141 terms

NA Test #3

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Reasons to measure lab values
comparison, before/after, progression, diagnosis, medical effectiveness, validating
CRP elevated
elevated levels can be from stress -- lead to heart attack
Hcy elevated
elevated means b vitamin deficiency
ioxides LDL
Adjusted Ca
50% Ca bound to albumin and 50% is ionized (free floating)
-ionized is only type of active Ca
-Ca test will show all Ca
- Pt low albumin levels -- make Ca look low to so you adjust
Characteristics of PCOS
irregular ferility
hairy
high FBG
Risks of PCOS
excess insulin
genetics
excess androgen
obesity
cysts on your ovaries
NAFLD characteristics
enlarged liver
fatigue
pain in the upper right abdomen
abdominal swelling
yelling of the eyes
Gastric Bypass
Surgical method promoting weight loss through an altered GI tract. Parts of the stomach and the duodenum are bypassed.
Nutrients effected by Gastric Bypass
Ferritin, Serum B12, RBC, Folate, CBC, Electrolytes
effected by how the stapling of the stomach can lead to malabsorption
NAFLD treatment
decrease risk factors - become healthier
consumption of unsaturated fats
Consequences of PCOS
infertility
depression
anxiety
sleep problems
Lower Hcy and CRP
heart healthy diet increased levels are both d/t body stress response and increased cholesterol
TC under
200 mg/dl
Triglycerides under
150 mg/dl
effected by sugar, simple carbs, alcohol, meds
HDL
>60 mg/dL
Optimal LDL under
100 mg/dl
Desirable HTN
<120/<80
Values of pre HTN (high blood pressure)
120-139/80-89
Pre diabetes
100-126 mg/dl
diabetes
> 126 mg/dl
3 nutrients emphasized in the DASH diet
1. magnesium
2. Potassium
3. Calcium
Values for HTN (high blood pressure)
>=140 / >= 90
ADH acts upon kidneys to
retain fluid
Aldosterone acts on the kidneys to
retain fluid and sodium
For each pound lost of fluid, how many cups of fluid should you drink?
2 cups per 1 pound lost
Main function of sodium
fluid balance
Static tests
measures compounds of interest
Functional tests
measures storage of compounds or physical activity depends on it
Lab test advantages
-validate ABCDs
-supports nutrition diagnosis
-assists with evaluating interventions
- diagnose dz
- monitor medication effectiveness
-objective
-useful for comparison
*can identify issues before they effect pt --> find underlying issues
Factors effect lab values
nutrition status
fluid status
pregnancy
medications
stress state
illness/disease
activity time of specimen
non specific
lab errors
How to improve HDL
omega 3
exercise
wt loss
LDL Cholesterol (Bad)
d/t obesity and/or inactivity
optimal: <100 mg/dL
Risk factors for hypertension
inactivity, smoking, caffeine, genetics, salt, age, ethnics, stress
Test for DM
Oral glucose tolerance test
FBG
Nonfasting BG
HbA1c test
HbA1c
>/= 6.5%
Pre DM 5.7-6.4%
over 3 month period
Type 1 DM
no insulin
lowers GB
Type 2 DM
insulin resistance
d/t abdominal obesity, age, genetics, inactivity
Fluid restriction
25 cc/kg ABW
Average fluid rec
30 cc/kg ABW
Dehydrated fluid
35 cc/kg ABW
Functions of h2o
regulate body temp, med for metabolic reactions, lubricant for joints, eliminate waste thru urine
Distribution of h2o
ICF 2/3
ECF 1/3
Maintaining fluid balance
assessed by checking Na levels in the blood
Hypothalamus - ADH kidneys conserve h20
Kidneys - Aldosterone conserve h2o and Na (starts with renin)
SIADH
over production of ADH
d/t - meds, tumors on pituitary and hypothalamus
sym - edma, low Na
Diabetes Insipidus (DI)
ADH deficiency
d/t - head trauma, meds
sym - excessive thirst, high Na in blood
hyponatremia (over hydration)
low Na in the blood
-increases ICF vol, headaches, swelling (CHF d/t left ventricle fatigue --> back flow fluid, pulmonary edema)
-pushes h2o into tissues and cells causing swell and burst
-must retain 3 liters before edema
*happen to athletes who don't consume electrolytes
BMP (basic metabolic panel)
fishbone
Na, Cl, BUN, Glu
K, HCO3, Cr
Na
-regulates ECF and ICF
