MD4900 Flashcards
(151 cards)
1
Q
Hamwi Method for IDW in lb and in
A
aka. Desirable body wt. (DBW). Men: 106lb for the first 5ft, plus 6 lb for every inch thereafter. Women: 100 lb. for first 5ft, plus 5 lb. for every inch thereafter. +/- 10% for range.
2
Q
How to convert inches to centimeters?
A
Inches X 2.54 = cm
3
Q
How to convert pounds to kilograms?
A
pounds ÷ 2.2 = kilograms
4
Q
Vitals signs
A
BP, radial pulse, temperature (looking for 24-hour range), respiration
5
Q
Blood pressure technique
A
Allow pt to rest 5 min. Take twice. Retake is high
6
Q
Normal/Abnormal blood pressure
A
120/80 is normal. High normal 121-130 & >85. Pre-HTN 131-139 or /85-89.
7
Q
Stages of HTN and their numbers.
A
Stage 1 (mild HTN) 140-159 or /90-99 Stage 2 (mod HTN) 160-179 or / 100-109 Stage 3 (severe HTN) 180 or > or /110 or >
8
Q
Normal Heart Rate
A
resting adult 60-100 bpm. resting child 75-130 bpm. Bradycardia: < 60 bpm. Tachycardia: > 100 bpm.
9
Q
Respiration Rate
A
Breaths per minute. Resting adult 12-20 bpm, resting child: 16-60 breaths/minute.
10
Q
Radial pulse technique
A
Count pulsations for 15 seconds, multiply by 4. If irregular, count for 60 seconds.
11
Q
Body Temperature
A
98.6 ºF via axilla; normal range is 97-100ºF via axilla.
12
Q
Defining wt in Pediatric Population
A
Percentile Cut-Off Value: < 5th percentile = underweight. ≥ 5th and < 85th = Healthy wt. ≥ 85th and < 95th = Overweight. ≥ 95th OR BMI ≥ 30 = obese
13
Q
What is the procedure for proper hand washing in the lab?
A
Wet hands with warm water. Apply soap. Lather for 15 seconds. Rinse & dry thoroughly.
14
Q
Nutritional Assessment
A
An evaluation of the nutritional status of individuals or populations through measurements of food & nutrient intake and evaluation of nutrition-related health indicators
15
Q
Nutritional & Physical Assessment
A
A comprehensive approach, completed by a registered dietitian, to defining nutritional status that uses: medical, nutritional, and medication histories (hx), physical exams, anthropometric measures, & lab values.
16
Q
Purpose of nutritional & physical assessment
A
To identify those at risk for becoming malnourished (either over or under fed). To identify those who are malnourished.
17
Q
Anthropometrics
A
Measurement of the physical dimensions and gross composition of the body. Reflects current nutritional status. Does not differentiate between acute & chronic changes.
18
Q
What are the types of anthropometric measurements?
A
Height, weight, BMI, circumferences skin folds, & body composition.
19
Q
Biochemical assessment
A
Measuring a nutrient or its metabolite in blood, feces, or urine or measuring a variety of other components in blood and other tissues that have a relationship to nutritional status.
20
Q
Example of biochemical assessment
A
Serum protein, serum lipids, hemoglobin / hematocrit, Iron status, Urinalysis
21
Q
Clinical assessment
A
The most practical method of assessment. Utilize physical signs known to be associated with nutritional status.
22
Q
Examples of clinical assessment
A
Medical hx. General clinical examination - hair, nails, gums, eyes, tongue, etc. Nutrition hx
23
Q
Dietary assessment
A
Involves surveys or records measuring the quantity of the individual foods, beverages, and perhaps supplements consumed during a specific time frame.
24
Q
Examples of dietary assessment methods
A
Dietary recall, food frequency, food record, observed food consumption, diet hx.
25
E is for Everything else
Anything that eventually would be used for understanding ABCSs. Examples: psychological state, social, behavioral, fitness - cardiovascular, strength, endurance, flexibility/balance.
26
Overweight
A body weight above some reference point of acceptable weight that is defined in relation to height.
