NHM 363 EXAM 2 QUESTIONS WITH
COMPLETE SOLUTIONS
Laboratory lTests l- l✔✔• lCritical lpart lof lthe lnutrition lassessment
• lCan lsupport lsubjective ljudgement land lassessment lfindings
• lObjective ldata
• lUsed lall lthe ltime
Interpreting lLabs l- l✔✔• lNo lsingle lvalue lis la ldiagnostic
• lConsider lpatient's lage, lsex, ldiet, lmeds, lhydration lstatus, letc.
• lDetermine lwhether la llab lvalue lrepresents la lfasted lor lpostprandial lsample
• lRefer lto la llab's lacceptable lrange
• lConsider lnon-nutritional lcauses lfor labnormal llab lvalues
• lAcute lillness/injury lcan ltrigger ldramatic lchanges lin llab lresults l
• lUnits lof lmeasure- lConventional lvs. lSI
Conventional lLab lUnits l- l✔✔• lBase lunit lis lmg/dL
• ldL l= l100 lmL
• l10 ldL l= l1 lL
• l1 lg l= l1000 lmg
• l1 lkg l= l1000 lg
• l100 lug l= l1 lmg
SI lLab lUnits l(International lSystem) l- l✔✔• lBase lunit lis lmoles lper lliter
Common lSpecimen lTypes l- l✔✔• lWhole lblood l(RBCs, lWBCs, lplatelets)
• lPlasma l(Liquid lcomponent lof lblood) l
• lSerum l(Fluid lafter lblood lclotted)
• lBlood lcells
• lErythrocytes l(RBCs)
• lLeukocytes l(WBCs)
• lUrine
• lFeces
Examples lof lTests lUsing lStool lSamples l- l✔✔• lFecal lFat l- lTests lfor lmalabsorption
l(Steathorrhea)
• lFecal lOccult lBlood lTest l- lTests lfor l"hidden" lblood llosses lin lfeces; lMay lindicate la lGI
lbleed, lcolorectal lcancer, letc.
• lTests lfor lpathogenic lbacteria, lviruses, lor lparasites
,Less lCommon lSpecimen lTypes l- l✔✔• lSaliva
• lNails
• lHair l- lCould ltest lfor lheavy lmetal ltoxicities lor lcertain ltrace lminerals; lResults leasily
lconfounded lby lexternal lcontaminants. l
• lSwear
Urinalysis l- l✔✔• lDetects lsubstance lor lcellular lmaterial lin lurine
• lMetabolic lor lkidney ldisorders
• lFull lurinalysis lincludes:
l- lAppearance lof lthe lurine
l- lResults lof ltests ldone lwith la ldipstick
l- lMicroscopic lexamination lof lurine lsediment
Schematics l- l✔✔• lA ldiagram lused lto lrepresent llab lvalues
Creatine-Height lIndex l- l✔✔• lEvaluates lfor lProtein lEnergy lMalnutrition l(PEM)
• lMeasure lof lskeletal lmuscle lmass
• lCreatine lis la lproduct lof lskeletal lmuscle; lCreatine lis lexcreted lin lurine lin la lconstant
lproportion lto lthe lmass lof lmuscle lin lthe lbody.
• lRequires lan laccurate l24-hour lcollection lof lurine
• lReference lvalues lare lavailable lfor ladults
Creatine-Height lIndex lLimitations l- l✔✔• lValues lskewed lwith lrenal ldisease lor
lexcessive lmeat lintake
• lValues lerroneous lwith lamputation/paralysis
• lNot lcommonly lused lto lassess lmuscle lmass
24-Hour lUrine lUrea lNitrogen l(UUN) l- l✔✔• lEvaluates lProtein lEnergy lMalnutrition
l(PEM)
• lSensitive lmesa lsure lof lprotein l(nitrogen) lbalance
• lRequires laccurate l24-hour lcollection lof lurine land lactual lprotein lintake
• lGenerally lonly lused lwith lTPN land ltube lfeeding
Anabolism l- l✔✔• lNitrogen lIntake l> lNitrogen lLosses
• lRepresents lnitrogen lretention
• lGrowth, lpregnancy, lheal lthing lfrom lmajor linjuries/wounds
Catabolism l- l✔✔• lNitrogen lLosses l> lNitrogen lIntake
• lRepresents lbody lnitrogen llosses
• lAssociated lwith ltrauma/severe lstress, lstarvation
24-Hour lUrine lUrea lNitrogen l(UUN) lEquation l- l✔✔• lNitrogen lBalance l= lN lIntake
l(PRO lintake/6.25) l- lN lLosses l(UUN l+ l4)
, 24-Hour lUrine lUrea lNitrogen l(UUN) lLimitations l- l✔✔• lNitrogen lbalance lformula lis lnot
laccurate lfor lpeople lwith:
l- lLarge lnon-urinary lnitrogen llosses
l- lDiureses
l- lFluid lretention
l- lRenal lfailure
l- lCertain lmedications l(e.g., lcorticosteroids)
l- lImprecise lurine lcollection
Hepatic lTransport lProteins l- l✔✔• lAlbumin, lPrealbumin, land lRetinol lBinding lProtein l
• lSynthesized lin lthe lliver
• lLow llevels lmay lprompt lyou lto lfurther lassess lfor lPEM, lbut lthey lshould lbe levaluated
lin llight lof lthe lpatient's lcondition.
