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Nutrition Assessment Overview Flashcards

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1
Q

What compromises the reliability of urinary urea nitrogen to calculate nitrogen balance

A

creatinine clearance <50mL/min

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2
Q

What micronutrient has been shown to decrease plasma homocysteine concentrations

A

folic acid

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3
Q

hyperhomocysteinemia concentrations has been associated with an increased risk of

A

atherosclerosis

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4
Q

which three micronutrients can be supplemented to decrease homocysteine levels in plasma to decrease the risk of atherosclerosis

A

folic acid, vitamin B12 and vitamin B6

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5
Q

what is the most appropriate fluid requirement for a healthy 78 year old adults

A

25mL/kg/day

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6
Q

what is the recommended fluid requirement for healthy adults between the ages of 18-55

A

35mL/kg/day

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7
Q

what is the recommended fluid requirement for adults between the ages of 55 and 75 years old

A

30mL/kg/day

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8
Q

what is the recommended fluid requirement for adults with fluid restriction such as CHF

A

25mL/kg/day

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9
Q

What enzyme initiates the digestive process of carbohydrates in the mouth

A

salivary amylase

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10
Q

Lipase is an enzyme released by the pancreas that helps the digestion of

A

fat

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11
Q

Lactase and Maltase are enzymes located in the ______ of the small intestine to aid in intraluminal carbohydrate digestion

A

brush border

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12
Q

Iron is primarily absorbed in the __________ and ________ in the _______ state. Gastric ____ is very important in maintaining dietary iron in the _____ state

A

duodenum and jejunum
ferrous
acid
ferrous

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13
Q

What amino acid is most crucial in small intestine structure and function

A

glutamine

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14
Q

In persons with phenylketonuria (PKU), tyrosine becomes an essential amino acid due to a deficiency of

A

the phenylalanine hydroxylase enzyme

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15
Q

Phenylalanine Hydroxylase catalyzes the hydroxylation of phenylalanine to _______, so phenylalanine levels become _____ and _____ levels are decreased

A

tyrosine
elevated
tyrosine

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16
Q

Conditionally essential amino acids are synthesized from other amino acids under normal conditions but require increased needs from dietary sources during ________. For example, arginine becomes conditionally essential for _______ and _____ during trauma

A

stress
wound healing
glutamine

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17
Q

glutamine becomes conditionally essential during

A

trauma

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18
Q

arginine becomes conditionally essential during

A

wound healing

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19
Q

What are the conditionally essential amino acids

A

arginine, cysteine, glutamine, glycerin, proline, tyrosine

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20
Q

An NPO post operative patient has been on 2 in 1 PN for 3 weeks. He develops hair loss, diffuse scaly dermatitis, anemia and thrombocytopenia. What is the probable cause

A

he has not been getting ILE for 3 weeks

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21
Q

Provision of fat free PN for ____ weeks has resulted in essential fatty acid deficiency

A

3 weeks

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22
Q

Essential Fatty Acid deficiency usually results after ___ weeks of fat free PN, although signs and symptoms of deficiency can be as early as ___ to ____ days

