Term
nDistinguish between each of the following: lean body mass, actual body weight, ideal body weight, body mass index |
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Definition
Lean body mass - amount of muscle, fat% in the body
Ideal body weight - What you SHOULD weight based on height and weight
Actualy body weight - What you weight without any adjustments
Body Mass Index - Chart that shows what combination of weight and height will qualify you as being "overweight," although waist circumference matters as well. |
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Term
nDescribe the importance of interpreting weight change in relation to time |
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Definition
One week --> 1-2% sig., >2% severe
One month --> 5% sig., >5% severe
Three months --> 7.5% sig., >7.5% severe
Six months --> 10% sig., >10% severe |
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Term
nKnow how to measure waist circumference |
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Definition
- Correlation between adiposity and CV risk
- Locate top right of iliac crest, position tape in horiz. plane at level of iliac crest
- Tape snug not tight
- Measure at end of normal expiration
- If your BMI is <35, then your waist circumference can independently determine your risk of comorbid conditions
- Men with waist >40" are at risk, women with waist size >35"
BMI's:
Underweight --> <18.5
Normal --> <25
Overweight --> >25
Obesity I --> >30
Obesity II --> >35
Obesity III --> >40 |
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Term
nInterpret changes, including non nutritional factors, in serum values of albumin, prealbumin and transferrin (Table 143-5, p2354) |
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Definition
Albumin (maintains oncotic pressure)- NR 3.5-5g/dL. Increase could be dehydration, infection, insulin, anabolic steroids. Decrease could be overhydration, edema, renal impairment, poor intake, CHF, cirrhosis, trauma, sepsis, hormones
Prealbumin (binds T3 then T4)- NR 10-40mg/dL. Increased by renal dysfunction. Decreased by cirrhosis, stress, inflammation, surgery, hyperthyroidism, CF, renal impairment
Transferrin (Binds iron in plasma and transports to the bone) - NR 200-400 mg/dL. Increased by iron deficiency, prego, chronic blood loss, hypoxia, estrogens. Decreased by chronic infection, cirrhosis, nephrotic syndrome, burns, corticosteroids. |
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Term
nRecognize common signs of trace mineral (Table 143-6, p2355) and vitamin deficiencies (Table 143-7,p2357) |
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Definition
Trace Metals:
Chromium - gluc. intolerance, neuropathy
Copper - Microcytic, hypochromic anemia, anorexia, neutropenia
Iodine - Hypothyroid
Manganese - N/V, hair color change
Molybdenum - Tachycardia, tachypnea, visual changes
Selenium - Cardiomyopathy, muscle pain
Zinc - Dermatitis, hypoguesia, alopecia
Water Soluble Vitamins
Niacin (B5) - Pellagra
Folate (B9) - Megaloblastic anemia
B12 - Macrocytic anemia, neuropathy
Thiamine (B1) - Cardiomyopathy (CHF), Wernicke-Korsakoff
Riboflavin (B2) - Mucositis, cheilosis, anemia
Pyridoxine (B6) - Dementia
Biotin - Dermatitis, depression
Ascorbic acid - Wound healing, decreased immune function
Fat Soluble Vitamins
A - Night blindness, dermatitis
D - Rickets, osteomalacia
E - Increased capillary fragility
K - Decreased clotting leading to increased risk of bleeding |
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Term
nDetermine recommended daily protein intake for a normal adult patient |
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Definition
Remember there are different "stress" levels which affect how many calories a person will get.
Normal - 25kcal/kg
Mild - 30kcal/kg
Moderate - 30-35kcal/kg
Severe - 25kcal/kg
Protein:
Adult Normal: 0.8g/kg/day
> 60yo: 1g/kg/day (to maintain lean body mass)
Stress: Up to 1.5-2.0g/kg/day
Renal failure can affect these numbers
Liver failure: 0.5g/kg/day
Burns: 3g/kg/day
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Term
nList clinical factors which alter recommended protein intake |
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Definition
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Term
nCalculate usual fluid requirements for adult patients |
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Definition
- Adults need to be making 50ml/h or urine, or 1200ml/day for adequate hydration.
- We need to give 30ml/kg, or ~1ml/kcal of fluid, and account for any fluid losses. |
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Term
nList factors which increase or decrease fluid requirements (Table 143-11) |
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Definition
Decrease fluid need: Fluid overload, CHF, decreased urine output/renal impairment, decreased albumin with third spacing.
Increased fluid need: Fever+sweating, Diuretics, Vomiting/ng suction, diarrhea/drains/fistula, glycosuria |
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Term
nBe familiar with the electrolyte content of different intestinal fluids |
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Definition
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Term
nList the required parameters that need to be gathered from the medical and dietary history in order to complete the nutritional assessment (Table 143-1) |
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Definition
- Nutrition intake and dietary habits
- Underlying Disease
- End Organ Effects
-Misc: Medication use and possible drug abuse |
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Term
nList four features in the patients general appearance which are suggestive of malnutrition (Table 143-2) |
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Definition
- Edema
- Cachexia or obesity
- Ascites
- Dehydration (sunken eyes, dry mucous membranes)
- Muscle wasting
- Loss of s/c fat tissue
Common terms:
nDecubitus ulcers: bed/pressure sores
nEcchymoses = bruising
nPetechiae = minute hemorrhagic spots
nGlossitis = inflammation of tongue
nCheilosis = swollen, cracked lips
nStomatitis = inflammation of mucous lining of mouth |
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Term
nList 3 consequences on the musculoskeletal system of malnutrition |
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Definition
- Retarded growth
- Bone pain or tenderness
- Epiphyseal swelling
- Reduced muscle mass |
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Term
nList 4 neurologic consequences associated with malnutrition |
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Definition
- Ataxia, decreased position sense
- Nystagmus
- Convulsion, paralysis
- Jaundice
- Encephalopathy
*Last two are hepatic effects, supposedly) |
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Term
nUse the Subjective Global Assessment to triage an individual’s nutritional status: well, moderate and severe |
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Definition
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