Health Assessment Chapter 11

C-reactive Protein:

(CRP)-plasma protein marker of inflammatory status produced by liver; used to monitor metabolic stress (e.g. trauma, surgery, burns) and determine when to begin nutritional support in critically ill patients; generally not detectable in blood of healthy individuals; also used to assess risk for myocardial infarction (MI).

HDL-C

(High-density lipoprotein cholesterol or "good" cholesterol)—inversely related to coronary heart disease risk 60+ is optimal. <40 in men, <50 in women: risk for heart disease.

LDL-C

(low density lipoprotein cholesterol or "bad" cholesterol)-major carrier of cholesterol in blood, associated with increased risk for atherosclerosis and coronary heart disease

Nutritional Assessment:

1. identify individuals who are malnourished or are at risk for developing malnutrition 2. provide data for designing a nutrition plan of care that will prevent or minimize the development of malnutrition 3. Establish baseline data for evaluating the efficacy of nutritional care.

What are the purposes of a nutritional assessment? What are the different ways to assess nutrition? (24 hour recall, food frequency, food diary, observation)

24 hour recall: Easiest and most popular. The individual or family member completes a questionnaire or is interviewed and asked about everything eaten w/in the last 24 hours. However some significant sources of error can come with this.

Normal CRP value:

<0.1mg/dL

Serum albumin:

A common measurement of visceral protein status. B/c of its relatively long half-life (17 to 20 days) and large body pool (4.0 to 5.0 g/kg), albumin is a better indicator of long-term protein status rather than acute protein acute protein malnutrition seen during serious illness.

Waist Circumference:

Abnormal findings (increased risk of CV and metabolic disease) > 35 inches in women > 40 inches in men

Android Obesity

Android obesity = greater proportion of fat in the upper body (apple) Waist-Hip Ratio Normal Android Obesity Men 1.0 and greater Women .8 and greater

Waist-to-hip Ratio:

Assesses body fat distribution as an indicator of health risk. Waist to hip ratio= Waist circumference/hip circumference. A waist to hip ratio of 1.0 or greater in men or 0.8 or greater in women is indicative of android obesity.

What physical findings could be used to indicate nutritional status?

BMI, waist-to-hip measurment, skinfold thickness, anthropometric measures, outer appearance: skin, hair, musculoskeletal system, hair, eyes, lips, tongue, gums, nails, neurologic.

Obesity:

Begins with a BMI of 30.0

Describe the different nutritional needs for various developmental periods through the life cycle (infants and children)

Birth to 4 months. Double weight weight by 4 months. Triple by 1 year of age. Breastfeeding: promotes normal infant growth, dev't, and a natural immunity. Infants increase length by 50% 1st year, Brain size also increases in infancy: by 2 yrs, its reached 50% of adult size, by 4 yrs-75%, and by 8 yrs 100% of size. For this reason calories and essential fatty acids are required for proper growth and central nervous development.

Triglycerides:

Blood fats are used to screen for hyperlidimia and the risk for coronary artery disease. Triglyceride values are age related.

What are some of the types of questions that would be asked during a nutritional history?

Eating pattersn, usual weight, changes in appetite, taste, smell, chewing, swallowing, recent surgery, trauma, burns, infections, chronic illness, nausea, diarrhea, constipation, food allergies or intolerance, medications, nutritional supplements, self-care behaviors, alcohol or illegal drug use, exercise and activity patterns, family history.

Anthropometric measures:

Evaluate growth, development, and body composition. BMI Waist to Hip Ratio (Assesses body fat distribution) Waist Circumferences

Adulthood:

Growth and nutrient needs stabilization. Lifestyle factors: Smoking, stress, lack of exercise, excessive alcohol intake, diets high in sat. fat, cholesterol, salt, and sugar are low in fiber- all factors in hypertension, obesity, atherosclerosis, cancer, osteoporosis, and diabetes mellitus. Imp time for educations preservation of health and prevent or delay the onset of chronic disease.

Food Frequency:

How many times per day, week, or month an individual eats particular foods. Errors: It doesn't always quantify amount of intake and it relies on the persons memory.

Aging Adult:

Increased risk for undernutrition or overnutrition. Poor physical or mental health, social isolations, alcoholism, limited functional ability, poverty, and polypharmacy are major risk factors for malnutrition. Normal aging adults: poor dentition, decrease visual acuity, decreased saliva production, slowed GI absorption, diminished olfactory and taste sensitivity. Loss of lean body mass, increase in fat mass.

Body Mass Index:

Indicator for undernutrition and obesity. <18.5= underweight 18.5-24.9=Normal 25-29.9=Overweight 30-39.9=Obesity 40+=Extreme Obesity

Pregnancy and Lactation:

Iron, folate, and zinc are essential for fetal dev't. Rec. weight gain of 25-35 lbs norm women, 28-40 lbs for underweight women, 15-25 lbs overweight women, 11-20 lbs for obese women.

Overnutrition:

Is caused by consumption of nutrients-especially calories, sodium, and fat-in excess of body needs. A major nutritional problem today. It can lead to obesity and is a risk factor for heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers, and osteoarthritis. 17% of children are overweight and 66% of adults in the US are overweight or obese. For kids this is being in the 95th percentile.

