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19 Cards in this Set

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Nutrition Assessment: Diet Hx
Review usual pattern of food intake
24 hour diet recall
Food frequency questionnaires
Food diaries
Food intolerance or allergies
Use of supplements
Specific dietary Rx
Dining out; fast food
Nutritional Asessment: Sx
Appetite - Increased or Decreased?
Steatorrhea (malabsorption)
Rash (B vitamin or essential FA deficiency)
Night blindness (vitamin A deficiency)
Easy bruising (vitamin K deficiency)
Pica (iron deficiency)
Sore tongue (iron or B vitamin deficiency)
Edema (depleted visceral protein stores)
Nutritional Assessment: Pertinent PMH
-Gastrointestinal Illnesses
-Oropharynx - tooth extractions, dysphagia
-Stomach - ulcers, chronic nausea, gastroparesis
-Intestine - diarrhea, celiac dis., Crohn’s dis.
-Chronic illness
Diabetes, Cancer, AIDS, TB, SLE
-Surgical History
Gastric surgery - ulcer operations, resections
Intestinal surgery - resections, anastomoses
Cholecystectomy
Nutritional Assessment: SHx
-Access to Food
Financial status – can the patient afford food?
-Mobility status – can the patient obtain food?
-Cooking
Who usually does the cooking?
Can the patient cook? How often?
-Food Traditions
National, ethnic, or regional food styles
Adaptation to local foods
Weight Hx
Current Weight and BMI
Ideal Body Weight
Calculated
Estimated (post-adolescent weight)
% Ideal Body Weight
Recent Change in Weight
% Usual Body Weight
Rate of Weight Loss
Maximum Lifetime Weight
Desired Weight
BMI
Body Mass Index:
weight (kg)/ height (m2)
ex: 77.2kg/ (1.78)2 = 24.4

1kg = 2.2 lbs and 1 inch =2.54 cm

Appropriate = bw 20 and 25
Ideal Body Weight
(Hamwi method)
F= 100lbs for 5ft and 5lbs for each inch over 5 ft
M= 106lbs for 5 ft and 6lbs for every inch over 5 ft
Appropriate is 90-110% of IBW
Interpreting Rate of Weight loss
Over 6 months, 10% is signifigant and >10% is severe
Nutrition Focused PE
General Exam
Weight, height, BMI (kg/m2)
Body fat distribution (waist/hip ratio)
Dermatologic: rashes, hair, nails
Musculoskeletal: muscle mass, wasting
Eyes: uveitis
Mouth: cheilosis, glossitis, poor dentition
Neurological:  vibration, proprioception
Extremities: edema, ecchymoses
Nutrition Parameters
Body Composition
Adiposity (% body fat)
Fat free mass (lean body mass)
Daily Requirements
Energy (kcal/day)
Protein (g/kg)
Visceral and somatic stores
Protein (muscle mass, plasma)
Vitamins (plasma levels)
Minerals (plasma levels)
Hydration
Interpreting % bosy fat
F= 25-32 = accepatable >32=obeses
M= 17-25 acceptable >25 obese
Energy Requirements: Harris Benedict Eqation
F= 655.1 + (9.563 x kg) + (1.850 x cm) - (4.676 x age)
M= 66.5 + (13.75 x kg) + (5.003 x cm) - (6.755 x age)
the total calories + BEE x (activity factor 1.2-2+)
Rule of thumb for weight loss/maintenance/illness/trauma
weightloss= 20-25 c/kg
maintenance = 35-30 c/kg
illness 30-40 c/kg
burn/trauma 40-50 c/kg
protein requirements
g/kg/d
normal 1
moderate stress= 1-2
severe stress 2-2.5
disease specific .4- 3
Determining Protein Status you should take into account (3 things)
Visceral Proteins, Nitrogen Balance, Lean body mass
Visceral Proteins
Albumin - half-life = 18-21 days
Transferrin - half-life = 7-10 days
Prealbumin - half-life = 2-3 days
Nitrogen Balance
Requires 24 hr urine collection and a 24 hr dietary protein count
Normal Serum Protein Levels for Albumin, prealbumin and transferrin
A- 5.5-3.5
pre- 40-14
trans-375-200
Visceral and Somatic stores Assessment
Water Soluble Vitamins
Thiamine, folic acid, vitamin B12
Fat Soluble Vitamins
Plasma vitamin A, D, E levels
Prothrombin time (vitamin K dependent)
Iron Stores
CBC: Hemoglobin, Hematocrit, MCV
TIBC, transferrin, ferritin
Serum zinc, copper, trace minerals
Plasma electrolytes