-critical for energy metabolism (Na/K pump)
Na normal levels
136-145 mg/dL
Aldosterone on Na
Low reabsorb Na from the blood
High excrete excess Na
Hypernatremia
>145
-h2o loss, dehydrated, too much saline
-labs high Na, BUN, Glu
*each 3 rise in Na = 2.2 # of fluid loss
Hyponatremia
<136
-over hydration, fluid retention, SIAH
-labs low Na, BUN, Alb
*each 3 drop in Na = 2.2 # of fluid gain
Serum Osmolality equation
2 Na + BUN/ 2.8 + Glu/ 18

Norm 285-295
Serum Osmolality
high - dehydration, hyperglycemia, hypernatemia
low - over hydration, ascites, SIADH, post op
BUN
Blood urine nitrogen
-test of kidney function
-directly related to Pro
BUN norm vals
8-23 mg/dL
BUN levels
High - azotemia (high nitrogen), increased PRO, dehydration, UTI, starvation
Low - liver dz (hard to make urea), malnutrition low pro, over hydration,
Creatinine (Crt)
nitrogenous waste product of PCr
produced at constant rate relative to muscle mass, age, and gender
Serum Crt normal values
0.6 - 1.2 mg/dL
Creatinine levels
increase: renal dz (creatine excretion reduced)(Crt +3), blocked urinary track, starvation
Decrease: pro energy malnutrition
BUN/Crt Ratio
>23 dehydration and acute kidney dz, CHF
<10 liver damage or low pro diet
Glucose normal values
70 - 99 mg/dL
Kwashiorkor
ht/wt = > 90% IBW
dyspigmentation of hair/skin
low serum albumin
FeDA
ketonuria
FeDA
cause - inadequate intake, higher, blood loss, liver disease, GI condition
s/s - SOB, Tachycardia, fatigue, mental sluggishness, generative tissue changes
FeDA labs
Serum Ferritin - low (storage form of iron)
TIBC - high
Transferrin -high
Folate deficiency
MVC >94
S/s - anorexic, wt loss, high homocysteine
(3-4 to develop)
Risk - preg women, infants, poverty
Diagnosis - RBC folate and homocysteine levels
B12 deficiency
MVC >94
S/S - SOB, loss of appetite, high homocysteine
causes - lack of intrinsic factor, stomach acidity, poor absorption
diagnosis - MMA (by product broken down by b12)
risk - older adults, GI conditions
Pernicious Anemia
B12 deficiency prolonged
d/t lack of intrinsic factor
s/s diarrhea, fatigue, anorexia, depression
A pt has been admitted due to a MVA; his blood glucose is 195. What do suspect is going on?
Diabetic, stress response
1st stabilize the patient
Anemia of Chronic Dz
d/t extended infection/inflammation (chronic dz, cancer, CHF)
low serum Fe --> micocytic cells
body has Fe in storage
looks like FeDA
Hyperkalemia
renal failure - cell trauma cause cell won't get rid of K, dehydration, metabolic acidosis - K into the blood stream
S/S nausea, bradycardia
Hypokalemia
diarrhea/vomiting - lose K, excessive sweating, mal nut
S/S muscle cramps, weakness
Liver Enzymes and effects if high
Alanine Amino Transferase (ALT)
Alkaline Phosphatase (ALP)
Aspartate Amine Transferase (AST)
Gamma Glutamyl Transpeptidase (GGT)
High = liver dz, central obesity, some meds
K normal values
3.5 - 5 mEq/L
Heart enzymes and effects if high
CPK - releases after a heart attack
Troponin - releases after a heart attack more sensitive -indicates heart damage
K functions
intracellular cation
acid -base balance
renal system buffer
fluid balance with Na/K pump
You have a patient admitted that you suspect is malnurished. You would like to check his visceral protein status; which lab(s) would you request and why?
PreAlbumin
Serum Albumin
need to rule out stress to body first
A pt is admitted to the hospital because of MI. Which labs would be elevated?
CPK or CK
Troponin
enzymes released with heart damage
You have a patient who has been vomiting numerous times daily since admission for a severe influenza. Which labs do you suspect to be low do to vomiting?
Chloride - decreased with vomiting and diaherra
NA down
K - fluid balance
A pt comes in with Trigycerides of 450. He wants to know what could be causing these levels; what do you tell him?
effected by sugar, simple CHO, alcohol, liver failure, medications
You have a pt who has an elevated AST and GGT. He also has a history of alcoholism. What has occurred?