LDL-C Ranges:

LDL Level What Numbers Mean < 110 mg./dL Desirable number (for children and adolescents) < 130 mg./dL Desirable number (for adults_ 130 to 159 mg./dL Borderline High 160 to 189 mg./dL High 190 mg./dL and above Very High

Whole grains:

Make at least half of grains consumed whole grains such as whole wheat bread and pasta. At least 3 oz. of whole grains/day. 1.0 oz is about a slice of bread and 1 cup of breakfast cereal or pasta.

What are the "new" guidelines entitled "My Plate" that replaced the food pyramid as of June 1, 2011? What are the specific recommendations that are being made with "My Plate" and recommendations made in 2010?

New "My Plate" logo suggests that people eat balanced means consisting of fruit, vegetables, grains, protein and small amount of dairy. New recommendations: Reduce portion size, Make at least half of each meal fruit and vegetables, Make at least half of grains consumed whole grains such as whole wheat bread and pasta, Switching to fat free or low fat (1%) milk, Urged to cut down on salt consumption, Drink water instead of sugary beverages.

What is the role that cultural heritage and values and how does it play in an individual's nutritional intake?

Newly arriving immigrants at risk for nutrition intake. (e.g. hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries. Other factors: Lots of changes, language barrier, culture diff, no known people, unfamiliar foods, familiar foods are difficult to find, low income may limit ability to access familiar foods.

What are some of the factors that might put a person at nutritional risk?

Newly arriving immigrants, aging adults, pregnancy, cancer, dehydration.

Triglycerides:

Normal (20-65: <150 mg/dL) (0-19: 10-100) Borderline High: 150-199 High: 200-499 Very High 500+

Direct Observations:

Observation of feeding and eating process can detect problems not readily identified through standard nutrition interviews. Observing typical feeding techniques by parent or caregiver and interaction between ind. and caregiver can help assess failure to thrive in children or unintentional weight loss in older adults.

Undernutrition:

Occurs when nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands. Vulnerable groups: Infants, children, pregnant women, recent immigrants, persons with low income, hospitalized people, and aging people. This puts them at risk for impaired growth and development, lowered resistance to infection and disease, delayed wound healing, longer hospital stays, and higher health care costs.

Fats:

Provide 9 cals. per gram

Normal serum albumin:

Range from 3.5-5.5 g/dL

Describe the different nutritional needs for various developmental periods through the life cycle-Adolescence

Rapid physical growth and endocrine hormonal changes. Bone growth and increase in muscle mass as well as menarche in females, calcium and iron requirement increases. Cannot be met by 3 meals a day, snacks play an important role in achieving adequate. (Adolescence poss. experience: skipped meals, excessive fast food, limited fruits and veggies, peer pressure, alt. dietary patterns, hectic schedules, and poss exp. of drugs and alcohol. Boys-grow taller and have less body fat than girls. % body fat increases in girls 25% and decreases in men (replaced by muscle) Girls-double weight between 8-14 yrs. Boys double weight between 10-17 yrs.

Fat (saturated vs. unsaturated)

Saturated fats increase the levels of LDL's in the body (worse for you) harder to digest, remain solid at room temp. (less than 10%) Unsaturated: liquid at room temp, to become solid it needs to be hydrogenated.

Carbohydrate: (Simple, Complex)

Simple: One or two sugar molecules, quick sugars. Complex: Digest more slowly, more stable. Think whole grains.

Cachectic:

Symptoms of cachexia. Wasting diseases, cancer, dehydration, and starvation. Sunken eyes; hollow cheeks and exhaustion, defeated expression.

Nutritional Screening:

The first step in assessing nutritional status, is required for all patients in health care settings within 24 hours of admission. Based on easily obtained data, nutrition screening is a quick and easy way to identify individuals at nutrition risk, such as those with weight loss, inadequate food intake, or recent illness.

Most americans consume what kinds of fat?

Too much saturated and trans fat and not enough mono and unsaturated fats.

Hemoglobin:

Used to detect iron deficiency anemia. Normal values; Adult Men 14 to 18 g/dL Adult Women 12 to 16 g/dL

Nutritional Screening Parameters:

Weight and weight history, conditions associated with increased nutritional risk, diet info, and routine lab data. (e.g. Malnutrition screening tool, and the mini nutritional assessment (used for older adults in LTC and community settings)

Food Diary:

Write down everything consumed for a certain period of time. Typically, three days, or two weekdays. Most complete and most accurate. Potential problems: noncompliance, inaccurate recordings, atypical intake on recording, and conscious alteration of diet during recording period.

Glucose:

amount of glucose in serum, usually a fasting test Normal Values Adults < 100 mg/dL

Nutritional Monitoring:

collection and analysis of patient data to prevent or minimize malnourishment

Cholesterol (total):

evaluates fat metabolism, risk for CV disease 120-200 mg. Normal Range >200-239 Borderline Risk 240 and > High Risk

Gynoid obesity

greater proportion of fat in the hips and thighs (pear)

Hematocrit:

measure of cell volume, also iron status Normal Values: Men-37-49% Women-36-46%