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Flashcards in Nutritional Assessment Deck (40)
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When should nutrition screening be done and who should do it? What is it for?

To identify individuals at risk of or who have poor nutritional status. Screening is preliminary, done by health care professionals of any kind. Should be done done within 24 hours of acute hospital admissions


What are some common criteria surveyed on a nutrition screening?

weight, skin integrity, diet, appetite, GI disturbances, dentition


What are the four categories of nutrition assessment?

A: Anthropometrics - physical measurements to determine body comp. Caution use with elderly / very sick
B: Biochemical tests - mainly assaying for protein status
N: Nutrition-focused physical findings
H: History - food/nutrition, medical, social, education


What is the cause of Kwashiorkor?

A protein deficiency, most often associated with the weaning of an older child off the breast when a sibling is born


What causes edema / ascites in kwashiorkor?

Loss of oncotic pressure in blood due to hypoalbuminemia


Why is fatty liver associated with kwashiorkor?

Lack of apoproteins to carry fats, causing hem to accumulate


What other symptoms are associated with kwashiorkor other than edema and fatty liver?

Patchy, scaly skin with loss of pigment (loss of keratin + collagen + pigment proteins), loss of hair, stunted growth, muscle atrophy


What are the symptoms of marasmus? What is the general underlying physiological process?

Severe muscle atrophy, severe stunted growth, impaired learning ability, lethargy, low body temp, GI tract atrophy.

->starvation lowers the BMR, growth, and response to infection


What is the difference in the speed and time of onset for marasmus + kwashiorkor?

Marasmus: Slow onset, seen at any age
Kwashiorkor: Rapid onset, seen in young children 1-3 years old


What are the weight ranges for kwashiorkor/marasmus?

<60% wt for age in marasmus, 60-80% weight for age in kwashiorkor


What are the common complications of kwashiorkor?

degradation of antibodies -> immunocompromization, dysentery -> intestinal inflammation leading to diarrhea, anemia

Ultimately the infections, fever, fluid imbalance, and anemia can cause heart failure / death


What is the treatment for kwashiorkor?

Rehydration + nutrition intervention, ANTIBIOTICS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Dis will be test question


What are the three types of malnutrition in adults? Which ones are associated with inflammation which should be treated first?

1. Starvation-related: chronic starvation or anorexia

2. Chronic disease-related malnutrition: organ failure, pancreatic cancer, rheumatoid arthritis

3. Acute injury-related malnutrition: trauma, burns, closed head injury

2/3 are inflammation related. 3 will have very severe inflammation.


What are the 6 criteria used for identification / diagnosis of malnutrition in adults?

1. Insufficient energy intake
2. Loss of muscle mass
3. Loss of subcutaneous fat
4. Presence of edema (fluid accumulation, local or general) which may be masking underlying malnutrition
5. Weight loss
6. Functional status characterized by hand-grip strength


What is the general Hamwi method formula?

For calculating ideal body weight
Women: 100 + 5 lbs for every inch over 5 ft
Men: 106 + 6 lbs for every inch over 5 ft

%IBW = Current wt / IBW x 100%


What adjustments do you make for frame size in the Hamwi method?

+10% to IBW for large frame, -10% for small frame, as determined by thumb and longest finger around spot just distal styloid process of ulna on the wrist.

Overlap = small
No touch = large


What adjustments are made in the Hamwi method for a spinal cord injury?

Paraplegia - subtract 5-10%
Quadraplegia - subtract 10-15%

from IBW


What is adjusted body weight used for??

Based on assumption that 25% of excess weight above IBW is lean body mass, and other 75% is adipose tissue. So you only want to nourish the 25% of lean body weight on top of their IBW.

Really only used if patient is >120% IBW


What are the underweight and starvation cutoffs for BMI?

<15 is starvation, <18.5 is underweight


What are the overweight + obesity cutoffs for BMI?

>25 = Overweight
>30 = Obesity - Type 1
>35 = Obesity - Type 2
>40 = Obesity - Type 3


What are general cautions when using BMI?

1. Originally for population studies
2. Does not take into account frame size.
3. Children should have separate standards
4. Overweight category is healthiest for elderly population


What is meant by current weight status? What is the calculation?

Their weight changes since last visit. Need to determine their % weight change since last visit. Subtract this visit's weight from usual, and divide by their usual weight. Multiply by 100. Positive % = weight loss


Who is at risk for involuntary weight loss and why does this matter?

Burn / trauma victims, spinal cord injuries, surgical patients, and people in nursing homes.

Matters because it's a major risk factor for malnutrition. Should not be losing >10% of their body weight in 6 months, or >2% in 1 week, very short term.


What is the purpose of the skin fold assessment?

Easy to do, non-invasive. About 50% of body's fat will be subcutaneous


What does the triceps skin fold work in conjunction with?

Mid-arm circumference, which helps you calculate their muscle circumference.


What test is used to assess nitrogen balance and what does this tell us?

Put patient on a calculated diet, or feeding tube, and collect a 24 hour urine sample during that time (consumption of protein will have been known).

If more nitrogen was ingested than excreted -> protein anabolism = position nitrogen balance.

It is a way of assessing nutritional status


What test is used to determine the type of anemia a patient has?

Mean corpuscular volume / mean cell volume

Macrocytic anemias: B12 (pernicious), B9 -> just supplement with both to be safe
Microcytic: iron deficiency

Normocytic: Can occur during iron + B deficiencies together, need further tests to determine cause


What were albumin / prealbumin previously used in testing for?

Prealbumin - protein status in last 48 days
Albumin - protein status over the last 14-20 days


Why are albumin / prealbumin not used anymore?

They are negative acute phase proteins (APPs) -> decreased in inflammation processes, so inflammation may indicate poor protein status when there really isn't one.


What, other than MCV, is used to determine anemia status?

Hgb levels, Hct (% of blood which is cells)