-
Serum Albumin normal lab values
3.5-5.0 g/dl
-
Serum albumin is what type of protein
Visceral protein (blood and organs)
-
______ is associated with edema, surgery.
hypoalbuminemia
-
best reflects protein status
prealbumin
-
serum albumin levels above normal range is likely due to...
dehydration
-
half-life of serum albumin
long
-
serum albumin does or does not reflect current protein intake
does not
-
Serum transferrin level is controlled by _____ storage pool
iron
-
-
-
half-life of transthyretin/prealbumin
short
-
RBP
retinol-binding protein
-
What does RBP do
- circulates with prealbumin
- binds and transports retinol
-
Hct (hematocrit) levels for men
42-52%
-
Hct (hematocrit) levels for women
35-47%
-
Hct (hematocrit) levels for pregnant women
33%
-
What is Hgb (hemoglobin)
iron-containing pigment of red blood cells
-
Hgb (hemoglobin) levels for men
14-17 gm/dl
-
Hgb (hemoglobin) levels for women
12-15 gm/dl
-
Hgb (hemoglobin) levels for pregnant women
≤11
-
What does serum ferritin measure
size of iron storage pool
-
Serum creatinine lab values
0.6-1.4 mg/dl
-
Serum creatinine is related to _____ and measures _____ protein
- muscle mass
- somatic protein
-
Serum creatinine may indicate...
renal disease or muscle wasting
-
CHI
creatinine height index
-
What is CHI
ratio of creatinine excreted/24 hours to height
-
CHI estimates
lean body mass - somatic protein
-
BUN (blood urea nitrogen) lab values
10-20 mg/dl
-
BUN is related to _____ and an indicator of ______
- protein intake
- renal disease
-
BUN: creatinine ratio lab values
10-15:1
-
Urinary creatinine clearance measures
GFR - glomerular filtration, renal function
-
TLC
total lymphocyte count
-
TLC lab value
>2700 cells/ cu mm
-
TLC is decreased in
protein-energy malnutrition
-
Severe depletion of TLC lab value
<900
-
-
What does CRP (C-reactive protein) measure
marker of acute inflammatory stress
-
FEP
Free erythrocyte protoporphyrin
-
FEP (free erythrocyte protoporphyrin is increased in _____
lead poisoning
-
Too much lead in the body depletes...
- iron leading to anemia
- calcium in the bone leading to zinc deficiency
-
-
PT (prothrombim time) lab values
11.0-12.5 seconds; 85-100% of normal
-
PT (prothrombim time) evaluates ____ and ____ will alter rate
- clotting adequacy
- vitamin K
-
SGA
- Subjective Global Assessment
- (history, intake, GI symptoms, functional capacity, physical appearance, edema, weight change)
- NO lab values
-
MNA
- Mini Nutritional Assessment
- (evaluates independence, medications, number of full meals consumed each day, protein intake, fruts and veg, fluid, mode of feeding
- 65 years of age and older
-
NSI
- Nutrition Screening Initiative
- (elderly)
-
GNRI
- Geriatric Nutritional Risk Index
- (serum albumin, weight changes)
-
Dietary intake assessment:
Present patterns of eating. Do not ask leading questions
diet history
-
Dietary intake assessment:
Exact record of everything eaten in a specific period of time
food record
-
Dietary intake assessment:
mental recall of everything eaten in previous 24 hours. Quick tool to estimate a sample daily intake. Clinical setting
24 hour recall
-
Dietary intake assessment:
how often an item is consumed. Community setting. Quick way to determine intakes on large numbers of people
food frequency lists
-
IBW for women
- 100 lbs for first 5'
- add 5 lbs for each additional inch
- +/- 10% for frame size
-
IBW for men
- 106 lbs for first 5'
- add 6 lbs for each additional inch
- +/- 10% for frame size
-
Amputations:
Entire leg
16%
-
Amputations:
Lower leg (below knee)
6%
-
Amputations:
Entire arm
5%
-
Amputations:
Forearm
2.3%
-
IBW equation with amputations:
(IBW - % amputation)/100 x IBW for original height
-
TSF measures
- Triceps skinfold thickness
- body fat reserves
- calorie reserves
-
AMA measures
- arm muscle area
- skeletal muscle mass (somatic protein)
- *important to measure in growing children
-
Healthy BMI for elderly
24-29
-
Healthy BMI for adults
18.5-24.9
-
Waist circumference for men and women
-
Waist/hip ratio (WHR) of ____ or greater in men, _____ or greater in women is indicative of android obesity and increased risk for obesity-related diseases (diabetes, hypertension)
-
Nutrition focused physical exam:
thin, sparse, dull dry brittle hair
vitamin C, protein deficiency
-
Nutrition focused physical exam:
easily pluckable hair
protein deficiency
-
Nutrition focused physical exam:
pale or dry eyes, poor vision
vitamin A, zinc or riboflavin deficiencies
-
Nutrition focused physical exam:
swollen, red, dry, cracked lips
riboflavin, pyridoxine, niacin deficiencies
-
Nutrition focused physical exam:
smooth, slick, purple, white coating on tongue
vitamin or iron deficiencies
-
Nutrition focused physical exam:
sore, red, swollen, bleeding gums
vitamin C deficiency
-
Nutrition focused physical exam:
missing or loose teeth, loss of enamel
calcium deficiency, poor intake
-
Nutrition focused physical exam:
pale, dry, scaly skin
iron, folic acid, zinc deficiency
-
Nutrition focused physical exam:
brittle, thin, spoon-shaped nails
iron or protein deficiency
-
Drug or nutrient effects:
Megestrol acetate
appetite stimulat
-
Drug or nutrient effects:
dextroamphetamin
- appetite suppressant
- anorexia
- nausea
- weight loss
-
Drug or nutrient effects:
orlistat
- decrease fat absorption by binding lipase
- vitamin/mineral supp.
