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Mariya- PCM 3 Exam 2 > Nutritional Assessment > Flashcards

Nutritional Assessment Flashcards

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1
Q

How do you calculate caloric need

A

3 components of total energy expenditure:

1) basal energy expenditure =55-65% of total calories
2) thermal effect of feeding = 10% of calories
3) activity energy expenditure = 25-33% of calories

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2
Q

In a sedentary hospitalized patient, how many kcal/kg of body weight will maintain weight?

A

30-35 kcal/kg of body weight will maintain weight

*idk what this means but it was underlined so maybe know it lol

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3
Q

In an acutely or severely ill patient (trauma, burn), how many kcal/kg of body weight will maintain weight?

A

35-40 kcal/kg

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4
Q

What are the risk factors that contribute to malnutrition and obesity?

A
  • Minority populations are at risk (76% African Americans, 80% of Mexican Americans- overweight or obese)
  • malnutrition is related to specific populations: older people who live alone, chronically ill patients, adolescents who eat and diet erratically, cancer patients undergoing chemotherapeutic or radiation protocols or other nutrient-drug interactions, alcoholics, homelessness, low SES
  • nutritional deficits: anemia
  • older adults (DETERMINE acronym)
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5
Q

Obesity vs. Overweight BMI?

A

obesity:: BMI>30; waist circumference >40” in men; >35” in women
overweight : BMI 25-29

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6
Q

What is the biggest factor related to obesity?

A

lifestyle

1% = neuroendocrine cases (rare)

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7
Q

Older adults should be screened for nutritional status using what acronym?

A 
DETERMINE
Disease
Eating poorly
Tooth loss/mouth pain
Economic hardship
Reduced social contract
Multiple medications
Involuntary weight loss
Need for assistance with self-care
Elderly years (>80)
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8
Q

Tetracyclines affect what nutrients?

A

Ca, Mg, Fe, Vitamin B12

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9
Q

Neomycin, kanamycin affect what nutrients?

A

fat-soluble vitamins, B12

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10
Q

Sulfasalazine affect what nutrients?

A

folate

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11
Q

Anticonvulsants like phenobarbital and phenytoin affect what nutrients?

A

Ca, VitD, folate, niacin

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12
Q

Hypolipidemics like cholestryramine and colestipol affect what nutrients?

A

fat and fat-soluble vitamins

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13
Q

Cytotoxic agents such as methotrexate affect what nutrients?

A

folate

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14
Q

Laxatives like mineral oil affect what nutrients?

A

water, electrolytes, fat and fat-soluble vitamins

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15
Q

Antituberculotics like isoniozid affect what nutrients?

A

Pyridoxine (B6) and Niacin (B3)

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16
Q

Anticoagulants like warfarin affect what nutrients?

A

vitamin K

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17
Q

Diuretics like thiazides + furosemide affect what nutrients?

A

K+, Mg, Ca, Zn

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18
Q

Lithium and amiodarone affect what nutrients?

A

iodine

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19
Q

What weight loss is considered significant?

A

unintentional weight loss of 5% over 6 months
OR
10% over one year

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20
Q

What is the formula to calculate %weight change?

A

%weight chain = [(usual weight- current weight)/ usual weight] x 100

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21
Q

What could be some reasons/symptoms pointing to decreased caloric intake?

A

anorexia, early satiety, difficulty chewing/swallowing, inability to feed or obtain food, social isolation/depression

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22
Q

What could be some reasons/symptoms pointing towards malabsorption or maldigestion?

A

diarrhea, fatty malodorous stools, changes in bowel habits

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23
Q

What could be some signs pointing to impaired metabolism or increased requirements?

A

fever, pregnancy, chronic dz, etc.

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24
Q

What could lead to increased loss/excretion in a patient?

