7. Nutritional Assessment

Question 1

3 components of total NRG expenditure

Answer 1

1. Basal NRG expenditure (55-65% of total calories)
2. Activity NRG expenditure (25-33%)
3. Thermal effect of feeding (10% of calories)

Question 2

• Sedentary hospitalized patient = ______kcal/kg of body weight will maintain weight.
• Acutely or severely ill patients (trauma, burn patient, etc.) = ______ Kcal/kg.

Answer 2

• Sedentary hospitalized patient = 30-35 kcal/kg of body weight
• Acutely or severely ill patients = 35-40 kcal/kg

Question 3

RF to obesity

Answer 3

1. Lifestyle = biggest RF
2. Minority populations

Question 4

RF to malnurition

Answer 4

1. Older ppl who live alone
2. Chronically ill pts (renal failure, celiac, COPD, CHF)
3. Adolescents who eat and diet erratically
4. Cancer pts undergoing chemo
5. Drugs/ Alcoholics
6. Homeless/lowSES

Question 5

Nutritional deficits W/O weight loss = uncommon.

One exception is what?

Answer 5

• Anemia due to strict vegetarian or vegan diets may have B12 deficiency

Question 6

Older adults should be screened for nutritional status using the acronym DETERMINE

Answer 6

1. Disease that makes it hard to cook/eat
2. Eating poorly
3. Tooth loss or mouth pain
4. Economic hardships
5. Reduced social contacts
6. Multuple meds
7. Involuntary WL
8. Need to assistance w self-care
9. Elderly (>80YO)

Question 7

when is WL significant

Answer 7

Unintentional WL of 5% over 6 months or 10% over a year.

Question 8

% weight change =

Answer 8

[(usual weight - current weight)/usual weight] * 100

Question 9

interview questions of WL should be directed to what

Answer 9

common areas that cause WL

1. Decreased caloric intake due to anorexia, hardtime swallowing, self-care, depression

2. Malabsorption and maldigestion: diarrhea, fatty stools

3. Impaired metabolism or increase requirements

4. Increase losses or excretions: vommit, diarrhea, open wounds

Question 10

PE findings that provide info on nutritional status

Answer 10

1. VS: height, weight and BMI
2. Tricep skin thickness to assess subQ fat
3. Rapid weight gain = fluid retention
4. Tissue loss

Question 11

Vit B3 deficiency = aka

Answer 11

Vitamin B3 = Niacin

Deficiency => pellegra = 3 D’s

1. Diarrhea
2. Photodermatitis in sun-exposed areas
3. Dementria

Glossitis, burning paresthesia, stomatitis, vertigo

Question 12

Vit C deficiency

Answer 12

• Scurvy = 4 H’s
  
  1. ​Hemorrhagic signs =>
     
     1. Gingivitis, inflamed gingiva, impaired wound healing,
  2. Hyperkeratosis of hair follicles => corkscrew hair
  3. Hypochondriasis
  4. Hematologic abnormalitis => perifollicular petachiae, bleeding

Question 13

Vit D deficiency

Answer 13

• Rickets = softening and weakinging of bones in infants and kids before epiphyseal closes.
• After closed => osteomalacia

Question 14

Vit B12 deficiency = aka

Answer 14

• Vit b12 = cobalamin
• Common in vegans/vegetarians and GI abnormalitis (celiacs, pancreatic disorder, atrophic gastritis)
  
  1. Hyperpigmentation in creases and folds
  2. Megaloblastic anemia
  3. Thrombocytopenia + anemia
  4. Weakness, paresthesias, numbness and ataxia

Question 15

What do you think is the recommendation for an adult for vegetables/day? Fruits?