Liver disease
A diabetic pt has a FBG of 250. He wants to know what FBG are ideal. What do you tell him?
anything under 100 mg/dL
A 45 y/o man comes in with a cholesterol level of 320. He asks for the desired level; what do you tell him?
desirable is under 200
5 to 1 ratio of Cholester/HDL
You screen a 70 y/o with a total cholesterol of 95, PAB 3 mg/dL, and MAC of 14 cm. What could be going on?
malnutrition
cholesterol is very low
When osm is high, what condition could be occurring?
dehydration, alcohol intoxication, uremia, hyperglycemia, elevated BUN d/t dz
A pt has 8% body fat with a slightly elevated Crt level. What could be going on?
starvation, rapid muscle loss or high meat intake
When ism is low, what condition could be occurring?
over hydration, ascites, SIADH, post op status, hyponatremia
A pt is a double amputee with low Crt. Should you be concerned? Why/ why not?
not concerned because lost wt d/t amputation
Your pt has albumin of 2.6, BUN of 12, and TLC of 1,000. What could be going on?
Albumin mod
BUN WNL
TLC mod --> low pro
RESULT:
moderately malnourished with PEM
poor pro intake, liver dz
You have a pt that has macrocytic anemia (MVC: 110). Why is it important to distinguish which B-vit is causing anemia? What tests will you order to determine the cause of macrocytic?
B/c by product of a metabolic reaction to be broken up and excreted by folate and B12 (12 activates folate)
MMA test for B12
Pt was admitted with pneumonia, and you suspected the he is also suffering from FeDA. Serum ferritin is 180 (low) and transferrin is 200. The doctor asks you if he should start iron supplementation through the pt IV. What should you tell him?
No b/c both are a sign of phys stress on the body. He needs to heal before you assess
Pt has been admitted with rebel failure and metabolic acidosis. Will his blood K levels be high or low?
High because they will not be passed out of the body
A pt has a blood Ca level of 11.3 mg/dL (high). What can occur if levels stay elevated for a long time? What are some potential causes of high blood calcium?
kidney stones -- d/t extremely high Vit D levels
hyperparathyroidism -- PSH released in excess
Your client has been diagnosed with metabolic syndrome. What are characteristics of this condition?
high waisted circumference
obesity
diabetes
hypertension
high cholesterol or trigyclerides
Richard is a 62 y/o male admitted with a hx of alcohol liver dz and cirrhosis. What would you expect to with Richard's liver function tests?
the number would be elevated d/t impaired function
Richard is a 62 y/o male admitted with a hx of alcohol liver dz and cirrhosis
What would you expect Albumin to be elevated or lowered? Why?
Low b/c albumin is made by the liver which would lead to decrease production with impaired function of the organ
Richard is a 62 y/o male admitted with a hx of alcohol liver dz and cirrhosis. Would you expect BUN to be elevated or lower? Why?
Low b/c decreased PRO metabolism
DASH Diet
Dietary Approach to stop hypertension
developed to lower BP with meds
heart healthy benefits and helps lower cholesterol
Focuses on Vit and mineral intake
Americanized Meditterain diet
Na 1500 mg/ day
Metabolic Syndrome
Waist circum = greater 40 men and 35 women
Trig > 150 mg/dL
HDL < 50 mg/dL
BP > 130/85 mm Hg
FBG > 100 mg/dL
Effects 35% of adults ---> higher risk for CVD
TLC diet
Therapeutic lifestyle changes diet
lifestyle changes through diet and exercise
-no smoking
main focus is to reduce sat fat
lowers ldl and keeps hdl
What is the first test we assess when checking fluid status?
Na
Albumin and Prealbumin article
these are not good markers of nutrition status --> acute phases reactants and are effected by many other things in the body
What happens to serum Albumin levels during infection or trauma? How could this impact your nutrition assessment?
body lowers amount of pro being made
impact leads to inaccurate read
What happens to serum albumin levels during marasmus?
normal d/t decreased pro and kcal intake but body compensates
Prealbumin is considered a more sensitive indicator of Protein status than albumin. Why?
b/c it has a shorter half life of 2-3 days
What happens to Transferrin during iron deficiency anemia? Why?
increases b/c stands for transfer iron but with anemia body will try to trap it
Kwashiorkor albumin levels are used to diagnose. Why?
fluid is pushed out leading to ednma which measures inflammation
Nutritionally speaking, why is it valuable to measure serum levels of C - Reactive Protein?
b/c you naturally aren't supposed to have this in your body d/t stress
What can lab values be effect by?
collection procedure
time of day
hydration status
recent exercise
health
stress
Why is important to take into account lab values that impacted by hydration status when assessing pt?
helps to see if direct effect of the illness or rule out other problems
Low serum albumin can indicate
physiological stress
acute malnutrition
What is the best biochemical test to diagnose impaired iron status
serum ferritin
What are other tests used to assess iron status?
