Malnutrition- Exam 1 Flashcards by Johannah Crumpton

______ general state of inadequate nutrient and/or energy intake and absorption to meet metabolic demands.

malnutrition

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malnutrition can be defined as ?????

“Not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat

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What are the causes of malnutrition?

poor intake
poor absorption
increased metabolic needs

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___ of deaths in children worldwide under 5 years of age have been linked to undernutrition

45%

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What are some impacts of malnutrition?

low mood
weight loss
low energy
muscle wasting
increased risk of fractures
increased risk of hospital admissions
confusion
infections
reduced independence
increased risk of falls
reduced mobility

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About ___ of households had “low” or “very low” food security
Jumps to ____ when looking only at households with children

13%

17%

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Estimated that up to ____ of US adults do not consume adequate amounts of the nutrients that they need, on a regular basis, to support optimal health

85%

specially fiber, vitamins, minerals, omega 3 FA

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What are some screening tools that screen for malnutrition?

Subjective Global Assessment (SGA)
Malnutrition Universal Screening Tool (MUST)
Malnutrition Screening Tool (MST)

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Types of screening tools: ______: combines hx, ROS, and PE findings
Categorizes pts as well-nourished, mild-moderately malnourished, or severely malnourished

Subjective Global Assessment (SGA)

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Types of screening tools: ______: Utilizes BMI, unintentional weight loss, and effects of acute disease to determine risk for malnutrition
Offers recommendations based on risk level

Malnutrition Universal Screening Tool (MUST)

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Types of screening tools: ______: Simple, 2-question screen to determine risk of malnutrition

Malnutrition Screening Tool (MST)

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Name some H&P findings that can help reflect nutritional status

Nutritional habits and intake (“picky eaters”)
Social questions - to determine food security
Psych history
Baseline “usual” weight compared to current
Percent usual weight - (actual weight ➗ usual weight) x 100

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How do you screen young children for malnutrition?

body length and head circumference

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**Cell with ???? are better ways to check for malnutrition. Give some examples

rapid turnover rate or high metabolism

Integumentary - skin, hair, nails, mucosal membranes

Hematopoiesis - immunosuppression, anemia, bleeding or bruising

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What are some physical screening processes that you can do to test for malnutrition?

skinfold thickness

midarm muscle circumference

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In men, what does the triceps skinfold thickness need to be? in women?

thickness < 12.5 mm = malnutrition, > 20 mm = overnutrition

thickness < 16.5 mm = malnutrition, > 25 mm = overnutrition

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In midarm muscle circumference, the value needs to be ??? in order to be considered malnutrition?

less than 15th percentile

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How do you assess underweight in children?

growth charts or failure to thrive

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____ is considered low height for age

____ is considered low weight for age

stunting: height

wasting: weight

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T/F: Every malnourished pt is underweight

FALSE!! Not every malnourished patient is underweight

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______ is considered the gold standard imaging tool for malnutrition. Not used very often

DEXA scan

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With labs associated with screening for malnutrition need to assess for ___ and _____

somatic and visceral proteins

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Somatic proteins assess ?????. What is a way to test for it?

relative state of skeletal muscle mass

24 hour urinary creatinine excretion

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Name 4 visceral proteins

albumin, transferrin, prealbumin, retinol-binding protein

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_____ is the most commonly used visceral protein. What is the 1/2 life?

albumin 20 days

Name some clinical scenarios in which albumin might be low?

low in acute sepsis and liver disease

_____ is more useful in a very acute malnourishment. What is the 1/2 life?

prealbumin also depressed in acute stress states 2 days

_____ is elevated in iron deficiency states. What is the 1/2 life?

transferrin 8-10 days

What labs would you want to order?

CBC, CRP, ESR Urinalysis +/- Urine culture

order ____ to screen for anemia, chronic infection, inflammation, cancer

CBC, CRP, ESR

order _____ to evaluate for kidney disease and chronic UTI

Urinalysis +/- Urine culture

Order ____ to test for amylase, lipase, +/- C peptide

pancreatic testing

_____ nutrient reference values developed by the Institute of Medicine to quantify recommended levels of a given nutrient necessary for optimal health based on a patient’s individual characteristics (e.g. height, gender, activity level)

Dietary reference Intake (DRI)

_____ average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals in a particular life stage and gender group

Recommended Dietary Allowance (RDA)

_____ recommended average daily intake level based on approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate

Adequate Intake (AI)

use _____ with an RDA cannot be determined

Adequate Intake

_______ average daily nutrient intake level estimated to meet the requirement of half (50%) the healthy individuals for a particular life stage and biologic sex

Estimated Average Requirement (EAR)

______ EAR specifically used for energy - average dietary intake predicted to maintain energy balance in healthy individuals of a given age, gender, weight, height, and physical activity level consistent with good health

Estimated Energy Requirement (EER)

EER includes extra metabolic needs during ?????

pregnancy, lactation or childhood

T/F: There is no upper intake level (UL) or recommended dietary allowance (RDA) for energy

True

_____ highest average daily nutrient intake level likely to pose no risk of adverse health effects to almost all individuals in the general population

Tolerable Upper Intake Level (UL)

_____ energy expenditure needed to sustain the metabolic activities of cells and tissues, blood circulation, respiration, GI and renal processing, and staying awake. How is it determined?

