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Assessment Flashcards

1
Q

Branch chain amino acids

A

leucine, isoleucine, and valine

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2
Q

Aromatic Amino acids

A

Phenylalanine, tyrosine, tryptophan,

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3
Q

Conditionally essential amino acids

A

Proline and Arginine. Cysteine, glutamine, glycine, tyrosine

Synthesized primarily in the order intestine And dependent on intestinal metabolism.

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4
Q

Essential amino acids

A 
Methionine
Valine
Phenylalanine 
Isoleucine 
Threonine
Tryptophan 
Histidine 
Leucine 
Lysine

histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.

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5
Q

Essential fatty acid deficiency

A

Diffuse scaly dermatitis, hair loss, anemia, and thrombocytopenia ( low platelets) hepatomegaly, fatty liver and anemia.

2-4% of total calories as fat should prevent

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6
Q

Lactated Ringer

A 
130 mEq/L
109 chloride
4 mEq/L potassium 
28 mEq/L lactate
2.7 mEq/L calcium

Most closely resembles jejunal and ileal electrolyte content (intestines have 10 to 30 mEq/l of bicarbonate as well)

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7
Q

0.9 NS

A

154 mEq/l sodium and chloride or 9 grams of salt or 3510 mg if sodium.

1 g salt (sodium chloride) = 390 mg sodium. 1 tsp salt = 6 g salt ≈ 2,400 mg sodium = 104 mmol sodium = 104 mEq sodium.May 12, 2016

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8
Q

Vitamin A supplementation for deficiency

A

25,000 IU/ day for max of 10 days

** caution in liver or renal failure and elderly

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9
Q

Thiamine deficiency

A

Wernicke’s encephalopathy

Thiamine plays a role in glucose metabolism

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10
Q

Thiamin deficiency

A

Lactitic acidosis

Thiamine used to convert pyruvate to acetyl CoA

Without thiamine pyruvate is converted to lactic acid

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11
Q

Positive acute phase protein

A

Increases during inflammation

C- reactive protein

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12
Q

Negative acute phase proteins

A

Decrease during inflammation

Albumin
Transferrin
Prealbumun

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13
Q

SIADH

A

Hyponatremia associated with SIADH

Water conserved
Urine concentrated

CNS disease
Malignancy
Lung disease

Urine sodium and osmolality elevated

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14
Q

Hypophosphatemia

A

Refeeding
DKA
Chronic alcoholism

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15
Q

Increased risk of metastatic calcification of calcium occurs when the ca & and p product is

A

Exceeds 55

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16
Q

Hyperphosphatemia can decrease

A

Calcium

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17
Q

Zinc deficiency caused by poor protein intake can cause

A

Diarrhea

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18
Q

Copper toxicity can cause

A

Nausea
Vomiting
Diarrhea
And

Wilson’s disease which is coma, hepatic necrosis, liver/renal failure

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19
Q

Copper is excreted in

A

Bile (80%)

So monitor copper in patients with liver disease

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20
Q

Zinc deficiency is common in

A

Liver disease so supplementation can improve amino acid metabolism and decrease encephalopathy

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21
Q

Aluminum toxicity can be treated with

A

Deferoxamine

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22
Q

Factors that can decrease indirect calorimetry

A

Chest tubes
Nasal oxygen
Dialysis because of loss of CO2 in dialysis coil

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23
Q

Respiratory quotient

A

0.7 fat oxidation
<0.82 underfeeding or protein oxidation
0.85 to 0.95mixed substrate
> 1 carbohydrate oxidation and overfeeding and potential lipogenesis

