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Flashcards in Nutritional Disorders Deck (25)
1

Marasmus
-definition
-etiology
-clinical & lab findings

def- protein calorie starvation caused by protein and energy deficiency, typically results from chronic diseases (COPD, CHF, cancer)

etiology-
-lack of food d/t lack of access (SES, education, parental neglect)
-physical disability (cant take in food)
-chronic illness
-prolonged hospitalization

clinical findings:
-hx of weight loss
-muscle wasting
-absence of sub Q fat
-decreased BP, HR, and temp
-dry thin dull hair
- mild anemia

Lab findings:
-mildly reduced serum proteins
-CBC indicates anemia

2

Kwashiorkor
-definition
-etiology
-clinical & lab findings

def- severe protein deficiency in the presence of adequate energy, results from hypermetabolic acute illness (burns, trauma, sepsis)

etiology:
-decreased intake
-increased losses(malabsoprtion/diarrhea
-increased requirement (fever, neoplasms, surgery)

Clinical findings:
-normal fat and muscle
-decreased BP, bradycardia, hypothermia
-edema
-hepatomegaly w/ ascities
-dry skin/hair


Lab findings:
-low serum albumin
-mild anemia
-decreased glucose and lipids
-hypokalemia
-hypophosphatemia
-metabolic acidosis

3

Overall PEM is characterized by...

-loss of body weight, adipose stores, & muscle mass

* proten mass is lost from liver, GI tract, kidneys, & heart

4

What lab could we order to help evaluate protein status?

albumin

5

What labs could we order to see how the liver is functioning?

Bilirubin- if build up of bilirubin from catabolized RBC in blood liver is not functioning well by filtering this out.

Prothrombin time- checks clotting time, liver makes clotting factors(fibrinogen), if liver isnt functioning well clotting time will be greater.

Albumin- produced in the liver

6

Proteins are important in maintenance of fluid balance. Explain.

if proteins are not being produced by the liver there will be a decrease in the oncotic pressure leading to movement of fluids from the vasculature to the interstitial tissue causing swelling.

7

Effects of Protein Energy Malnutrition (PEM): MUSCLE MASS

-fat and muscle stores are used for fuel
-muscle loss results in weakness and lost protein

8

Effects of Protein Energy Malnutrition (PEM): CARDIAC

-decrease in mass and stroke volume---> decreased cardiac output

9

Effects of Protein Energy Malnutrition (PEM): RESPIRATORY FUNCTION

-weakness and atrophy of respiratory muscles
-decrease in vital capacity, tidal volume, minute volume, and breathing capacity
-mucocilliary clearance is abnormal

10

Effects of Protein Energy Malnutrition (PEM): IMMUNE FUNCTION

-all components are adversely affected
-lymphocyte decrease
-t cells depressed
-specific aby responses depressed
-impaired compliment
-neutropenia (decreased # of neutrophils)


* cannot trust CBC in elderly manlnourished pt, if they cant mount an immune response, labs wont change

***MOST IMPORTANT CHANGE W/ PEM

11

Effects of Protein Energy Malnutrition (PEM): GI TRACT

-gastric motility slows
-gastric acid secretion decreases
-lack of absorption d/t decrease in small bowel mass
-bacterial overgrowth

12

Effects of Protein Energy Malnutrition (PEM): BONES

-calcium not absorbed so you take from bones leading to brittle bones

13

Effects of Protein Energy Malnutrition (PEM): MENSTRUAL CYCLE

-irregular/absent menses
-infertility

14

Effects of Protein Energy Malnutrition (PEM): TESTICULAR FUNCTION

-decreased sperm production
-testicular atrophy
-infertility

15

Effects of Protein Energy Malnutrition (PEM): WOUND HEALING

-neovascularization, collagen synthesis, fibroblast proliferation, wound remodeling all delayed

-local edema

16

Causes of Malnutrition in Hospitalized patients

- decreased oral intake (nausea, pain, old age, depression)

-increased nutrient loss (malabsoprtion, diarrhea, bleeding, nephrosis, glycosuria)

-increased nutrient requirements (fever, burn, trauma, surgery, infection, neoplasm, medication)

-

17

What is the most common abx that causes C-Diff and what medication is used to treat it?

cause- clindamycin
treat- vancomycin

18

3 phases of metabolic responses to critical illness

1.) ebb phase: occurs immediately following injury (12-24hrs)
-fever
-increased CO2
-vasoconstriction
goal: prevent organ failure

2.) Flow phase:
-hypercatabolism
-fat used as fuel source

3.) Anabolic Phase
-begins onset of recovery
-things start to normalize
-improved appetite & diuresis

19

Explain how Inflammatory Bowel Disease affect nutritional status

Decreased nutritional intake
-altered taste
-medications
-anorexia
-early satiety
-association of food w/ Diarrhea and/or pain
-lactose intolerance
-malabsobrtion

Increased Energy expenditure:
-when Chrohns active, resting energy expenditure increases


Enteral Protein Loss:
-capillary leak of proteins through inflammed tissues
-results in decreased concentration of plasma proteins in blood
-cellular proteins continue to get broken down to feed the pool.

20

2 Types of IBD:
Chrohns & Ulcerative Colitis
explain each disease.

Chrohns- autoimmune disease all throughout the bowel. Bowel becomes inflammed and does not absorb well, ulcerations in the lining intestines.

Ulcerative Colitis: autoimmune disease of rectum and colon. Bowel becomes inflammed so its not absorbing well, lots of blood in stool, fissures, skin tags. Much higher risk of colon cancer, usually end up with some sort of bowel resection.

21

Explain how Cancers affect nutritional status

-mucositis
-loss of appetite
-inability to ingest or absorb adequate calories
-in catabolic state b/c of neoplasm
-treatments (surgery) can worsen problem

22

Explain how Lactose Intolerance affect nutritional status

- a lot of fluid loss
- abd pain
-bloating
-flatulence
-diarrhea
-vomiting (adolescence)
-bacterial overgrowth
-infectious enteritis
-mucousal injury (IBD)

23

Explain how Mental Status affect nutritional status

ex. alzheimers
- forgot to eat
-nauseous from meds
-lack of interest in food d/t diminished taste and smell
-poor dental health

24

How do you work up malnourished patients?

Check labs- CBC, CMP ABG (pH), sed rate, electrolytes

25

Common signs of malnutrition

edema, low diastolic BP and pulse, slow wound healing, muscle wasting, edema (from loss of plasma proteins-->loss of osmotic colloid pressure in plasma)