27
Obesity
An excess of body fat in relation to lean body mass.
28
How to take proper measurement of ht?
Ideally in stocking feet, back against flat surface, deep breath, Frankfurt plane
29
How to take proper measurement of wt?
Wearing minimal clothing, no shoes, calibrated scale, should be in metric
30
Surrogate measures of height
Knee ht - elderly, tricky to get angle. Forearm length - good measure to detect growth. Arm span - very close for most.
31
Quetelet Index
aka BMI. kg/m^2
32
Advantage of BMI
A good measure of overweight in large population studies.
33
Disadvantage of BMI
Body composition not considered. ex. power lifters.
34
Head circumference
Screening tool for head & brain growth - important in 1st three years.
35
How to take head circumference?
Use Frankfort plane. Place tape measure around head snugly (no obstructions). Place just above supraorbital ridge & over occiput. Tape to be parallel to ground.
36
Location & how to for proper measurement of waist?
This is the NHANES location. Best due to bony marker. Top of iliac crest, parallel to ground, at end of exhalation. Measure to nearest 0.1cm with a linen tape.
37
Location & how to for proper measurement of hips?
Use linen tape, measure to nearest 0.1cm over little clothing. Measure at widest point either from front or from side.
38
5ft is ?cm & ? inches
60 inches = 152.5cm
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6ft is ? inches & ? cm
72 inches = 182.9sm
40
Knee height
Can also predict wt. Age, gender, ethnic specific. Is tricky to get angles correct.
41
Forearm Length
Pediatrics. Good measure to detect growth or total height. Ulna to radial notch
42
Equipment & how to for knee height
Subject in supine position, left leg at 90º. Calipers fixed blade under left heel, moveable blade on anterior of left thigh.
43
Arm Span
Generally within 3cm of standing ht, off by average of 7cm. Not appropriate for Afro-caribbean males.
44
Weight gain goal for Underweight clients?
Add 25% of the difference between current wt and appropriate weight to get to a higher actual wt.
45
How to calculate the 25% difference for Underweight client?
Ex. Client wt 60kg and should wt 80kg. Step 1: 0.25 (80-60) = 5kg. Step 2: 60kg + 5kg = 65kg
46
Weight loss goal for Overweight clients
Subtract 25% of the difference between current wt and appropriate wt to get a better 'intermediate' wt goal
47
How to calculate 25% wt loss goal for overweight clients
Ex. Client wt 80kg and should wt 60kg. 80kg - [0.25(80kg-60kg) = 75kg
48
How to calculate 'Appropriate wt' for an Amputee
Use charts that show percent of total wt represented by that body part. Ex. hand = 0.8%. Adjusted wt = [Current wt ÷ (100- % of amputation)] x 100
49
Korotkoff sounds
Are five, the sounds that occur when you listen for blood pressure.
50
The 1st Korotkoff sound
Is the snapping sound first heard at the systolic pressure. A clear tapping sound; onset of the sound for two consecutive beats is considered systolic.
51
The 5th Korotkoff sound
Is silence as the cuff pressure drops below the diastolic blood pressure. The disappearance of sound is considered diastolic blood pressure two points below the last sound heard.
52
Equipment used to take blood pressure.
Sphygmomanometer & Korotkoff sounds.
53
How to take blood pressure?
Subject should be seated quietly in chair for 5 minutes with feet on floor and arms supported at heart level. An appropriately sized cuff should be used.
54
Normal resting HR for adults & children?
60-100 beats /min. 75-130 beats /min.
55
Normal resting respiration rate in adults & children
12-20 breaths /min. 16-60 breaths /min
56
Normal body temperature?
98.6ºF. The normal range is 97º-100ºF
57
Clinical observations is?
A systematic examination of physical appearances, vital signs, & anthropometrics without appearance of judging the client.
58
Sign vs symptom
Signs are observations made by a qualified examiner. Symptoms are self-reported & can not be measured.
59
Height - weight tables
Are quick and convenient & both measures can easily be taken.
60
Elbow breadth
Used for determining frame size.
