NFSC 370 CLINICAL NUTRITION
Review for Exam I
Fall, 2006
McCafferty
In writing your responses to case study questions, I will be looking for “concise but thorough” answers. In
other words, you’ll want to organize your thoughts before you begin to respond to the question.
Understand all steps involved with the Nutrition Care Process. Be able to apply these steps to a case study.
(Also, who are the participants in the care process? What are their respective roles? )
Know the components involved in assessing nutritional status, and be able to apply them to a case
study. Example: If I give you X information about a patient, what else do you need to ask
him/her? What information is missing, why is it important, and how can it be obtained?
Some specifics:
In terms of Anthropometric Measurements:
Be able to calculate and interpret IBW range, %IBW, %UBW, and unintentional wt. loss.
Be able to recognize factors that might skew your anthropometric measurements so you
can take these into account when looking at a case study.
In terms of Biochemical Tests:
Understand each of the biochemical tests we went over in class. Know the reference values for
normal albumin, sodium, and fasting glucose levels.
Be able to write a SOAP note – in other words, if I give you a case study, you should be able to
decipher what is nutritionally significant information, put it logically into the SOAP format,
and come up with a basic plan of care (nothing fancy at this point).
In terms of analyzing assessment data and coming up with a plan of care:
Be able to estimate energy needs using the Harris-Benedict Equation and Long’s Method.
Know the activity factors. I will provide necessary injury factors in a case study.
Of course, be able to determine other nutrient needs as necessary. We’ll be using these
methods throughout the semester.
Remember: for protein, use actual weight if they’re not obese, adjusted weight if they are
using the adjusted body weight calculation:
[(ABW-IBW) x .25] + IBW
Medical Nutrition Therapy:
Know what a diet order is (the doctor’s order), the R.D.’s responsibilities with regard to
the doctor’s order, and what the diet orders are (from NPO to Regular). Know what foods are
allowed, why the diet might me nutritionally inadequate (if it is), when it would be appropriate,
and how you would advance the diet (if it were appropriate to advance the diet, that is!).
Be able to come up with ideas to help your patient increase his/her intake when appropriate. Be
sure to think about what the patient’s problems are, and what you think the best course of action
would be.
The cheat sheet on the next page WILL be provided for you during your exam.
200% IBW = morbidly obese (or 100# over
IBW)
>120 % (130%) = obese
110 - 120 = overweight
90 - 109 = normal
80 - 89 = mild
70-79 = moderate
< 70% = severe
Interpreting % UBW
85-90% mild
75-84% moderate
<75% severe
OR
wt. change (unintentional weight loss)
mild
moderate severe
1 week
1-2% >2%
1 month
5%
>5%
3 months
7.5%
>7.5%
6 months
10% 10-15% >15%
albumin
-5.0 = adequate
2.8= mild def.
2.1- 2.7 = moderate def.
<2.1 = severe def.
Transferrin
Normal:
Mild
Moderate
Severe
>200 mg/dl
150-200 mg/dl
100-149 mg/dl
<100 mg/dl
Prealbumin (TTHY)
Normal: 15-40 mg/dl
Mild:
10-15 mg/dl
Moderate:
5-10 mg/dl
Severe: <5 mg/dl
WBCs
Normal: 5,000-10,000/mm3
Possible critical values: <2500 or >30,000/mm3
Total Lymphocyte Count (TLC)
Normal: >1500 mm3
Mild: 1200 - 1500
Moderate: 800-1199
Severe: <800
Hemoglobin
12-16 g/dl females
14-18 g/dl males
Hematocrit
12-16 g/dl females
14-18 g/dl males
MCV normal: 80-953
Creatinine: 0.6-1.3 mg/dl
BUN: 7-25 mg/dl
Women: 655+ (9.6 x W) + (1.8 x H) - (4.7 x
A)=BEE
Men: 66.5 + (13.8 x W) + (5 x H) - (6.8 x
A)=BEE
AF = Activity Factor
Bedrest
1.2
Ambulatory
1.3
IF = Injury Factor
Minor Surgery 1.2
Skeletal Trauma 1.35
Major Sepsis
1.6
Severe Burns
2.1
[(ABW - IBW) X0.25] +RBW = adjusted weight
Protein
Normal
Mild
Moderate
Severe
0.5 - 0.8 g/kg/day
0.8 - 1.0 g/kg/day
1.0 - 1.5 g/kg/day
1.5 - 2.0 g/kg/day