-
Drug or nutrient effects:
marinol
appetite stimulant
-
Drug or nutrient effects:
methylphenidate (Ritalin)
- anorexia
- weight loss
- nausea
-
Drug or nutrient effects:
lithium carbonate (antidepressant)
- maintain consistent sodium and caffeine intake
- if restricted, lithium excretion decreases, leading to toxicity
- 2 gm Na diet too low
-
Drug or nutrient effects:
propofol
1.1 cals/cc
-
Drug or nutrient effects:
vitamin B6 and protein
- decrease effectiveness of levodopa (Parkinson's disease)
- Take drug in morning with limited protein - no more than 10 g
-
Drug or nutrient effects:
tyramine
hypertension if taken with MAOI (monoamine oxidase inhibitor)
-
Foods with high tyramine content
- hard, aged cheese (cheddar, swiss)
- sauerkraut
- some sausgaes
- lunch meats
- tofu
- miso
- sour cream, yogurt, buttermilk
Best to buy, cook, eat fresh foods
-
Nutrition assessment of population and community needs:
HRA
- Health Risk Appraisal
- Survey categorizing a populations' general health status
- used in work sites, government agencies as a health education or screening tool
-
Define incidence
number of NEW cases of a disease over a period of time
-
Define prevalence
TOTAL number of people with a disease during a period of time
-
Infant mortality rate:
- infant deaths under 1 year of age
- expressed as the number of deaths per 1000 live births
-
3 strategies that strengthen local food systems:
- farmer's markets
- food recovery and gleaning programs
- PPFPs - Prepared and Perishable Food Programs
-
what are PPFPs
- Prepared and Perishable Food Programs
- nonprofit programs that link sources of unused, cooked and fresh foods with social service agencies that serve the hungry
-
Examination of a population group at a particular point of time
nutrition survey
-
Continuous collection of data
nutritional surveillance
-
nutritional surveillance detects ____ by using...
- changes in trends
- by using height, weight, hematocrit, hemoglobin, serum cholesterol
-
Promote nutrition and improve nutritional care for the ELDERLY
NSI - Nutrition Screening Initiative
-
Level II screen for Nutrition Screening Initiative provides
- more specific diagnostic info on nutritional status
- RD most involved with level II
-
PNSS
Pregnancy Nutrition Surveillance System
-
NSLP acronym
National School Lunch Program
-
National School Lunch Program and School Breakfast Program are regulated by....
USDA
-
With the National School Lunch Program, lunch must provide on average
- 1/3 of the recommended intake for
- -protein
- -vitamins A and C
- -iron
- -calcium
-
With the School Breakfast Program, breakfast must provide on average
- 1/4 daily recommended levels for:
- -protein
- -vitamin A and C
- -iron
- -calcium
-
Together the National School Lunch Program and the School Breakfast Program provide ___ of the recommended intake.
~1/2
-
2 surveys that are based on what America is eating
WWEIA and NFCS
-
WWEIA:
acronym and what it is
- What We Eat in America
- survey - dietary intake component of NHANES
-
WWEIA is regulated by...
USDA
-
WWEIA is alson known as
National Food and Nutrition Survey (NFNS)
-
NFCS:
acronym and what it evaluates
- Nationwide Food Consumption Surveys
- Evaluates 7 nutrients: protein, calcium, iron, thiamin, riboflavin, vitamins C and A
-
NFCS is regulated by...
USDA
-
BRFSS
acronym and what it is
- Behavioral Risk Factor Surveillance System
- Telephone interviews: info on height, weight, smoking, alcohol use, food frequency for fat, fruits and vegetables, preventable health problems, diabetes
-
YRBS acronym
Youth Risk Behavior Survey
-
What does the Commodity Food Donation/Distribution Program do?
- Provides foods to help meet nutritional needs of children and adults
- Strengthens agricultural market for products produced by American farmers.