A

10-20 days

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23
Q

what are the signs and symptoms of EFAD

A

alopecia, scaly dermatitis, impaired wound healing, anemia, thrombocytopenia

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24
Q

Provide __ to ___% total calories from ____ or ____ ILE to prevent EFAD

A

4-10% total calories

soy of safflower oil ILE

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25
Which IV fluid most closely resembles jejunal and ileal electrolyte content
lactated ringers
26
Fluids and electrolytes of the jejunum contains ____ mEq of sodium, ___ mEq of potassium, ___ mEq of chloride and ____ mEq of bicarb
95-120 mEq of sodium 5-15 mEq of potassium 80-130 mEq of chloride 10-20 mEq of bicarb
27
Fluids and electrolytes of the ileum contains ____ mEq of sodium, ___mEq of potassium, ___ mEq of chloride and ___ mEq of bicarb
110-130 mEq of sodium 10-20 mEq of potassium 90-110 mEq of chloride 20-30 mEq of bicarb
28
Lactated Ringers IV solution contains ___ mEq/L of sodium, ___ mEq/L of potassium ____ mEq/L of chloride, ____ mEq/L of lactate and ___ mEq/L of calcium
``` 130 mEq/L of sodium 4 mEq/L of potassium 109 mEq of chloride 28 mEq/L of lactate 2.7 mEq/L of calcium ```
29
Normal saline contains ___ mEq/L of sodium, ____mEq/L of chloride
154 mEq/L sodium | 154 mEq/L chloride
30
Half Normal saline contains ___ mEq/L of sodium and ____ mEq/L of chloride
77 mEq/L sodium | 77 mEq/L chloride
31
Dextrose and half normal saline contains ____ g/L of glucose, ___ mEq/L of sodium and ____ mEq/L of chloride
50 g/L dextrose 77 mEq/L sodium 77 mEq/L chloride
32
What are the clinical symptoms of inappropriate diuretic hormone (SIADH)
increased urinary sodium hyponatremia increased urinary osmolality
33
a disorder of sodium and water balance caused by inappropriate release of anti-diuretic hormone which causes increased total body water which causes dilution hyponatremia
SIADH
34
In SIADH, increased sodium and osmolality of the urine is due to
excessive water retention/re-absorption
35
In SIADH to compensate for the expansion of the extracellular fluid, aldosterone secretion is inhibited to maintain
euvolemia
36
A 45 year old patient with chronic corticosteroid use has suspected vitamin A deficiency. Supplementation of vitamin A (3,000 to 5,000 IU) should be given at a max of ____ days
7 days
37
what are the main functions of vitamin A
wound healing, cell differentiation, and collagen synthesis
38
what is the typical dose for vitamin A supplementation
3,000 to 5,000 IU for 7 days
39
when should vitamin A be supplemented
to enhance wound healing with corticoid steroid therapy
40
Corticosteroid therapy has been shown to decrease vitamin ______
vitamin A
41
A patient with alcoholism is admitted with a small bowel obstruction and is started on PN. The PN provides 400 grams of dextrose, If after 3 days, the patient develops mental status changes, it is most likely due to a deficiency of
thiamine
42
alcohol related thiamine deficiency presents as
Wernicke's Encephalopathy
43
Symptoms of Wernicke's Encephalopathy are
mental status changes, confusion, nystagmus, gait ataxia
44
The glucose load in PN is associated with PN increases metabolic demand for ____ which is essential for glucose metabolism
thiamine
45
Lactic acidosis can be a result of which vitamin deficiency
thiamine
46
Thiamine is required for ____ metabolism. When Pyruvate is converted to acetyl CoA. If thiamine is not present, pyruvate will convert to production of _____ fermentation
glucose | lactic acid fermentation
47
In addition to aggressive refeeding, what else places patients at high risk for hypophosphatemia
DKA
48
Which patients are at the highest risk for hypophosphatemia
malnourished, DKA, chronic alcoholism, respiratory and metabolic acidosis, critical illness
49
Insulin is an anabolic hormone that drives potassium and phosphorous into the cells causing serum _____ of these electrolytes
depletion
50
in DKA, large amounts of ____ is lost in urine from the osmotic diuresis resulted from hyperglycemia
phosphorous
51
The risk of metastatic calcification in soft tissues begins to increase when the product of serum calcium and phosphorous exceeds
55 mEq
52
Hyperphoshpatemia can cause which issues
soft tissue and vascular calcification hyperparathyroidism renal osteodystorphy
53
Zinc deficiency is most commonly associated with
diarrhea
54
what are the functions of zinc
catalytic reactions structural function regulatory functions
55
When is additional zinc provision recommended
thermal injury (burns) excessive GI loss from diarrhea decubitus ulcers high output fistulas
56
Copper toxicity is associated with ___ disease
liver
57
what are the signs of copper toxicity
severe nausea, diarrhea
58
Copper toxicity can cause
``` Wilson's disease Coma Hepatic Necrosis Liver Failure Renal Failure Death ```
59
80% of copper is excreted via
bile
60
a patient with liver disease should be monitored and supplemented or be
decreased or eliminated
61
Hemolysis increases copper
loss
62
Enteral zinc supplementation can compete with ____ for absorption
copper
63
Hepatic encephalopathy is most likely to be improved by which trace element
zinc
64
Liver disease can cause altered ____ metabolism leading to decreased serum ____ levels. ____ supplementation has been shown to help in hepatic encephalopathy
zinc zinc zinc
65
In hepatic encephalopathy zinc should be supplemented in doses of ____ mg/day for 3 months
150 mg per day
66
What is the function of aluminum in PN solutions
Aluminum has NO KNOWN BIOLOGICAL function
67
Aluminum is only present in PN as
a contaminant
68
What can result in an invalid indirect calorimetry measurement
``` air leak chest tube leak extracorperoal membrane oxygenation hemodialysis FiO2 >60% in mechanically ventilated patients/spontaneously breathing patients reliance on supplementation oxygen unable to cooperate claustrophobia anxiety ```