61
Body Composition
The description of component tissues & amounts that compose or make up the total body mass. The ratio of fat mass (FM) to fat-free mass (FFM). FM (kg) + FFM (kg) = Total Body wt (kg).
62
Fat Mass
Contains little water, cannot conduct electricity. Resists electrical current, subcutaneous layer (1/2 under skin), diffracts x-rays, floats when in water.
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Lean Mass
Composed of significant water and electrolytes. Conducts electricity, composed of electrolytes, diffracts x-rays, sinks in water.
64
Density of lean body tissue
= 1.10g/cm^3
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Density of Fat tissue
D = 0.900 g/cm^3
66
Which methods of body composition are bases on displacement measurements?
Hydrodensityometry (under water weighting) and Air Displacement Plethysmography
67
Field methods of Body Composition?
Relatively easy, cheap, and quick. Skin folds &/or circumferences. Bioimpedance, Near-Infrared Interactance
68
Laboratory Methods of Body Composition?
More precise, but require techinical skill, expensive, equipment needs maintained. Hydrodensitometry. Plethysmography. DXA. Others: MRI, CT, Isotope dilution
69
Limitation of field methods of body comp?
Requirers participation of the client. Ethnic calculations? Not as precise, make assumptions. Could be time consuming. Practitioner needs skill and understanding.
70
Limitations of lab methods of body comp?
Requirers participation of the subject. May provide radiation, or require risk. Can be costly to clients. Equipment is expensive. Technical skill required to run.
71
Assumption that BIA makes about conductance in the body?
That body water conducts electricity & fat does not.
72
Requirements of the BIA process
Well hydrated, no lrg meal within 2-4 hours, no exercise within 12-24 hours. Properly placed electrodes, arms & legs do not touch trunk (i.e. create correct cylindrical electrical circuit).
73
BIA equipment delivers how much electricity?
50kHz, or 800mA of current to the body.
74
What does BIA assess?
Resistance (R), usually between 400-600; and Reactance (Xc) usually between 50-80.
75
Skinfold equations assume?
50% of the fat is subcutaneous, the rest is visceral. Standard sites are used, equations are gender, age, ethnic specific and require a density calculation.
76
Limitations of SKFs
Require significant skill, not all equations apply to all people (inappropriate for obese), big assumption about 50% subcutaneous fat.
77
Advantages of SKFs
Cheap method - except for training. Can be done anywhere. Also, demonstrates distribution of fat.
78
How long do you wait before reading the SKF caliper
4 seconds.
79
Circumferences are best used in what population?
Overweight and obese. Circumferences are used to describe fat distribution.
80
Advantages of circumferences?
Cheap and easy, but some skill is needed.
81
Disadvantages of circumferences?
Few equations are validated against sophisticated method.
82
Air Displacement Plethysmography (ADP)
aka. BODPOD. Estimation of body density assessed by air displacement. Measures the change in air pressure. Determines body volume (BV), which is used to calculate body density (Db).
83
How is density calculated from the subjects V in ADP
Boyle's Law. D = m/V
84
Density equations for % body fat depend on?
Ethnicity and gender. The most appropriate must be selected.
85
Being prepared for the BodPod?
Four hour fast (including fluids). Emptying of bladder & bowels. No exercise for 4 hours. Proper attire to decrease adiabatic air.
86
What body comp numbers does the BodPod give?
Lean mass in kg and % total mass. Fat mass in kg and % of total mass.
87
Advantages of BodPod
Non-invasive, limited subject participation, easier, can be used in obese population.
88
Limitations of BodPod
Claustrophobic, specific clothing must be worn. Lung V must be measured to be most accurate. Limited validation. Cost. Skilled tech required.
89
Dual Energy X-Ray Absorptiometry (DXA)
aka. bone densitometer. Uses x-ray technology to produce image of the body, it differentiates bones and soft tissue (fat vs. lean).
90
How DXA works?
Sends a thin, invisible beam of low-dose x-rays through the body. One is absorbed by fat and diffracted by lean mass and vice versa. Total mass (g) = Bone mass (g) + soft tissue (g).
91
Requirements of participant in DXA
No metal, remain still for 7-13 min.