-
Who regulates the Commodity Food Donation/Distribution Program
USDA
-
CSFP
acronym and who administers
- Commodity Supplemental Food Program
- administered by state health agencies
Part of the Commodity Food Donation/Distribution Program ran by USDA
-
SMP
acronym and what it is
- Special Milk Program
- encourage consumption of milk by children
-
-
SFSP
acronym and what it is
- Summer Food Service Program
- Initiate, maintain or expand foodservice programs to children when school is not in session
-
SFSP is regulated by...
USDA
-
CACFP
acronym and what it is
- Child and Adult Care Food Program
- Reimburses operators for meal costs
- Provides commodity foods and nutrition education materials
Eligibility standards same as NSLP
-
CACFP is regulated by...
USDA
-
FFVP
acronym and what it is
- Fresh Fruit and Vegetable Program
- Introduce children to fresh fruits and vegetables
- Free to children nationwide in selected schools
-
WIC
acronym and what it does
- The Special Supplemental Nutrition Program for Women, Infants, and Children
- Provides food, nutrition education, and referrals to other agencies for low income mothers at nutritional risk
-
is WIC an entitlement program?
NO
-
For WIC a health exam is _____
required
-
WIC is regulated by...
USDA
-
EFNEP
acronym and what it is
- Expanded Food and Nutrition Education Program
- Provides grants and nutrition education
-
EFNEP is regulated by...
USDA
-
Maternal and Child Health Block Grant provides...
training, consultation, and funding for public health nutrition programs
-
Maternal and Child Health Block Grant is regulated by...
USDA
-
NSIP acronym
Nutrition Services Incentive Program
-
OAA
acronym and what it is
- Older American Act Nutrition Program
- One hot meal each day, 5 days/week for all aged 60 and older plus spouse
-
OAA is regulated by...
USDA
-
ambulatory; transportation essential for rural elderly (OAA nutrition program)
Congregate Meals
-
An example of home delivered meals
- Meals on Wheels -- must be home bound
- OAA nutrition program
-
SNAP
acronym and what it is
- Supplemental Nutrition Assistance Program
- Assist low income with monthly benefits
-
Largest food assistance program
SNAP
-
SNAP is regulated by...
USDA
-
CMS
acronym and its parts
- Centers for Medicare and Medicaid Services
- Medicare and Medicaid
-
CMS is regulated by...
DHHS
-
Medicare for what population
- People over 65
- Any age with end stage renal disease
-
Part A for Medicare
Hospital Insurance
-
Part B for Medicare
Optional insurance for supplementary benefits (outside hospital insurance)
-
Medicaid is for what population
eligible needy: all ages, blind, disabled, dependent children
-
CHIP
acronym and what it is
- Children's Health Insurance Program
- expands health coverage to uninsured children whose families earn too much income to qualify for Medicaid but too little to afford private coverage
-
Headstart is regulated by...
DHHS
-
NET
acronym and what it is
- Nutrition Education Training Program
- Provides nutrition education training to teachers and school foodservice personnel
Amendment to School Lunch Act
-
NET is regulated by...
USDA
-
SFMNP
acronym and what it is
- Senior Farmers' Market Nutrition Program
- Grants to states to provide low income seniors with coupons to be exchanged for eligible foods at farmers' markets, roadside stands, community supported agriculture programs (CSA)
- Nutrition education and information is provided (how to select, store, prepare)
-
SFMNP allows participants to buy..
fresh, nutritious, unprepared fruits, veg, herbs, and honey
-
SFMNP is regulated by...
USDA
-
An award of financial or direct assistance
Grant
-
What is an entitlement program
- requires payment of benefits to all eligible people as established by law
- for a specific population who meet certain income or other eligibility requirements
-
The 5 Entitlement Programs
-
_____ diagnosis changes as the patient's response changes. (example)
- Nutrition
- Undesirable overweight status
-
____ diagnosis does not change as long as the condition exists. (example)
-
Dietetic professionals are responsible for treating the nutrition diagnosis ____
independently
-
3 domains for Nutrition Diagnostic Labels
- NC: Clinical
- NI: Intake
- NB: Behavioral-environmental
-
3 parts to Clincial NC
- Functional balance
- Biochemical balance
- Weight balance
-
Which nutrition diagnostic label is the RD's priority?
NI - Intake
-
What enteral nutrition would be given for normal GI function & it must provide how many calories
- Standard polymeric (whole nutrients, least expensive)
- Provide 1-1.5 calories/cc
-
What can be added to enteral nutrition as an emulsifier
Lecithin
-
Enteral Nutrition is initiated full strength at a rate of
10-40 ml/hr
-
What is modular enteral nutrition
- mix individual components
- adds flexibility
-
What is blenderized enteral nutrition
whole food, large bore tube, thick intact protein, high residue
-
Least expensive enteral nutrition formulas
intact protein (NOT pre-digested), and isotonic (osmolality is close to that of blood)
-
Pre-digested protein or amino acids, glucose or sucrose, small fat, vitamins, minerals, electrolytes
- elemental, chemically defined enteral nutrition formula
- Used with malabsorption (problem with GI tract)
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