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71 Cards in this Set
- Front
- Back
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What causes olfactory sensation loss?
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age, nasal sinus disease, head trauma, URI, neurodegenerative disease, environmental toxins, drugs
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What is hypogeusia?
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diminished taste
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What is ageusia?
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absent taste
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What is dysgeusia?
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altered taste
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What are some taste changes with aging?
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1. reduction in number of papillae and taste buds per papillae
2. taste losses due to changes at the level of taste cell membranes (not just loos of taste buds) 3. medications, radiation, and disease which reduces the amount of taste buds and papillae 4. degenerative changesin central taste pathways that alter taste perception 5. change in salt and bitter detection |
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What is the number one cause of taste loss?
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medications
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What are some examples of medicines that reduce taste?
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sulfydryl groups (aka catopril)
HIV infections antibiotics |
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What are some examples of aging-causing decreases in food intake?
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undernutrition, sarcopenia, impaired immunity, physical frailty, quality of life.
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What are age related changes with the esophagus and what diseases can occur?
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minor alterations in the upper esophageal spincter, whcih causes dysphagia and GERD
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What are age related changes iwth the stomach and what diseases can occur?
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Decreaesd pepsin, prostaglandins, mucosal blood flow, and gastric fluid secretion.
This causes gastritis types A & B, delayed gastric emptying, and achloyhydria (production of gastric acid is absent or low) |
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What are some age related changes in the small intestine and what diseases occur because of them?
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decreased lactase, intestinal blood flow, and sodium/glucose co-transport.
Causes: bacterial overgrowth, lactose intolerance, inflammatory bowel disease |
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What are some age related changes in the colon and what diseases occur because of them?
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decrease in neuronal density, wall elasticity, and resting pressure of the internal anal sphincter.
Causes: constipation, diverticulitis, and angiodysplasia |
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What are some age related changes in the liver and what diseases occur because of them?
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decrease in liver size and blood flow, decrease in dynamic liver function
Causes: hepatic encephalopathy, cirrhosis |
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What are some age related changes in the pancreas and what diseases occur because of them?
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decrease in pancreatic mass, ductular changes/fibrosis
Causes: pancreatic cancer, chronic pancreatitis, diabetes |
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What foods should people with GERD avoid?
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high-fat foods, alcohol, chocolate, nicotine, peppermint, acidic foods (orange, tomato, apple juices)
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What diet does a person with liver disease need?
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high calorie, high protein
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What do you recommend to someone who is constipated?
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6-8 glasses of water, increase fiber
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What is xerostomia?
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dry mouth due to decreased saliva
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What medications cause xerostomia?
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antidepressants, antihypertensives, and bronchodilators
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What drug can cause an altered sense of taste?
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ACE inhibitors
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What drugs cause dry mouth?
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Anti-depressants
Anti-anxiety Anti-histamine High Blood pressure medications Anti-diarrheal Muscle relaxants Drugs for urinary incontinence Parkinson’s disease medications |
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What drugs cause nausea?
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antibiotics, theophylline, and aspirin
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What drugs cause increased energy metabolism?
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thyroxine, theophylline
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what drugs cause malabsorption?
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sorbitol, cholestyramine
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What drugs cause anorexia?
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digoxin, fluoxetine, quinidine, hydralazine, vitamin A, psychoatives, morphine, methotrexate
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how does chronic illness impair nutrition?
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Disability can hinder ability to prepare or ingest food. chronic diseases and impaired cognitive status effects swallowing, appetite, and/or assimilation/excretion of food.
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How does isolation affect nutritional intake?
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If you live alone, you may lose the desire to cook because of lonliness. The appetite of a widow decreases. There is difficulty cooking due to disabilities, and a lack of access to transportation to buy food.
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How does depression affect nutrition?
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it is associated with a decreaesd dietary intake, decreased appetite and weight loss.
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What are macro nutrients?
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energy! carbs, protein, and fat
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What are micro nutrients?
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vitamins and minerals
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what is malnutrition?
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any disorder of nutrition status, including disorders resulting from a deficiency of nutrient intake, impaired nutrient metabolism or over-nutrition
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What is malnutrition in the elderly characterized by?
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faulty or inadequate nutritional status; under nourishment characterized by insufficent dietary intake, poor appetite, muscle wasting, and weight loss
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What is protein-energy malnutrition, and what are two types?
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An imbalance between nutrient supplies and requirements. Protein-caloire malnutrition, protein-calorie undernutrition, and protein-energy undernutrtion.
Marasmus- characterized by wasting Kwashiorkor- charactreized by edema |
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What is protein-caloire malnutrition, or protein-energy undernutrition? What causes primary and secondary PCM?
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It is the presence of clinical (physical signs such as wasting, low BMI) and biochemical (albumin or serum protein) evidence of insufficient intake.
Primary PCM: nutritional needs are not met as a result of poor eating habits Secondary PCM: alteration or defect in ingestion, digestion, absorption, or metabolism. "disease related" malnutrition |
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What is marasmus?
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Depletion of muscle mass and fat stores. There is normal visceral protein and organ function. The patient looks malnourished, catchetic. There is a history of weight loss, and the patient will have adapted to decreased nutrient intake. They function fairly well, unless exposed to additional metabolic stress.