Basal Metabolic Rate (BMR) subject reclining after a 12 hour fast

What is the difference between BMR and BEE?

Basal energy expenditure (BEE) - BMR extrapolated to 24 hours

______ Similar to BMR; accounts for energy expenditure increases due to recent food intake or recently completed physical activity

Resting Metabolic Rate (RMR)

The RMR is ______ than BMR on average

10-20% higher

What is the difference between RMR and REE?

Resting energy expenditure (REE) - RMR extrapolated to 24 hours

What is the clinical presentation of malnutrition?

iron deficiency, folate, vit D, B vitamins, Vit A, Iodine deficiency

Malnutrition in underdeveloped countries tends to show up as ____ and _____

Vit A and iodine deficiencies

_____ is the most common deficiency in the US

folate deficiencies

_____ state of protein and total energy malnutrition body’s requirements for calories are not met by intake

Marasmus

**Relatively large head with large, staring eyes Emaciated, weak appearance Thin, dry skin with thin, sparse hair that is easily plucked Shrunken arms, thighs, and buttocks with redundant skin folds Bradycardia, hypotension, hypothermia Irritable, fretful demeanor What am I?

marasmus

_____ protein malnutrition in the presence of caloric intake. Classically seen in babies weaned from the breast in low-income countries

Kwashiorkor

Growth retardation Changes in skin and hair pigmentation, and thin, dry, peeling skin Low serum albumin Bradycardia, hypotension, and hypothermia Distended abdomen with dilated intestinal loops May see hepatomegaly from fatty liver infiltrates Lethargic, apathetic, irritable Classic edematous appearance What am I?

Kwashiorkor

________: multifactorial wasting syndrome defined by continuous loss of skeletal muscle mass, with or without loss of fat mass

Cachexia

Can cachexia be fully reversed?

Cannot be fully reversed by conventional nutritional support

Cachexia affects ____ of cancer patients

50-80% of cancer patients

Cachexia is thought to be tied to ______

mitochondrial dysfunction

Mitochondrial dysfunction _____ ATP and protein synthesis. ______ oxidative stress in the body. _____ inflammatory markers

Decreases Increases Elevated

Enteral feeding includes _____ and _____ tubes. Give some examples

oral and feeding NG tubes PEG tubes

How is parenteral nutrition usually delivered? When is it indicated?

usually delivered through a central line only indicated if the gut is not working

What does parenteral nutrition carry a higher risk of ??

bacteremia and sepsis, poorer weight gain

_____ : fever, HSM, and coagulopathy due to fat sludging

Fat overload syndrome

_____ is associated with bone metabolism disease in children with long-term use

parenteral nutrition

What are some helpful principles of low appetite/anorexic patients?

Frequent spacing of small meals Prioritize energy-dense foods Avoid distractions during mealtime Powdered or liquid nutritional supplementation Pediasure, Ensure, protein powders Adding calories and nutrition to preferred foods

T/F: All dietitians recommend powdered or liquid nutritional supplementation to help anorexic patients?

False: Controversial - not always shown to reduce hospitalizations, survival, QOL

_____ sweating, flushing, dizziness, and tachycardia caused by large amounts of foods (especially high intake of simple sugars) moving rapidly from the stomach into the bowel. How do you prevent it?

Dumping syndrome Slow infusion rate and amount of feeding given at one time

_____ synthetic progestin which has been found to promote appetite

Megestrol acetate (Megace)

_____ is used in anorexic/ cachexia associated with AIDS and cancer related cachexia (off label)

Megestrol acetate (Megace)

_____ 1st generation Antihistamine. Commonly given to pediatric patients.

Cyproheptadine (Periactin)

MAOI therapy; urinary or gastric obstruction (BPH, stenosis, etc.); acute angle-closure glaucoma; gastric ulcer. premature infants, neonates, pregnant or breastfeeding women, elderly or debilitated patients These are the CI for _____

Cyproheptadine (Periactin)

______ Cannabinoid-derived agent (THC); can suppress N/V and promote appetite Used mostly in patients AIDS and patients on chemotherapy Controlled - Schedule III

Dronabinol (Marinol)

use of disulfiram or metronidazole in last 14 d; allergy to alcohol or sesame oil. These are the CI to ______

Dronabinol (Marinol)

GI upset, headache, insomnia, rash SE of _____

Megestrol acetate (Megace)

dizziness, drowsiness, anticholinergic These are the SE of _____

Cyproheptadine (Periactin)

euphoria, GI upset, dizziness, drowsiness, AMS These are the SE of _____

Dronabinol (Marinol)

**What is the major CI to Dronabinol (Marinol)?

allergy to alcohol or sesame oil

Malnutrition- Exam 1 Flashcards

(77 cards)