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24
Q

Mufflin-St. Joer

A

Best to estimate needs of obese and non obese

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25
Cheilosis (cracking of corners of the mouth) is associated with deficiency of
Niacin Riboflavin Iron Pyridoxine (B6)
26
Arginine could be beneficial for patients with
``` Trauma Surgery Compromised immunity *as it increases production of nitric oxide *increases blood flow ``` ***** avoid in those with septic shock *****
27
Colon length
150 cm
28
Small bowel length
600 cm or 10 feet
29
Primary fuel of colonocytes
Short chain fatty acids
30
SCFA are
Acetate Butyrate Propionate
31
SCFA stimulate absorption of
Water and sodium absorption
32
Fat from oral intake is absorbed
In the duodenum and proximal jejunum
33
Valproic acid can induce a deficiency of
Carnitine Involved in metabolism of fatty acids Idiopathic encephalopathy can be associated with carnitine deficiency
34
Thiamin deficiency
Edema | Lower extremity weakness
35
Hair loss could be attributed to
Inadequate protein B12 Folate
36
Brittle hair could be due to
Biotin deficiency
37
Hair color changes could be due to
Zinc deficiency
38
Dry hair could be due to what deficiency
Vitamin A and E
39
Easy pluckability of hair could be due to low
Protein Biotin Zinc
40
Coiled or corkscrew hair could be due to
Deficiency of vitamins A and C
41
Petechiae ( small red purple spots on skin) could be due to what deficiencies
Vitamins A and C
42
Bitot spots are the buildup of keratin located superficially in the conjunctiva, which are oval, triangular or irregular in shape. These spots are a sign of what deficiency?
Vitamin A
43
Xerosis (dry skin) could be due to what deficiency?
Vitamin A and or essential fatty acid deficiency
44
Inflammation of the eyelids (angular palpebritis) could be due to what deficiency?
Riboflavin
45
Magenta tongue is due to what deficiency
Riboflavin
46
Glossitis is due to what deficiency?
Niacin Folate B12
47
Bleeding gums could be deficiency of
Vitamin C
48
Angular stomatitis (inflammation and small cracks in the corners of the mouth) and cheilosis ( cracks in corners of mouth)could be signs of what deficiencies?
B complex especially riboflavin Iron Protein
49
Loss of lower extremity deep tendon reflexes could be due to what deficiencies?
Thiamin | Vitamin B12
50
Calf pain could be due to what deficiency?
Thiamin
51
Joint pain or arthralagia could be due to what deficiency?
Vitamin C
52
High white blood cell count or leukocytosis can
suggest an inflammatory response 3.5 to 10.5 billion cells/L
53
Nitrogen balance equation
Protein/6.25. - (urine urea nitrogen + 4)
54
Schillings test helps identify the cause of what vitamin deficiency?
Vitamin B 12
55
EFA deficiency is determined by checking
Triene:tetraene ratio and it would be more than 0.2 to 0.4 1 to 3 weeks of fat free PN
56
To prevent EFA deficiency provide this much if linoleic and linolenic....
1 to 2 % of linoleic | and 0.5% from linolenic
57
Selenium deficiency
Can cause cardiomyopathy
58
Ileostomy output contains high amounts of
Sodium
59
Magnesium is absorbed where?
Distal jejunum And ileum
60
Hyperkalemia can be caused by
Metabolic acidosis Which shifts potassium from intracellular to extracellular causing increased k in serum. So correct the acidosis with acetate that converts it to bicarbonate and corrects the acidosis
61
Hyperglycemia is associated with what type of sodium/fluid balance?
Hypertonic hyponatremia. It shifts water from intra cellular to extracelluar space ( where sodium is) and dilutes sodium.
62
If a pt. also has Hypokalemia also asses:
Assess for hypomagnesemia and if low correct magnesium first. Mg is important in the regulation of intracellular k.
63
Copper deficiency clinical signs can be similar to
B12 deficiency ``` Pancytopenia Neuro deterioration Sensory ataxia Lower limb spasticity Acral parthesias ( pins and needles sensation) ```
64
Visceral proteins are
Albumin half life 20 days Pre- albumin 2-3 days Retinol binding protein 12 hours All made n the liver Not good to assess in liver dz except can indicate severity of the disease.
65
Lactic acidosis can be the result of what vitamin deficiency
Thiamin
66
Vitamin D deficiency can be shown as
Less than 20 no/mL Muscle weakness Increased production of parathyroid hormone ( reduced excretion) Increased serum lipids Hypertension due to increased renin activity
67
Parkinson’s pt on levodopa needs to avoid what vitamin or foods with high amounts of this vitamin?
``` B6 or pyridoxine Beef liver Organ meats Starchy vegetables Potatoes Fortified cereals Non citrus fruits ```
68
Sarcopenia
Loss of lean body mass and strength
69
Marasmus
Loss of somatic muscle Gradual wasting of body fat Preservation of visceral proteins
70
Kwashiorkor
Visceral protein wasting (decreased albumin) | Preservation of fat and somatic muscle
71
Elderly
Increased fat oxidation | Lower glucose oxidation
72
Acute phase response effect on iron and transferrin is
Decrease iron | Increase ferritin
73
Folate is resorbed by
Enterohepatic circulation: liver to the bile, followed by entry into the small intestine, absorption by the enterocyte and transport back to the liver.
74
Acute phase response does what to iron and ferritin?
Decrease iron | Increase ferritin
75
Folate is resorbed via
Enterohepatic circulation
76
Stress and trauma increases
Cortisol Epinephrine Growth hormone Glucagon Increase liver glucose production Increased protein breakdown from muscle Increased fatty acid oxidation
77
Ileal brake
Dietary fiber in distal ileum causes delayed gastric emptying
78
Half life of transferrin
8 to 10 days Iron transport protein The saturation can indicate iron deficiency
79
Body is ? Water
2/3 ``` Three compartments if total body water Intracellular ...2/3 Extra cellular ...1/3 of this 1/4 is intravascular and 3/4 interstitial Trans cellular only 3% ``` Intravascular means fluid in veins Interstitial means fluid between veins and cells
80
Vitamin b 12 is absorbed in the
Distal ileum
81
Folic acid is absorbed in the
Proximal small intestines via carrier mediated process.
82
Parietal cell secrete
Intrinsic factor to bind to b12 which is absorbed in the distal ileum
83
Primary intracellular osmole is
Potassium
84
Primary extra cellular osmole is
Sodium
85
Hypotonic fluids move water
2/3 move to ICF and 1/3 ECF then 1/4 intravascular area in the vessels 3/4 interstitial which is area around a cell
86
Hypertonic fluids move
Movement of water out of cells
87
Isotonic fluids
All goes to ECF and then divides to interstitial and intravascular
88
Avoid dextrose solutions when treating Hypokalemia
As dextrose prompts insulin which will promotes an intracellular shift of potassium.
89
Magnesium absorption
Distal jejunum and ileum
90
Corrected total calcium equation
[Measured calcium in mg/dL ]+ 0.8 x [4-alb in g/dL]
91
Metabolic alkalosis can do what to ionized calcium?
Decrease An increase in phosphorus can decrease ionized calcium too
92
Body fluid normal pH
6.8 to 7.8
93
Regarding acid base balance in the body only the kidneys can
Regulate Alkaline substances in the blood and eliminate metabolic acids from the body.
94
Kwashiorkor is characterized by
Edema, ascites, easy hair pluckability as well as well nourished appearance
95
Which vitamins can reduce plasma homocysteine concentration which indication increased risk for CAD?
Folate B6 B12
96
Iron is absorbed in ferric or ferrous state?
Ferrous state in the proximal jejunum. Gastric acid is important in maintaining iron in the ferrous state.
97
In PKU what amino acid is in the special formulas?
Tyrosine as there isn’t the phenylalanine enzyme hydroxylase to convert phenylalanine to tyrosine

Nutrition Support (7 decks)

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