92
DXA results
give body composition - plots vs NHANES or WHO. Bone mineral density - T & Z-scores.
93
T-score
Compares subject's BMD to that of a young adult with peak bone mass (same gender). Used to predict risk of fracture.
94
Z-score
Comparison to same age/gender group.
95
Advantages of DXA
Is the gold standard for bone density, but not body comp. Non-invasive. Instant results. Delivers little radiation
96
Disadvantages of DXA
Expensive. Delivers radiation. Must remain very still. Bigger subjects require more time. Not all population can be scanned.
97
How do we get actual numbers for body composition?
Determine D of the body Db. Calculate FM and FFM from equations - determine one from the other by subtracting fro 100.
98
Siri equation
Useful in the general population. % body fat = (495/Db) - 450
99
Jackson Plollock equation
Uses 3, 5, or 7 skinfold site measurements to determine Db, and % FM.
100
The 3 steps to go from Skinfold number to body composition (%fat or %lean)?
1. Determine density of the body (Db). 2. Use equation that takes density and calculates FM or FFM. 3. Determine the other (FM or FFM) by subtracting from 100.
101
What are the Suggested Values for % body fat classifications from Am Council on Exercise?
Essential Fat 2-5%M, 10-13%W. Athlete 6-13%M, 14-20%W. Fitness 14-17%M, 21-24%W. Average 18-24%M, 25-32%W. Obese >25%M, >30%W.
102
T-score values
Normal: -1 or greater. Osteopenia: -1 to -2.5. Osteoporosis: -2.5 of less. Severe Osteoporosis: -2.5 of less & fragility fracture.
103
BodPod Measurement Procedure
1. Volume/Pressure of empty chamber. 2. Pressure w/ cylinder of known volume. 3. Pressure & V of subject in chamber. 4. Measured lung capacity (to correct for residual V).
104
The effect of adiabatic air in the BodPod
Adiabatic air is not fully compressed creating a falsely higher V reading which = a smaller density.
105
Calorimetry
The process and measurement of calorie (kcal) requirements.
106
Total Energy Expenditure (TEE)
kcal needed to remain wt stable. = RMR + SDA (or TEF) + PA + ?(ex injury).
107
Direct Calorimetry
A direct measurement of heat given off by the body. Also measure CO2 and O2 and methane.
108
Assumptions the Direct Calorimetry makes?
All heat production by humans can be counted. Heat given off or lost is a measure of kcals needed for life of body.
109
Advantages of Direct Calorimetry?
Current technology captures well; Very accurate; measures person over a full 24hr period for most accuracy. Is able to measure TEE.
110
Limitations of Direct Calorimetry?
VERY costly. Requires highly skilled engineers.
111
Indirect Calorimetry
A measure of a surrogate of heat; O2 and CO2.
112
Assumptions made by Indirect Calorimetry
Calorie expenditure is equated to volumes of gases used and expired.
113
Advantages of Indirect Calorimetry?
Easier, less costly than direct. Good precision & relatively quick. Measures RMR. Able to use in ventilated pts.
114
Limitation of Indirect Calorimetry?
Can be expensive, best with both gas analyzers. Must have controlled environment & participant must comply with requirements and be still during measurement.
115
General requirements for RMR measurement conditions (of subject)
Resting prior to test ∿30min. Fasted state: ∿12 to 16 hours. No exercise in past 24 hours.
116
Factors that increase RMR
Gender, PA, drugs, nicotine/caffeine, muscle mass, diet (small frequent meals), illness, stress, injury.
117
Factors that decrease RMR:
Age, sedentary lifestyle, caloric restriction, loss of lean mass (wt loss)
118
What is RQ?
A numerical ratio between CO2 and O2 typically between 0.7 & 1.0. It can be used to determine fuels being used by body. = VCO2/VO2. aka. Respiratory exchange ratio.
119
RQ for fat burning etc.
Fat = 0.7-0.8. Mixed = 0.8-0.9 (includes PRO). CHO = 0.9-1.0. Fat being synthesized = >1.0
120
Isotope Dilution (DLW)
aka doubly labeled water. Is a measure of CO2 loss as it reflects metabolism.