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What is Kwashiorkor?
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hypoalbuminemic malnutrition. There is a loss of visceral proteins (low albumin, transferrin, and prealbumin). This causes edema. The patient may not have a history of weight loss or appear malnourished. This is caused by inadequate protein intake relative to the body's needs during hypermetabolic states- injury, infection, and draining wounds
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What are the ICD-9 classifications of kwashiorkor?
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severe protein deficiency, retarded growth, changes in skin and hair pigment, edema, and pathologic changes in the liver. The liver has fatty infiltrates and necrosis fibrosis.
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What classifies 'other' or 'unspecified' protein-calorie malnutrition?
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This is a disorder caused by lack of proper nutrtion or the inabiltiy to absorb nutrients from food. There is an imbalanced nutritional status from insuffcient intake of nutrients to meet normal physiological requirements. Inadequate nutrition can result from a poor diet, malabsorption, or abnormal nutrient distribution. There is a lack of sufficient energy or proteins to meet the body's metabolic demands, as a result of either and inadequate dietary intake of protein, intake of poor quality dietary protein, and increased demands due to disease or an increased nutrient losses.
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What is an important indicator of malnutrition in the elderly?
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weight loss
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How much weight loss in six months is cause for concern in an elderly patient?
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ten pounds
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What is the definition and etiology of unintentional weight loss?
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-an involuntary loss fo total body weight over time. the etiology may include anorexia, starvation, sarcopenia, cachexia, or a combination of these factors
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What is considered long term unintentional weight loss?
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a loss of either 5kg or more or 5% of usual body weight over a 5-10 year periodq
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What is acute unintentional weight loss?
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an unintentional loss of total body weight more than 7.5% of baseline body weight in six months
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What is significant unintentional weight loss?
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a loss of 5% of body weight over a 1 month period, or 10% over a six month period
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What is cachexia?
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cytokine-mediated inflammatory disease, severe wasting of fat and fat-free mass
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What is starvation?
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pure protein deficiency, conserve lean body mass, deplete fat mass
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What is sarcopenia?
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age related loss of fat-free (muscle or lean) mass, muscle strength and function. Depletion of lean body mass, weight may not change, mediated by testosterone, growth hormone, ILFG-1, immobility
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What is sarcopenic obesity?
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The patient has an increase in fat mass and a reduction in lean mass. It can be due to aging when muscles become weak due to lack of exercise, or it can be genetic. The patient will have an approriate BMI, but look very fat. it is an inflammatory state.
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What is the aim of EuroOOPS?
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implement the nutritional risk screening and to assess the association between nutritional risk and clinical outcome.
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What is the problem with prevalance studies?
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there is no universal 'gold' standard for diagnosis of malnutrition. Different studies also use different indicators.
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How do you assess the height of a patient who cannot stand?
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knee-height measurements or demi-span
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How do you perform a demi-span?
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Demi-span is measured as the distance from the middle of the sternal notch to the tip of the middle finger in the coronal plane. Height is then calculated from a standard formula.
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How do you calculate BMI?
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kg/msquared
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What are the ranges for BMI for the nutrition screening initiative?
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22-27
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What are the national heart and lung instutite BMI range?
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18.5-24.9
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What is the albumin level indicating malnutrition?
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under 3.5g/dL
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What is the transferrin level indicating malnutrition?
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under 200mg/dL
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What is the prealbumin level indicating malnutrition?
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under 15mg/dL
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What is the retinol-binding protein level indicating malnutrition?
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2.7-7.6mg/dL
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What is wrong with looking at the serum album?
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it lacks sensitivity and specificity as a nutritional indicaor during acute stress. Normally, it reflects underlying disease states. It is a proxy indicator of inflammation, and is associated with adverse outcomes
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What does the c-reactive protein tell us?
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elevated levels due to inflammation.
0-1 is normal |
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What is the Hs-CRP tell us?
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it measures the risk for heart problems.
1-3 = average risk 3+= high risk |
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What is the purpose of nutritoin screening per the WHO?
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use of simple tests across a healthy population in order to identify individuals who have disease, but do not yet have symptoms.
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What is the ASPEN Nutrition screening?
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a process to identify individuals who are malnourished or who are at risk for malnutrition, to determine if a detailed nutrition assessment is indicated.
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What is the ESPEN screening?
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a rapid and simple process conducted by admitting staff or community healthcare teams
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What is the nutrition screening controversey?
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there is no agreement on procedures to conduct the screen. there is no agreement on a cutoff point at whih a given patient is said to have a positive screen
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What is the aim of nutrition risk screening in acute care?
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To survey managers of clinical nutritoin services in aute care hospitals regarding procedures for screening for nutrition risk.
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What kind of information does nursing gather in a nutrition history?
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1. history of weight loss
2. poor intake PTA 3. nutrition support 4. chewing/swallowing issues 5. skin breakdown |
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What kind of information does nutrition services staff gather in a nutrition history?
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1. diagnosis
2. nutrition support 3. NPO/clear liquid order 4. visceral proteins 5. specific diet orders |
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What is involved in a mini-nutritional assessment?
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Food intake, mobility, BMI, weight loss, psychological stress or acute disease, dementia or psychological conditions. 11 points or more.
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When is nutrition day USA?
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november 5
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