nutritional assessment

Question 1

recognize physical diagnosis feaures of common nutritional deficiencies

Answer 1

vitamin A- worse with condition that have fat malabsorption

Niacin (B3)-glossitis, stomatitis, vertigo, and burning paresthesia’s

B12- common with GI abnormalities: celiac disease, pancreatic disorder, atrophic gastritis)

Vitamin C (scurvy)= inflamed gingiva, petechia, hemorrhage, impaired wound healing, hyperkeratosis, bleeding into the body cavity

VitaminD- osteoporosis, and sarcopenia, osteomalacia

Question 2

identify lab values associated with common nutritional deficiencies

Answer 2

Labs that correlate with inflammation may indicate underlying pathology or illness, such as Creactive protein, elevated WBC and albumin. Albumin <3.5 g/dL is considered to indicate a mild systemic inflammatory response. A value of < 2.4 g/dL represents a severe systemic inflammatory response, reflecting systemic inflammation that produces anorexia (limiting food intake) and increases protein catabolism and thus accelerates the development of proteincalorie malnutrition.

Lab checking

1. CBC- Iron,

B12- folate

TSH- Iodine

Total protein-albumin Protein calorie malnutrition

Question 3

identify resources for the patient education regarding healthy diets

Answer 3

Academy of Nutrition and Dietetics: www.Eatright.org

American Academy of Fmaily Physicians: https://familydoctor.org Office of Disease Prevention and Health Promotion: https://health.gov/dietaryguidelines/

Health & Human services: https://www.choosemyplate.gov/dietary-guidelines

American Academy of Pediatrics: https://www.healthychildren.org/english/healthyliving/nutrition/pages/default.aspx American Heart Association: www.heart.org

American Diabetes Association: www.diabetes.org

Question 4

indentify risk factors that contribute to malnutrition and obesity

Answer 4

obesity is BMI >30 overweight is BMI 25-29 or circumference of waist circumference >40 in men and > 35 in women

lifestyle is the biggest factor to obesity

malnutrition is related to specific populations

1. older person who live alone
2. chronically ill patients (renal failure, CHF, end-stage COPD, celiac disease
3. adolescents who eat and diet erratically
4. cancer patients undergoing chemotherapeutic or radition protocols or other nutrient-drug interactions
5. alcoholics
6. homelessness ness, low socioeconomic status
7. nutritional deficit without assocaited eight loss are relatively uncome except for anemia secondary to strict vegetarian or vegan diets may have B12 deficiency. wide spread fortification of folate in food in developed countried is protective for most people

Question 5

include screening and questions to assess nutritional status

Answer 5

older adults should be screened for nutritional status usinf teh acronym DETERMINE

Disease: any disease that makes it hard to cook, eat or shop

Eating poorly: too much, too little, drining too much alcohol, older aults lose ability to taste salt, over compensate and difficulty identifying spoiled food as smell decrease as well

Tooth loss or mouth pain: poor fitting dentures, lost teeth, dental carriers

Economic hardship: low nutritional food choices

Reduced social contact: loneliness, social isolation

Multiple medication: alter the sense/ irriate the stomach, interfere with absorption

Involuntary weight loss

Need for assistance with wself-care

Elderly years >80 yo

Question 6

read and interpret food labels including type of fat, salt, and calories

Answer 6

Calories are the measure of how much energy you get from a serving of a food. For example, inactive or older people usually need fewer calories. Active people and teens may need more calories per day. Keep this in mind when you read the label. The label lists the number of calories that come from fat in a serving of the food. If the food has 200 calories and 100 calories are from fat, 50% of the calories come from fat, which means the food is high in fat.

Fat

Fat-free means the food has less than 0.5 grams (g) of fat per serving.

Low-fat means 3 g of fat or less per serving.

Reduced fat or less fat means the food has at least 25% less fat than the regular product.

• Trans fat free means the food has less than 0.5 g trans fat per serving. Even though a food says “trans fat free,” it may still contain 0.49 g trans fat.

Cholesterol

Cholesterol free means less than 2 milligrams (mg) of cholesterol per serving. It also means that the food has 2 g or less of saturated fat per serving.

Low cholesterol means 20 mg of cholesterol or less per serving. It also means that the food has 2 g of saturated fat or less per serving.

Salt/sodium

Salt/Sodium-Free means less than 5 mg of sodium per serving.

Very Low Sodium means less 35 mg of sodium or less per serving.

Low sodium means 140 mg of sodium or less per serving.

Reduced Sodium means at least 25% less sodium than in the original product.

Light in Sodium or Lightly Salted means at least 50% less sodium than the regular product.

No-Salt-Added or Unsalted means that no salt is added during processing. It does not mean that there is no sodium in the product.

Question 7

discuss diets that are commonly used as guidelines for healthy eating

Answer 7

mediterrranean diet

1. plant-based
2. eggs, dairym poultry and fisk eaten several times/week, but in small portions
3. minimal fat intake
4. 1-2 glasses of red wine

DASH diet (based on study limiting sodium to 2300mg/d)

Question 8

be able to estimate caloric needs in a hospitalized patient

Answer 8

there are 3 components of total energy expenditure

1. basal energy expenditure (55-65% of total calories)
2. thermal effect of feeding (10%)

activity of energy expendituree (25-33%)

so in sedentary hospitalized patient, 30=35kcal/kg of body weight will maintain weight. however, acutely or severely ill patients (trauma, burn patient) may require 35-40kcal/kg

Question 9

what medication affect nutritional status?

Answer 9

tetracycline-calcium, magnesium, iron, vitamin B12

Neomycin, Kanamycin-fat soluble vitamins, B12

sulfasalazine-folate

anticonvulsants

1. phenobarbital, phenytoin-calcium, vitamin D,folate, niacin

Hypolipidemic

1. cholestrytamine, colestipol-fat and fat vitamins

cytotoxic agents

1. methotrexate- foalte

laxatives

mineral oil-water, electrolytes, fat and fat-soluble vitamins

Antituberculotics

1. isoniazid-pyridoxine (B6), Niacin (B3)

anticoagulants

1. warfarin-vitamin K

diruetics

1. thiazides, furosemide-potassium, magnesium, calcium, zinc

lithium, amiodarone-iodine

Question 10

how can I asses the importance of weight loss

Answer 10

5% over 6 months or 10% over 1 year is considered significant

1. decrease caloric intake?
2. malabsorption and maldigestion?
3. imparied metabolism or increased requirement?
4. increased losses or ecretion: draining fistula or open wounds, diarrhea, excessive vomiting