nutr assesment final

clincal assesment

assesing nutr status by checking signs of deficiencies on the body and asking about symptoms

symptom

patient is aware and may complain of (subjective)

sign

observed by exmainer (objective)

nutr assesment tools

SGA: asses nutr status by using info from hisotry and physical exmaination without biochemcial or anthropotetic data

protein energy malnutrtion (PEM)

two categories kwashiorkor and maramus

kwashiorkor

protein deficency (edema, hair changes, thin muscles)

maramus

energy deficency (thin muscles, thin fat, no edema, very underweight)

% height for age

(actual height / reference height) x 100

% weight for height

(actual body weight / reference bw for height) x 100

stunting

low hieght for age “shortness” generally result from long term inadequate food or poor diet quality

wasting

low weight for height “thinness” often develops rapidly, can be revsered quickly

no inflammation risk

starvation/ anorexia

mild/ moderate inflammation risk

chroninc disease

marked inflammatory response risk

acute diease or injury related

ASEPN malnutrtion criteria

(2 of 6) inadquate energy intake, weight loss, muscle wasting, loss of subcutaneous fat, fluid accumulation, reduced handgrip strength

GLM malnutrtion criteria

(1 phenotype) weight loss, low bmi, reduced muscle mass (1 etiologic) reduced food intake, inflammation/diease

cachexia

physical wasting and malnutrtion associated with chronic disease

nutrtion focused physical exam

hands on assesment specific to nutrtion elated components of health. looking for physical signs consistent with medical record. evaluation of body systems, muscles and subcutaneous fat wasting, oral health, suck, swallow, breathe abilty, appetite

comprehensive exam

reviews all body systems

focused exam

selected body systems

inspection

close observation of details of the patients appearance, behvaior, and movement

palpation

fell pulsations and vibrations using fingertip pads to asses areas of skin, depression, texture, size, temp, tednerness

initating the NFPE

general survey of overall appearance, observe globally

part 1 of NFPE

visual overview and vital signs

normal blood pressure

less than 120/80

normla heart rate

60-100 bpm

normal respiratory rate

12-18 breaths per min

orbital assesment

fat loss: hollows, depressions, loss skin around eyes

well nourished: slightly buldged fat pads

temporal

tempression/pit: muscle loss

clavicular

sqaured off shoulders: muscle and fat loss

acanthosis nigricans

increased brownness of skin. areas of darker, velvety skin in body folds and creases. commonly triggered by high levels of insulin

jaundice

excess billibrubin causing yellow skin. sign of liver disease

cyanosis

incrased deoxyhemoblon. low blood oxygen

anemia

pale skin

koilonychia

spoon shaped concave nails

beau’s lines

transverse line in nailssuggesting acute disease

cheilosis

dry mouth caused by fungi, bacteria or b/iron deficency

stomatitis

Inflammed/sore mouth. suggesting b/iron deficency

pressure ulcers

localized injury to the skin and underlying tissue as a resul of pressure/friction

wound healing needs

energy, protein, zinc

ulcer stages

1. suspected deep tissue injury - discolored intact skin, painful, mushy, warmer

2. stage 1 intact localized redness

3. stage 2 partial thickness, open, only in epidermis

4. stage 3 full thickness, skin loss, fat may be visible but not bone or muscle

5. stage 4 full thickness tissue loss, exposed bone/muscle

6. unstageable - full thickness tissue loss obscured by slough, can’t determine depth

stages of wound healing

1. hemostasis

2. inflmmation

3. proliferative

4. remodeling

hemostasis

wound is being closed by clotting, slowing of bleeding

inflammation

partial granulation (new connective tissue), swelling (damaged cells are removed from wound area,) ,slight warmth

proliferative

fully granulating (beefy, red tissue covors wound)

remodeling

more orgnaized collagen bundles turns from pink to translcent silver then white

dehydration factors

eldery, hisotry of dysphasia, depression, heart failure, draining wounds, meds that promote fluid loss, unplanned weight loss, fluid restriction

edema

visible swelling caused by a buildup of fluid within tissues

pitting edema

when an indentation remains after the swollen skin is pressed

pellagra

niacin deficiency (dermatitis, dementia, diarrhea) thick, scaly, darkly pigmented rash

biochemcial assesment

quantitative, objectvie data, biomarkers ro detect nutr deficiencies. important to detect changes, validate dietary assesment tools

static (direct)

measurments based on measurments of nutrient/metabolite in blood, urine, or body tisse. often most readily available. ex: vitamin d levels.

