability/time to cook
  • working schedule, travelling
  • allergies, intolerances, restrictions
  • cognitive funciton
62
Q

functional assessment- handgrip strength

A

muscle strength correlates with muscle mass. Predicts malnutrition in many patient populations.

63
Q

with what the handgrip strength is measured

A

with a dynamometer

64
Q

what are the 4 steps for the nutrition care process model

A
  1. nutrition assessment and requirements
  2. nutrition diagnosis
  3. nutrition intervention
  4. nutrition monitoring and evaluation
65
Q

how do we do a nutrition diagnosis with the PES statement

A

Problem: diagnosis
Etiology: cause
Signs and symptoms: evidence

ex: unintended weight loss (p) related to severe diarrhea (e) as evidenced by 7 kg loss in 2 moths (s)

66
Q

what are the components of total energy expenditure

A

thermic effect of food
physical activity
REE or BMR

67
Q

what are some equations to estimate REE

A

harris-benedict
mifflin-st jeor
fao/who
rule of thumb

68
Q

true or false
harris-benedict estimation tends to overestimate the REE

A

true

69
Q

what is the consensus for protein requirements in healthy adults and older adults

A

healthy adults 1.0g/kg/d
older adults 1.0-1.2g/kg/d

70
Q

What are some ways to calculate the fluid requirement

A
  • by weight
    the first 10kg 100ml/kg
    the next 10kg is 50ml/kg
    20 ml/ kg body for each kg above 20
  • weight and age
    16-30 years: 40 ml/kg body weight
  • based on energy requirement
    1ml/kcal
  • base on fluid balance: urine output + 500
71
Q

what are dehydration symptoms

A
  • thirst
  • dark urine
  • decreased skin turgor
  • dry mouth lips
  • headache
  • tachycardia
  • confusion
  • rapid weight loss
  • lowered body temperature
  • increase Na, albumin, BUN, creatinine, Hb, Hct
72
Q

true or false
older adults don’t know how to detect thrist so people may diagnose with dementia

A

true

73
Q

overhydration symptoms

A
  • increased blood pressure
  • decreased pulse rate
  • edema
  • decreased Na, K, albumin, BUN, creatinine, Hb, Hct
  • rapid weight gain
74
Q

what are some special considerations for older adults (nutrients)

A

nutrients:
- energy reduced
- protein and calcium needs a higher reqt
- vit d is less efficient synthesis by skin, kidney conversion, and exposure
- vit b12 : less efficient absorption due to achlorydia
- fluids : decreased sense of thirst, presence of other diseases

75
Q

what are some special considerations for older adults (other)

A

dental status, capacity for mastication
swallow function, dysphagia
GI function
medical diagnosis
polypharmacy
social environment
cognitive function
functional ability

76
Q

prevalence of malnutrition in
1. community
2. hospitals
3. long term care

A

community : 15%
hospitals 50%
long term care 80%

77
Q

element of screening for malnutrition

A

current condition - bmi
stable condition- involuntary weight loss
will condition deteriorate - less food intake

78
Q

what are some examples of screening tool

A

nutritional risk screening and Canadian nutrition tool

79
Q

canadian nutrition tool (CNST)

A
  • simple tool
  • used more
80
Q

How do we diagnosis malnutrition by Global Leadership initiative on malnutrition (GLIM)

A
  • consensus report
  1. risk screening (use validated screening tools)
  2. diagnostic assessment ( phenotypic - what we see weight loss, low BMI, and etiologic - reduced food intake or assimilation disease burden)
  3. diagnosis - one phenotypic and one etiologic
  4. determine the severity of malnutrition by he phenotypic criterion (grille)

Clinical nutrition (11 decks)

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