69
How should a critically ill patient's energy delivery be modified in response to resting energy expenditure measured by indirect calorimetry
use the caloric target WITHOUT adding a stress or activity factor
70
in calculating energy delivery, should a stress or activity factor be added
no, it can result in overfeeding
71
A respiratory quotient of 0.87 most likely suggests
mixed substrate utilization
72
RQ measures CO2 _____ divided by O2 _____
CO2 produced | O2 consumed
73
An RQ 0.7 or less likely indicates and >1 likely indicates
hyperventilation , hypoventilation
74
An RQ of 0.71 indicates primarily ____ oxidation
fat
75
An RQ of 0.82 indicates primarily ____ oxidation
protein
76
An RQ of 0.85 indicates _____ oxidation
mixed substrate
77
An RQ of 1.0 indicates primarily ____ oxidation
carbohydrate
78
which predictive equation has demonstrated the greatest accuracy in estimating actual resting metabolic rate in healthy obese and non-obese adults
Mifflin St. Jeor
79
Cheilosis is a physical symptom associated with a deficiency of _____, which can include hyperemia, edema of the oral mucosa, angular stomatitis, or glossitis
riboflavin
80
Malnutrition is most common in which form of IBD due to its involvement in the small intestine where micronutrients are absorbed
Chron's Disease
81
A patient with end stage liver disease with refractory ascites awaiting liver transplantation is on PN due to intolerance to tube feeding. Sodium is 123 mEq/L. In addition to fluid restriction, what changes to his PN prescription is most appropriate?
restrict sodium | give 1.5 g/kg/day of protein
82
What is the dietary recommendations for patients on ascites
fluid and sodium restriction 1-1.5 g/kg/day of protein with cirrhosis
83
_______ nutrition formula should be used with patients who have ascites from ESLF to avoid further sodium and fluid overload
concentrated
84
Arginine supplementation should be used most cautiously in patients with
septic shock
85
arginine increases the production of ______ which causes vasodilation. Providing arginine during septic shock would further exacerbate ______
nitrous oxide | hemodynamic instability
86
the normal length of the small intestine in adults is about
300-600 cm long
87
when the small bowel is less than _____ cm, to an end jejunostomy/ileostomy, PN and hydration will likely be needed
120 cm
88
The presence of an ileocecal valve and colon significantly improves _____ , ______ and _____ absorption. If the ileocecal valve is left intact, a patient may NOT need PN with as little as 60 cm left of the small bowel
fluid, electrolytes, and short chain fatty acids
89
What is the primary fuel of colonocytes
short chain fatty acids
90
the three primary short chain fatty acids are
butyrate, acetate and propionate
91
short chain fatty acids can provide up to ______ kcals in short bowel syndrome
1,000 kcals
92
Dietary fat is predominantly absorbed in what part of the GI tract
duodenum and proximal jejunum
93
Gastrectomy patients are at risk for a deficiency of which vitamin
B12
94
___ is the total or partial removal of the stomach
gastrectomy
95
the _____ cells of the stomach produce intrinsic factor
parietal cells
96
Intrinsic factor aids in the absorption of ___ in the small bowel
vitamin B12
97
When the stomach is resected, there is no longer adequate intrinsic factor to bind is B12 and may result in
deficiency
98
what areas of the GI tract has the the LEAST impact on nutrient absorption and intestinal adaptation following significant intestinal resection?
jejunum
99
resecting the proximal bowel (duodenum & upper jejunum) is usually _____ tolerated than ilelal resection
BETTER tolerated because the ileum is good at adaptation of absorption of nutrients
100
the jejunum _____ adapt well when the ileum is resected
doesn't
101
preservation of the ____ is important as it slows intestinal transit allowing for better absorption of nutrients
ileocecal valve
102
The colon is critical for ___ and ____ absorption. patients without a colon are at increased risk for _____ but can salvage calories through _____________
water & nutrient absorption dehydration anaerobic bacterial fermentation of undigested carbohydrates into short chain fatty acids
103
During fasting, fuel oxidation shifts from carbs to mainly ____ oxidation
lipid
104
During fasting lipolysis will _____, glycogenesis will ____, gluconeogenesis and glucose oxidation will ______
Increase decrease decrease. The body increases lipid oxidation to provide the body with fatty acids for energy
105
how much fluid per day is required to maintain fluid balance in an average healthy adult
25-35mL/kg/day
106
Valproic acid has been shown to induce a deficiency of ______
carnitine
107
Valproic acid is a ____ drug and can cause a deficiency in carnitine
anti epileptic drug
108
Carnitine plays a role in fatty acid metabolism and is an essential cofactor in the elimination of ___ and ___ from the body
valproic acid and ammonia
109
carnitine supplementation should be considered for patients
in a coma, with elevated ammonia, have liver disease or with valproic acid medications >450mg/day
110
methotrexate acts by interfering with the normal intracellular metabolism of which of the following nutrients
folate
111
Methotrexate is a ____ drug and ______ analogue, so that it's binding sites are commentative
chemotherapeutic drug | folate
112
Methotrexate competes with folate for absorption to catalyze the function of the enzyme dihydrofolate reductase, which converts dihydrofolate to tetrahydrofolate, a cofactor for the production of purine synthesis making up ______
DNA
113
what vitamin absorption is most likely to be impaired with chronic use of proton pump inhibitors
B12

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