121
Assumptions of DLW
Deuterium, and O-18 are stable isotopes. Hone H & O are 'labeled' and ingested, we lose them as parts of water and CO2. The latter reflects oxidation of foods and the energy production. Measure in urine and derive CO2 and thus RMR.
122
Advantages of DLW
Easy, VERY accurate, drink water with isotopes. The gold-standard.
123
Limitations of DLW
Expensive to buy isotopes and analyze samples. Cannot study a specific event, must assess over time periods (∿10 days). Still assumes O2. No radioactivity.
124
Advantages of using equations for RMR
Easy to use, especially for healthy individuals. Quick
125
Limitations of equations for RMR?
Often need additional factors added. We have TEE equations that use RMR equations. Add activity factors and TEF factor. Need more information for ill pt.
126
Simplest Rule of Thumb for estimating RMR
= 10 x BW(lb)
127
Another rule of thumb method for RMR
Male = 1.0 kcal/kg/hr. Female = 0.9 kcal/kg/hr
128
How do you go from REE to TEE?
Use REE and add: PA factor, TEF factor (actually included in REE. May need to add factors for lactation, pregnancy, disease; or remove for wt loss.
129
Rule of Thumb used in hospitals for adults for REE?
25-35 kcal/kg/day.
130
Urinalysis Strips
Use colorimetric reactions to test for proteins of other chemicals that should not be in the urine.
131
What is Urinalysis used for
It is a point of care assessment used to screen for renal /metabolic disease, to monitor kidney, liver, or urinary tract disease, check status of diabetics.
132
Turbidity of urine may indicate
Cloudiness or thickness may indicate cells or crystals in the urine.
133
Microscopic inspection of urine may reveal presence of
RBCs, WBCs, epithelial cells, casts, bacteria, yeast, crystals.
134
Five components of Physical Fitness
Cardiovascular fitness, muscle strength, muscle endurance, body composition, diet.
135
What does Core Strength tell you about a client?
Says something about ability to heal and exercise. Aging decreases strength/balance, muscle mass, and walking speed.
136
Hand Dynamometer
Hand strength correlates with total body strength /endurance.
137
What are the various grips?
Crush, pinch, support.
138
Hand strength measurement associated with?
Diseases (i.e. arthritis). Progression of disease. Rehab from illness. Decline with age.
139
Benefits of flexibility
Greater freedom of movement. Improved posture, balance, blood flow. Increases physical & mental relaxation. Releases muscle tension & soreness. Reduces risk of injury (especially from falling).
140
Arm muscle area
Used as an index of lean tissue or muscle in the body.
141
cAMA equation
= [MAC - (3.14 x TSF)]^2 ÷ (4 x 3.14). Measurements are in cm
142
Subjective Global Assessment (SGA)
Is a clinical technique for assessing the nutritional status of a pt based on features of the pt's hx and physical exam. Integration of historical and physical data.
143
Elements of pt's hx in SGA
wt loss, change in dietary habits, GI symptoms, pt's functional status (energy level).
144
Elements of pt's physical data in SGA
Loss of subcutaneous fat, muscle wasting, presence of edema or ascites,
145
Significant wt loss in SGA
wt loss > 10% in the last 6 months. % wt chg = (wt 6 mo. ago - current wt) /wt 6 mo. ago
146
Final step in SGA
Rating of nutritional assessment. Rank A = well nourished. Rank B = moderately malnourished (or suspected of). Rank C = severely malnourished.
147
Rickets is associated with which nutrient deficiency?
Vit D
148
Which nutrient deficiency are related to the mouth?
Vit C, B Vits. Eventually iron and protein.
149
Which nutrient deficiencies are related to the mouth and tongue?
B vitamins. Vit C. Eventually iron and protein.
150
Which nutrient deficiencies are related to the fingernails?
Iron - spoon nails. Protein - traverse ridging. Chromium
151
Which nutrient deficiencies are related to the skin?
Vit A, C, K. Essential fatty-acids, protein, niacin. Also excess Vit A
