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19 Cards in this Set
- Front
- Back
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Nutrition Assessment: Diet Hx
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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 |
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Nutritional Asessment: Sx
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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) |
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Nutritional Assessment: Pertinent PMH
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-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 |
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Nutritional Assessment: SHx
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-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 |
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Weight Hx
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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 |
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BMI
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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 |
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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 |
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Interpreting Rate of Weight loss
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Over 6 months, 10% is signifigant and >10% is severe
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Nutrition Focused PE
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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 |
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Nutrition Parameters
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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 |
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Interpreting % bosy fat
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F= 25-32 = accepatable >32=obeses
M= 17-25 acceptable >25 obese |
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Energy Requirements: Harris Benedict Eqation
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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+) |
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Rule of thumb for weight loss/maintenance/illness/trauma
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weightloss= 20-25 c/kg
maintenance = 35-30 c/kg illness 30-40 c/kg burn/trauma 40-50 c/kg |
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protein requirements
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g/kg/d
normal 1 moderate stress= 1-2 severe stress 2-2.5 disease specific .4- 3 |
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Determining Protein Status you should take into account (3 things)
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Visceral Proteins, Nitrogen Balance, Lean body mass
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Visceral Proteins
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Albumin - half-life = 18-21 days
Transferrin - half-life = 7-10 days Prealbumin - half-life = 2-3 days |
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Nitrogen Balance
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Requires 24 hr urine collection and a 24 hr dietary protein count
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Normal Serum Protein Levels for Albumin, prealbumin and transferrin
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A- 5.5-3.5
pre- 40-14 trans-375-200 |
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Visceral and Somatic stores Assessment
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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 |
