Introduction to Nutrition Flashcards Preview

DEMS: Unit IIb > Introduction to Nutrition > Flashcards

Flashcards in Introduction to Nutrition Deck (12)
Loading flashcards...

Situations that place patient at risk for nutritional problems

  • Factors/conditions in HPI/chief complaint: 
    • Impaired absorption: cystic fibrosis, celiac disease
    • Decreased utilization
    • Increased losses: blood loss, diarrhea
    • Increased requirements: growth, pregnancy, high metabolic rate, lactation, pulmonary/cardiac disease
    • High/low level of physical activity
    • Consider nutrient/energy inadequacies or excess: sodium, fats, etc.


Characteristics of a "very high risk" patient

  • Very young or very old
  • Underweight or recent loss of > 10% usual body weight, or both
  • Obese with central adiposity/insulin resistance
  • One consuming limited variety: inadequate or excessive intake of certain foods
  • Protracted nutrient losses: malabsorption, enteric fistulae, draining abscesses or wounds, renal dialysis, chronic bleeding or RBC destruction, history of bariatric surgery
  • Hypermetabolic states: sepsis, protracted fever, extensive trauma, burns
  • Chronic use of alcohol or meds with anti-nutrient or catabolic properties: steroids, antimetabolites (e.g. methotrexate), immunosuppressants, anti-tumor agents
  • Marginalized circumstances: impoverishment, isolation, advanced age, altered mental status including mental retardation
  • Middle aged adults at risk for heart disease
  • Post-menopausal women


3 methods of obtaining diet information: questions to be asked, content to be seeking

  1. Qualitiative: screening questions/comments - ranging from open-ended questions to more focused
    • Most open-ended --> tell me about your diet
    • More focused questions --> appetite specifics
    • Listen for variety vs. restriction, excess vs. inaequacy, issues relevantt o patient including saturated fats, calories, Na+, Ca2+
  2. Semi-quantitative: actual or estimates of intakes of food or nutrients - e.g. 24 hour recall, diet record
  3. Quantitative: diet record for one day or multiple days, comparison of nutrient intakes to recommendations


Nutrient requirement

  • Applies to groups, not individuals
  • Intake estimated to meet requirement defined by specific indicator of adequacy in 50% of individuals in life stage and gender group
    • Includes adjustment for assumed bioavailability of nutrient
    • Used to assess inadequte intakes and planning goal intake for mean intake of a group
  • Ex. need one orange slice/day to keep scurvy at bay


Nutrient allowance and RDAs

  • Applies to individuals, not groups
  • RDAs: average daily dietary intake level sufficient to meet the nutrient requirements of nearly all (95-97%) individuals in a life stage and gender group
  • Guidelines have less emphasis of prevention of deficiency and more emphasis on decreased risk of chronic disease and health promotion


3 applications of nutrition in medicine

  1. Public health issues --> addresses chronic disease
  2. Ambulatory medicine --> pregnancy, hypertension, diabetes, etc.
  3. Nutrition support/inpatients --> ICU, surgical, trauma, TPN, etc.


Components of nutrition assessment (4)

  1. History
  2. Anthropometrics
  3. Exam
  4. Labs


Role of history in nutrition assessment

  • Intake of food and nutrients relative to needs and risks
    • Meds and supplements
    • Allergies to drugs and foods
    • Family history including risk for diet-related chronic illness
    • Social history including diet, physical activity, habits, socioeconomic status
    • Review of systems including weight gain, increased losses, poor intake, systemic illness


Role of anthropometrics in nutrition assessment

  • Length/height
  • Weight
  • Head circumference in infants
  • Waist circumference


Role of exam in nutrition assessment

  • Clinical signs, especially in relation to:
    • Skin: acanthosis nigricans, skin breakdown, discoloring
    • Hair: hypopigmentation
    • Mouth: rapid turnover of cells
    • Extremities


Role of labs in nutrition assessment

Biochemical changes/levels


How to address dietary and lifestyle changes with a patient

  • Traditional dietary counseling
    • Focuses on what patients should be advised to eat
    • Concept of why they eat as they do and impediments to changing dietary behavior less understood, less emphasized
  • Failure to change diet in most patients is not result of inadequate motivation but of excessive difficulty/barriers
    • Only ways to achieve change: 
      • Reduce difficulty
      • Increase motivation further
    • Barriers to change typically >> factors contributing to motivation for change
  • All patients should receive at least some counseling to modify diet to promote health +/- to achieve specific therapeutic goals
  • Starting point is to ask patient to describe their diet and level of physical activity
  • Use motivational interviewing, assess confidence and conviction, stage of readiness, etc.