Mvc down with deficiency
MCH pale
Hemoglobin/Hematocrit low in def
TIBC increase
What happens to Na, K, Mg during refeeding syndrome? What are some physical effects that can come from these values being off?
1) low blood volume, insulin anabolicly active pushes electrolytes back to the cells with food
2) lead to death, nausea, vomitting
CRP maker of inflammation
to fix treat underlying condition to fix
Hcy market of inflammation
more effected by diet d/t fat intake and b vitamins - break down substance
Why is important to accurately identify the cause of macrocytic anemia?
b12 activates folate
Side effects of b12 deficiency
high homocysteine levels
nerve damage
wt loss
fatigue
depression
Sources of folate
fortified foods
green leafy vegetables
beans
How does diet effect serum Ca levels?
through vitamin D and Ca consumption not as strictly controlled through food more through body regulation
When learning about acid base - balance, there were two compensatory mechanisms that kick in to try and get blood pH back to normal. Which occurs first?
Respiratory rate
Risk factors of NADFL
Obesity central
Type II DM (insulin resistance)
Key points with acid-base balance
respiratory compensation can occur within minutes
renal compensation may take 3-5 days
compensation may not be 100% successful
Respiratory Acidosis
plasma pH - low
primary disturbance - increased PCO2
Compensation - increase renal acid excretion w/resulting increase in serum bicarbonate
Cause - emphysema, COPD, respiratory retain CO2
Respiratory Alkalosis
plasma pH - high
Primary disturbance - decreased CO2
Compensation - decreased renal acid excretion w/resulting decrease in serum bicarb
Cause - intense exercise, anxiety, excessive expiration
Metabolic Acidosis
Plasma pH - low
primary disturbance - decreased HCO3
Compensation - hyperventilation w/resuling low PCO2
Cause - diarrhea, uremia, ketoacidosis, uncontrolled DM, starvation, high fat/low cho diet, renal failure
Metabolic Alkalosis
Plasma pH - high
Primary disturbance - increased HCO3
Compensation - hyperventilation with resulting increase in PCO2
Cause - diuretic use, vomiting, loss of chloride
Hyperparathyriodism cause
The parathyroid glands help control calcium use and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps control calcium, phosphorus, and vitamin D levels in the blood and bone.

When calcium level is too low, the body responds by making more PTH. This causes the calcium level in the blood to rise.

When one or both of the parathyroid glands grow larger, it leads to too much PTH. Most often, the cause is not known.
Hyperparathryiodism consequence
Bones become weak, deformed, or can break
High blood pressure and heart disease
Kidney stones
Long-term kidney disease
Hyperparathryiodism dietary treatment
Drinking more fluids to prevent kidney stones from forming
Exercising
Not taking a type of water pill called thiazide diuretic
Estrogen for women who have gone through menopause
Having surgery to remove the overactive glands (usually for people under age 50)
Which labs assess kidney function
Blood Urea Nitrogen Test
Creatinine
Risk factors for kidney dz
diabetes
genetics
high blood pressure
infection
Consequences of kidney dz
hemodialysis
peritoneal dialysis
kidney transplant
hemo dialysis
uses a machine. It is sometimes called an artificial kidney. You usually go to a special clinic for treatments several times a week.
peritoneal dialysis
dialysis uses the lining of your abdomen, called the peritoneal membrane, to filter your blood.
albumin range
3.5 -5 g/dL
What albumin indicates
low: liver dz, PO, inflammation, fluid overload, poor protein intake - depletion of muscle mass
high: medication, dehydration
Cl range
98-107 mEq/L
What Cl indicates
low: vomiting, diarrhea, sweating
high: dehydration, DI
HCO3 range
22 - 29
HCO3 indicates
high: metabolic alkalosis - diarrhea, starvation
low: metabolic acidosis - vomit, loss of Cl