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44 Cards in this Set
- Front
- Back
carbs
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sugars and starches.
in plants and animals as lactose or "milk sugar" classified as simple (mono or disaccharides) or complex (poly) |
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conversion of carbs
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to glucose. 90% of carbs are digested, percentage decreases as fiber increases.
the liver stores glucose and regulates its entry into the blood. Hormones, esp insulin and glucagon are responsible for keeping se glucose levels constant. |
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glycogenesis
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if muscle or liver glycogen stores are deficient glucose is converted to glycogen and stored.
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glycogenolysis
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glycogen is broken down in time of need to supply a ready source of glucose
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Protein
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contain nitrogen. Nine amino acids are essentail
-are complete (high quality) or incomplete (low quality) based ont ehir amino acid composition. |
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protein, what happens
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Broken down into amino acids by pancreatic enzymes in the small intestine. then transported to the liver. Released into bloodstream for use in protein synthesise
excess amino acids are converted to fatty acids, ketone bodies, or glucose and are stored or used as metabolic fuel. |
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nitrogen balance
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comparison between catabolism and anabolism is measured by compaing nitrogen intake and nitrogen excretion
a positive balance when protein intake is greater than excretion (growth, pregnancy, lactation, recovery from illness) negative balance, starvation and the catabolism that immediately follows surgery, illness, trauma, and stress |
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RDA protein
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protein is oxidized to provide 4cal/g. using protein for energy is more expensive physiologically.
RDA--.8g/kg of desirable body wt or about 56g for average woman and 63g for average man.or 46g/56g 10-20% of total cal intake. |
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RDA carbs
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50-100g is needed daily to prevent Ketosis.
50-60% o diet's total cal. all carbs provide 4cal/g regardless of source |
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stressed pts: protein
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.8-1.0 g/kc/actual wt
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severely stressed pts: protein
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2-3 g/kg/actual wt
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water intake daily
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2000-2500 mL/day for adults
35/ml/kg (25-50yrs) 25ml/kg (50-75) 25mL/kg (75 and older) adolescents: 40-60 ml/kg Infants: 100-150 ml/kg |
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interventions for dehydration
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-replace known losses
-use the higher range of fluid reqs in the estimation of need. -in cases of fever, add 200ml of water for each degree celsuis that the temp is elevated -monitor lab values closely and adjust fld needs |
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fat soluble vits
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vit A, D, E, K
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Water soluble vits
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Thiamine, Riboflavin, Niacin, Folic Acid, B12
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Stress or illness
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-hypermetabolic response, req more energy
-sympathetic nervous system> catecholamines (epinephrine, dopamine, etc) -catecholamines> hormone and mediators (cortisol) -conversion of amino acids for glucose -skeletal muscle breakdown with amino acids used for energy -higher levels of stress release more catecholamines. |
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protein requirements: renal failure
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calories=25mgm/kg/day
protein restriction=.6mgm/kg/day malnourished=.8mgm/kg/day on dialysis-increase to 1.2-1.5 mgm/kg/day |
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chronic hepatic disease: protein
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increase to 1.5 mgm/kg/day
Hepatic encephalopathy, reduce to .5-.8 mgm/kg/day |
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hepatic encephalopathy
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liver caused mental impairment
Because the shunted blood has bypassed the liver, it contains high levels of amino acids, ammonia, and possibly toxins. |
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3 phases of starvation
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1-blood glucose levels maintained by production of glucose from glycogen (glycogenolysis), fats and proteins broken down
2--weeks, adipose tissue releases stored fats, fatty acids and glycerol, fatty acids, ketone bodies, primary source of energy. 3--fat reserves are depleted, protein major energy source. skeletal muscles broken down for energy. proteins essential for cells |
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anthropometric data measurement
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-BMI
-waist circumference -triceps skinfold measurements -mid-arm circumference MAC |
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BMI calculation
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wt (kg)/height (m2)
1 meter=3.28 feet |
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BMI general
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measure of proportional weight not adiposity.-in absence of a direct emasure of body fat, it is the most satisfactory index based on wt and ht.
-doesn't apply to children, adolescents, pregnant women -useful for diagnosing obesity b/c it is a more accurate measure of body fat than wt alone. |
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BMI <20, 2-25, 25-27, >27
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<20, ass with health problems, <16 malnutrition.
