Chapter 3

• Red flags in high risk patients?

  substance abuse, significant weight loss prior to hospitalization, present weight <80% than usual/idea BW, poor mental health, malabsorption
• Anthropometrics: height, weight, BMI, % of usual body weight, growth percent chart, Z-scores
• What is Nutrition Assessment?


  systematic method for obtaining, verifying, and interpreting patient data
• Nutritional status is altered when nutrients are altered due to what?

  increased need, altered utilization, altered intake
• Nutrition screening is a process of assessing the nutritional status of a patient.
• Nutritional status reflects nutrient stores
• Example of Food & Nutrient Intake ?

  mom reports child‘s food intake for previous 24 hours
• Medication & Complimentary/Alternative medicine use example?

  patient reports current medication and herbal supplement use
• Knowledge, Beliefs and Attitudes example?

  patient states that he avoids “sweets and desserts“ as his diet modification for diabetes
• Behavior example?

  patient decided that she will only eat in the kitchen table with relatives as a step to decrease snacking behaviors
• Factors affecting access to food and food-nutrition-related supplies

  patient reports that he only has access to microwave
• Physical Activity and Function

  patient states she is unable to walk up more than one flight of stairs
• Nutrition-related patient-client centered measures

  patient says she doesn’t see the point in improving blood glucose levels due to the diets she tried in the past not working
• Biochemical Data Protein

  Albumin, transferrin, prealbumnin, and total protein and C-reactive protein(critical illness)
• Biochemical Data Heme

  hemoglobin, hematocrit, iron binding capacity, mean corpuscular volume, etc
• Biochemical Data Electrolytes

  sodium, potassium, chloride, Ca, Phos
• 4 levels of food security

  1. high food security
  2. marginal food security
  3. Low food security
  4. very low food security
• Growth charts for children 0-2yrs old

  WHO
• Growth chart for children 2-20yrs old

  NCHS
• BMI underweight by age

  <5th %-ile
• BMI obese by age

  >95th %-ile
• BMI overweight by age

  85th to <95th %-ile
• BMI range(kg/m^2)

  
• skinfold measurement

  uses skin fold calipers
• Dual-energy-X-ray absorptiometry (DEXA) measures 3 compartments

  mineral mass, mineral-free mass, fat mass
• Nutrition-focused physical exam areas

  1. oral health
  2. head/neck
  3. nails
  4. loss of subcutaneous fat
  5. muscle mass/strength
  6. skin
  7. Fluid accumulation
• Blood, urine, feces, tissue samples are indicators for

  biochemical measurements of nutritional markers
• Biochemical assessments

  1. protein assessment
  2. immunocompetence
  3. hematological
  4. vitamin and mineral assessment
• Creatinine coefficient for males

  23mg/kg of ideal BW
• Creatinine coefficient for females

  18mg/kg of ideal BW
• Negative Acute Phase proteins

  1. Albumin
  2. transferrin
  3. pre albumin or transthyretin
  4. retinol-binding protein(RBP)
• Positive acute phase protein

  c-reactive protein(CRP)
• Common causes of the “acute phase response”

  1. Trauma
  2. malignant neoplasms
  3. burns
  4. inflammation
  5. pancreatitis
• Half-life days of Albumin

  17-21 days
• Half-life of transferrin

  8-10 days
• Half-life of prealbumin

  2-3 days
• Half-life of Retinol-binding protein

  10-12 days
• When is CRP released?

  during periods of inflammation, infection, acute illness
• TLC

  Total lymphocyte count
• TLC is deceased by 4 things

  1. trauma
  2. stress
  3. diseases(cancer, HIV)
  4. medications that impact immune system(chemo, corticosteroids)