Answer 15

6 –9 fruits & vegetables

Question 16

besst diet to eat

Answer 16

mediterranean: plant based, small portions of eggs/dairy/poultry and fish, MINIMAL red meat, sugar, flour, butter, fats

1-2 glasses of red win/day

Question 17

No meat + may or may not include eggs or dairy

Answer 17

vegetarian

Question 18

no meat, eggs, dairy and honey

Answer 18

vegan

Question 19

no meat + [eats eggs and dairy]

Answer 19

lacto-ovo-vegetarian

Question 20

no meats + eats eggs & egg products but no dairy

Answer 20

ovo-vegetarian

Question 21

vegetables, fruits, nuts, seeds, legums, grains, uncooked food = 75%-100

Answer 21

raw vegan

Question 22

1. What nutritional deficiency may result in a strict vegetarian or vegan diet?

Answer 22

1. B12 (cobalamin)

Question 23

1. current recommendation of salt=
2. average consumption of salt =
3. why is salt bad =

Answer 23

1. 2300mg/d
2. 3400mg/d
3. salt => directly increase BP and fluid retention

Question 24

what is dash diet and how does it affect BP and cholesterol

Answer 24

• limit sodium to 2300mg/d
• decrease BP and LDL cholesterol

Question 25

what are required on food labels \_\_\_\_\_ MUST be labeled

Answer 25

* vit D, potassium, Ca, iron (vit A and C are optional) * Major allergens (milk, eggs, peanuts)

Question 26

1. ________ means less than 5 mg of sodium per serving. 2. _________ means less 35 mg of sodium or less per serving. 3. _______ means 140 mg of sodium or less per serving. 4. __________ means at least 25% less sodium than in the original product. \*\*\* 5. __________ means at least 50% less sodium than the regular product. \*\*\* 6. _________ means that no salt is added during processing. It does not mean that there is no sodium in the product\*\*\*

Answer 26

1. **Salt/Sodium-Free** means less than 5 mg of sodium per serving. 2. **Very Low Sodium** means less 35 mg of sodium or less per serving. 3. **Low sodium** means 140 mg of sodium or less per serving. 4. **Reduced Sodium** means at least 25% less sodium than in the original product. 5. **Light in Sodium or Lightly Salted** means at least 50% less sodium than the regular product. 6. **No-Salt-Added or Unsalted** means that no salt is added during processing. It does not mean that there is no sodium in the product.

Question 27

PE maneurvers to asses muscle strength = tell us about nutirional status

Answer 27

1. grip strength = squeeze infex and middle fingers for 10 seconds 2. ambulation = walk across and bac kroom 3. LE strength against resistance

Question 28

labs measure deficiency in what? 1. **CBC** 2. **TSH** 3. **Total protein and albumin**

Answer 28

1. **CBC =** iron, B12, folate 2. **TSH =** iodine 3. **Total protein and albumin =** protein calorie malnutrition

Question 29

waist circumfrance that means obsese

Answer 29

men: \>40' women: \>35'

Question 30

**Vit A** deficiency due to?

Answer 30

1. epithelium problems = skin and eye due to hyperkeratosis 2. problems with malapbsotion = crohns, celiacs, bariatric surgery, chronic mineral oil for constipation

Question 31

Which of the following is a **risk factor** for vitamin D deficiency? A. Elderly nursing home resident B.Treatment for seizure disorders C.Dark-skinned patients living in northern climates D.Patients with milk/dairy allergy E.All of the above

Answer 31

A. Elderly nursing home resident B.Treatment for seizure disorders C.Dark-skinned patients living in northern climates D.Patients with milk allergy **E.All of the above (no sun, no milk/dairy, too much sunscreen)**

Question 32

**goiter** can be caused by ___ deficiency

Answer 32

iodine

Question 33

iron deficiency can cause

Answer 33

1. spooning of nail beds 2. pale skin 3. conjunctiva pallor 4. glossitis

Question 34

what can cause **glossitis**

Answer 34

1. riboflavin (B2) 2. niacin (B3) 3. Folate (B9) 4. Iron

Question 35

most likely deficiency

Answer 35

niacin (B3) = photodermatitis in sun-exposed area

Question 36

most likely deficiency

Answer 36

**A.Riboflavin** **B.Pyridoxine** **C.Niacin** **D.Iron**

Question 37

what people require a low salt hospital diet (1gm, 2gm, 3gm)

Answer 37

*CV disease: CHF, HTN, Angina*

Question 38

hospital diet that requires a **consistent carb diet**

Answer 38

**DB type 1 and 2**

Question 39

what can cause 1. parotid gland enlargement 2. dry and scaly skin 3. conjunctiva pallor 4. angular stomatitis

Answer 39

1. parotid gland enlargement = protein 2. dry and scaly skin = protein 3. conjunctiva pallor = iron, B12, folate 4. angular stomatitis = riboflavin, pyridoxine, niacin