20-25: lowest risk for illness. 25-27: ass with health problems for some >27: ass with increased risk for health problems. |
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BMI limitation
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-homogenous population--primarily white
-overestimates body fat in very muscular people -underestimates body fat in some underweight people. |
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assessment of wt status
% of usual weight=current weight |
85-95%= mild malnutrition
75-84% moderate malnuttion 0=74% severe malnutrition |
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recent weight chance
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can be expressed as actual kilograms lost/gained or as a percenteage of weight chcange, where:
%wt change=usual wt-actual wt x100 10%--milk wt loss 10-25--moderate |
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biochemical tests: metabolic assessment of nutritional status
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-protein status
-serum albumin: half-life of 18-20 days -reflects nutritional status over the past 3 months -levels may decrease with stress, overhydration, trauma, surgery, liver disease, and renal disease. -significantly reduced levels of se albumin are ass with increased morbidity serum transferrin >200 serum prealbumin >30 |
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gut defense mechanisms
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-gut contains 70-80% of the immune tissue of the entire body.
-growth of mucosa depends on presence of food in gut -food is ingested, salivary and biliary tract secrete antibodies that bind with bacteria and prevent bacterial attachment -lymphoid tissue within the mucosa and submucosa -cells of the liver and spleen trap and detox bacteria and endotoxins that penetrate beyond the gut and regional lymphatic tissue |
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enteral nutrition
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-1kcal/ml
-isotonic -designed to mimic diet -100% of vits, minerals, and electrolytes -concentrated formulas for pts with fluid retention, renal, hepatic cardia -monitor fld balance b/x as the pts improve, may bcm dehydrated |
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elderly nutrition
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-inadequate diet due to comorbidities, physical disability inability to chew, polypharmacy,and social isolation, poverty
-total cal, calcium, vit B12, folate intake declines -osteoporosis |
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pulmonary disease
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causes of wt loss:
-increased work of breathing -increase in their daily energy expenditure -increased resistive load -reduced respiratory muscle efficiency -frequent, recurrent respiratory infections |
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Chronic Obstructive Pulmonary Disease COPD
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-25-50% have some degree of nutritional depletion
-wt loss common, reduced fat reserves and muscle mass -more severe the greater the wt loss -greater the wt loss, the smaller the mass of resp muscles and diaphragm -decreased cell immunity -altered immunoglobulin production 0impaired cellular resistance |
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poor nutritional intake in COPD
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-chronic sputum production adn frequent coughing
-SOB -depression -flattening of the diaphragm and pressure on teh abdominal cavity during eating -o2 desaturation during eating, resulting in increased dyspnea -side effects of meds |
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Total parenteral nutrtion TPN
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hypertonic, thus administered through a central vein. Medications such as insulin(b/c it contains high glucose) and heparin (prevent clotting at tip of catheter).
-high glucose concentration, why its hypertonic, cannot be stopped suddenly can cause a hypoglycemic reaction. |
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PPN
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isotonic, peripheral vein.
provide fewer calories and supplement a pt's inadequate oral intake. 10% glucose |
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triceps skin-fold measurement
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meausre of subcutaneous fat stores
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midarm circumference
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measure of skeletal muscle mass
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midarm muscle circumference
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measure of both skeletal muscle mass and fat stores
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protein status: biochemical data
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determinded by measuring serum albumin and transferrin levels and by a total lymphocyte count.
lymphocyte count reflects immune status and is directly affeected by impaired nutritional states. albumin is an imortant lab value to assess over a period of time: level doesn't change with increasing age, but malnutrition and disease states cause it to decrease. |
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24 hour urine tests
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used to measure protein metabolism include urine creatinine excretion and urin urea nitrogen.
urea-breakdown product of amino acids. reflects protein intake and the body's ability to detox and excrete this product. creatinine: directly proportional to the body's muscle mass, and a dreduction in this reflects severe malnutrition. |
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biochemical data: older adults
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low se albumin level may be a reflection of aging process rather than a nutritional risk factos. albumin synthesis declines with age.
hemoglobin levels that are lower may only reflect anemia |
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water soluble vitamins
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absorbed through intestinal wall directly into blood. usually are not stored in body. deficiency symptoms are apt to develop quickly.
amounts consumed over need are excreted in urine, toxicities are not likely. |
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fat soluble vitamins
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absorbed with fat into the lymphatic circulation. must be attached to a protein to be transported through the blood. stores in liver and adipose tissue.
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