*indicate nutr levels in tissue/fluid but fail to reflect overall nutrient status of an individual

functional (indirect)

based on ultimate outcome of a nutrient deficency which is failure of the physiologic process that rely on that nutrient. ex: measurment of dark adaption of eyes > assesses vitamin A. tend to be nonspecific, may indicate general nutr status but not identify specifci nutrient deficiency

creatine excretion

waste product of skeltal muscle not related to protein intake

postive nitrogen balacne

intake exceeed ooutput (growth, pregnancy, recovery)

nitrogen balacne equilibrium

healthy adult stage

negatvie nitrogen balacne

output exceeds intake (inadquate protein intake, fevers, burns, bed rest)

albumin

indicator of depleted protein status and decreased protein intake over several weeks. does not mean malnutrtion. responds slowly to changes

transferrin

transport protein for iron. better index of changes in protein status. decrease could mean infection, protein wasting, draining wounds, surgery. increase could mean pregnancy, estrogen therapy, acute heptitis

prealbumin

transport protein for throid horomone, carrier for retinol binding protein. sesntive indicator of protein status. decreases rapidly in early malnutrition. increases rapidly once adquate nutr begins

hemoglobin

contains iron in RBC, carries oxygen and CO2, index of bloods oxygen carrying capacity

hematocrit

% of RBC that make up the entire volume of blood

stages of iron depeletion

1. deplted stores

2. early functional iron deficiency

3. iron definecy anemia

mean corpuscle volume (MCV)

average size and volume of RBC

microcytosis

low (<80) MCV, iron defiency anemia

norma MCV

80-99

macrocytosis

high (>100) MCV, b12/ folate defiency

low blood calcium

reneal disease, pancreitsis

high blood calcium

bone reabsorption, excessive vitmain D intake

high potassium (hyperkalemia)

renal failure

low potassium (hypokalemia)

diuretics, excessive loss in urine, IV fluids, vommitting, diarrhea, eating disorders

high sodium (hypernatremia)

dehydration, excessive output, loss of ADH control by increasing water retetion

low sodium (hyponatremia)

overhydration, fluid retantion, diuretic use, vommiting, diarrhea

osteporosis

loss of bone mass + deteriroation of bone, compromised bone strength, increase suseptibilty to frature. peak bone mass by age 30

CRP (C-reactive protein)

predictor of risk for CHD + MI, marker for inflamamtion

coronary heart disease (CHD)

build up of plague within the artery (disrupts the flow of oxygen and nutrtinets to the heart) > increased pressure to pump blood. fatty streaks (lipid accumulation )

total cholestrol

less than 200mg/dL

triglyerides

less than 150 mg/dL

LDL

less than 100 mg/dL

HDL

greater than or equal to 60 mg/dL

hemoblogin A1c

blood test measuring the averga amount of glucose attached to hemoglobin over the past 2-3 months. used to diagnosis diabtes.

diabees indicator

A1c greater than 6.5%

ALT

7-55 IU/L

ALP

30-130 U/L

AST

10-40 U/L

injury to liver

enzymes increase in blood

billibrium

0.1 - 1.2 mg/dL

inceased when liver is unable to excrete. driect: blockage of passages. indirect: excessive destruction of RBC

blood creatinine

0.6-1.2 mg/dL

GFR

high in blood, low in urine = poor clearence

BUN (blood urea nitrogen)

• increased = renal failure, dehydration

• normal = 7-20 mg/dL

• decreased = liver disease, overhydration, malnutrition