A

draining fistula or open wound, diarrhea, excessive vomiting

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25
what does tricep skinfold thickness assess?
subcutaneous fat; approx 50% of body fat is subq
26
Rapid weight gain vs. weight loss is more likely related to what?
weight gain - fluid retention | weight loss - tissue loss
27
A patient presents with dry and scaly, cellophane appearing skin. What deficiency does this point to?
Protein
28
A patient presents with flaking dermatitis on their skin. What deficiency does this point to?
Zinc
29
A patient presents with follicular hyperkeratosis on their skin. What deficiency does this point to?
Vitamin A
30
A pt presents with pigmentation changes. What deficiency does this point to?
Niacin
31
A patient presents with petechiae on their skin. What deficiency does this point to?
vitamin C
32
A patient presents with purpura on their skin. What deficiency does this point to?
vitamin C, vitamin K "bloody spots"
33
A patient presents with skin pallor. What deficiency does this point to?
iron, vitamin B12, folate
34
A patient presents with night blindness. What deficiency does this point to?
vitamin A
35
A patient presents with conjunctia pallor. What deficiency does this point to?
iron, vitamin B12, folate
36
A patient presents with xerosis, keratomolacia, and bitot spots . What deficiency does this point to?
vitamin A
37
A patient presents with angular stomatitis on their mouth. What deficiency does this point to?
riboflavin, pyridoxine, niacin
38
A patient presents with cheilosis on their mouth. What deficiency does this point to?
riboflavin, pyridoxine, niacin
39
A patient presents with glossitis. What deficiency does this point to?
riboflavin, niacin, B vitamins, iron, folate **impt
40
A patient presents with bleeding gums. What deficiency does this point to?
vitamin C, riboflavin
41
If a patient presents with interosseous muscle atrophy, squaring off of shoulders, poor hand grip and leg strength (temporal, supraspinatus). What deficiency does this point to?
protein, calories, vitamin D
42
A patient presents with tetany. What deficiency does this point to?
calcium, magnesium
43
A patient presents with nail spooning. What deficiency does this point to?
Iron
44
A patient presents with a goiter (enlarged thyroid) on their neck. What deficiency does this point to?
Iodine
45
A patient presents with parotid enlargement. What deficiency does this point to?
protein
46
A patient presents with corkscrew hairs. What deficiency does this point to?
vitamin C
47
What physical exam maneuvers can provide info about nutritional status?
Appearance: muscle mass, hair texture, nail health, skin texture Muscle strength: grip strength (ask pt to squeeze index and middle fingers for 10 seconds); ambulation(walk across room and back); LE strength against resistance
48
What labs are helpful in identifying inflammation?
CRP, elevated WBC and albumin albumin <3.5 g/dL= mild systemic inflammatory response; <2.4 = severe systemic inflammatory response
49
A CBC can determine which potential nutrition deficiency?
iron, B12, folate
50
TSH can determine what potential nutritional deficiency?
iodine
51
A total protein, albumin can determine what potential nutritional deficiency?
protein calorie malnutrition
52
one of the LOs is where can i find the reliable nutrition info for patients...
Academy of Nutrition and Dietetics: www. Eatright.org more on the DSA...but i dont think this is worth a question lol, happy studying!
53
What are clinical features of scurvy?
vitamin C deficiency four Hs: hemorrhagic signs, hyperkeratosis of hair follicles (keratotic plugging--> "CORKSCREW hairs" = good visual clue), hypochondriasis and hematologic abnormalities characteristic cutaneous finding: perifollicular petechiae bleeding gums, poor healing collagen problems!! so energy go down and everything go down--> fatigue, depression, widespread CT abnormalities
54
What are clinical features of pellegra?
niacin deficiency (B3) 3 Ds: Diarrhea, dermatitis (photosensitivity), dementia dermatologic findings are SUN exposed areas -glossitis, stomatitis, vertigo and BURNING parasthesias
55
What are clinical features of rickets?
result of deficient mineralization of osteoid matrix before closure of the epiphyseal plate causing softening and weakening of bones in infants and children - mineralization impairment may be secondary to abnormal calcium, phosphorous, or vitamin D metabolism --> accumulation of osteoid before epiphyseal closure, compromising bone stability at sites of rapid bone growth - in adulthood: osteomalacia
56
B12 deficiency clinical features:
glossitis, hyperpigmentation, and canities = main dermatologic manifestations - bright red tongue, sore , and atrophic - creases and flexures mostly (seen on hand) - pigmented nails - premature gray hair (canities) - often present with megaloblastic anemia seen in VEGETARIANS (bc its NOT in plants)
57
What is the recommendation for an adult for vegetables/fruits per day?
6-9 fruits + vegetables
58
What is the recommended amount for protein foods in a 2000 calorie diet?
5.5 oz-eq/day
59
What is a Mediterranean diet?
• Based on the eating habits of Greece and southern Italy in the early 1960’s • Plant based: fruits, vegetables, nuts, grains, seeds, beans and olive oil • Eggs, dairy, poultry and fish are eaten several times/week, but the portions are small • Minimal intake of red meat, refined sugar, flour, butter and fats (except for olive oil) • Includes: 1-2 glasses of red wine/d*
60
What is the current recommendation for salt intake? average consumption?
<2300 mg/day average: 3400 mg/day salt is directly related to blood pressure and fluid retention
61
salt is directly related to what?
blood pressure and fluid retention lower salt improves blood pressure
62
A strict vegetarian or vegan diet can result in what deficiency?
B12
63
Food label laws include what?
ingredient lists: descending order of predominance (mc-->lc) mandatory labeling of major allergens: milk, eggs, peanuts
64
BE able to read a nutrition label.
she said *hint hint* serving size, total calories notice vitamin D, potassium, calcium, and iron = required; vit A + C = optional
65
What is the difference between all the types of salt/sodium content?
-Salt/Sodium-Free = less than 5 mg of sodium per serving. • Very Low Sodium = less 35 mg of sodium or less per serving. • Low sodium = 140 mg of sodium or less per serving. • Reduced Sodium = at least 25% less sodium than in the original product. (**) • Light in Sodium or Lightly Salted = at least 50% less sodium than the regular product. • No-Salt-Added or Unsalted = that no salt is added during processing. It does not mean that there is no sodium in the product
66
What is the difference between all the types of fat labelling content?
-Fat-free means the food has less than 0.5 grams (g) of fat per serving. • Low-fat = 3 g of fat or less per serving. • Reduced fat or less fat = the food has at least 25% less fat than the regular product. • Trans fat free = 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. Eating many servings of a food with small amounts of trans fat per serving can add up. (NOT FAT FREE)
67
What disease processes could lead to vitamin A deficiency
Crohns dz, celiac dz, chronic mineral oil use for constipation, bariatric surgery
68
What are some risk factors for vitamin D deficiency?
elderly nursing home resident, treatment for seizure disorders, dark-skinned pts living in northern climates, pts with milk allergies
69
With a strict vegan diet, what lab could you see?
Megaloblastic anemia from vitamin B12 deficiency
70
Vitamin A deficiencies affect what mostly?
the epithelium
71
What can cause gingival dz/bleeding of gums?
vitamin C deficiency

Mariya- PCM 3 Exam 2 (2 decks)

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