• lDuring lstress land lillness lnot laccurate lindicators lof lnutritional lstatus
• l"Negative lacute lphase lproteins" l- lDecrease las lpart lof lan lacute linflammatory
lresponse
Negative lAcute lPhase lRespondents l- l✔✔• lSynthesis ldecreases lunder lstress
• lAlbumin, lTransferrin, lPrealbumin, lRetinol lBinding lProtein
Positive lAcute lPhase lRespondents l- l✔✔• lIncreases linflammatory lresponse
• lC-Reactive lProtein l(CRP) land lother lCytokines
Serum lAlbumin l- l✔✔• lMajor lprotein lin lblood
• lMaintains lcolloid losmotic lpressure l(water ldistribution)
• lMajor ltransport lprotein
• lWidely lused lnutrition lscreening ltool lin lAmerican lhospitals
• lFair lindex lof lmalnutrition lat lbest
• lLow llevels lassociated lwith lliver ldamage
Serum lAlbumin lNormal lRange l- l✔✔• l3.5 l- l5 lg/dL
Serum lAlbumin lLimitations l- l✔✔• lLong lhalf-life l(14-20 ldays) l- lNot la lsensitive lindicator
lof lrecent lnutrition
• lInflammation, linfection, lburns, lor ltrauma lmay lcause llow lalbumin llevels lindependent
lof lnutritional lstatus.
• lLow llevels lseen lwith lfluid lretention l(hemodilution), lESLD, land lheart lfailure.
• lLevels lmay lbe lnormal l(or leven lelevated) lin lpatients lwith lstarvation l(e.g., lmarasmus,
lanorexia lnervosa)
• lLevels lmay lbe lfalsely lhigh lwith lblood ltransfusions lor ldehydration.
Serum lPrealbumin l(Transthyretin) l- l✔✔• lSensitive lindex lof limproving lnutritional lstatus
lin lthe labsence lof linflammation
• lShort lhalf-life l(~ l2 ldays)
• lBecoming lmore lcommon lscreening ltool lin lhospitals
• lA llittle lbetter lindicator lthan lAlbumin
COMPLETE SOLUTIONS
Laboratory lTests l- l✔✔• lCritical lpart lof lthe lnutrition lassessment
• lCan lsupport lsubjective ljudgement land lassessment lfindings
• lObjective ldata
• lUsed lall lthe ltime
Interpreting lLabs l- l✔✔• lNo lsingle lvalue lis la ldiagnostic
• lConsider lpatient's lage, lsex, ldiet, lmeds, lhydration lstatus, letc.
• lDetermine lwhether la llab lvalue lrepresents la lfasted lor lpostprandial lsample
• lRefer lto la llab's lacceptable lrange
• lConsider lnon-nutritional lcauses lfor labnormal llab lvalues
• lAcute lillness/injury lcan ltrigger ldramatic lchanges lin llab lresults l
• lUnits lof lmeasure- lConventional lvs. lSI
Conventional lLab lUnits l- l✔✔• lBase lunit lis lmg/dL
• ldL l= l100 lmL
• l10 ldL l= l1 lL
• l1 lg l= l1000 lmg
• l1 lkg l= l1000 lg
• l100 lug l= l1 lmg
SI lLab lUnits l(International lSystem) l- l✔✔• lBase lunit lis lmoles lper lliter
Common lSpecimen lTypes l- l✔✔• lWhole lblood l(RBCs, lWBCs, lplatelets)
• lPlasma l(Liquid lcomponent lof lblood) l
• lSerum l(Fluid lafter lblood lclotted)
• lBlood lcells
• lErythrocytes l(RBCs)
• lLeukocytes l(WBCs)
• lUrine
• lFeces
Examples lof lTests lUsing lStool lSamples l- l✔✔• lFecal lFat l- lTests lfor lmalabsorption
l(Steathorrhea)
• lFecal lOccult lBlood lTest l- lTests lfor l"hidden" lblood llosses lin lfeces; lMay lindicate la lGI
lbleed, lcolorectal lcancer, letc.
• lTests lfor lpathogenic lbacteria, lviruses, lor lparasites
,Less lCommon lSpecimen lTypes l- l✔✔• lSaliva
• lNails
• lHair l- lCould ltest lfor lheavy lmetal ltoxicities lor lcertain ltrace lminerals; lResults leasily
lconfounded lby lexternal lcontaminants. l
• lSwear
Urinalysis l- l✔✔• lDetects lsubstance lor lcellular lmaterial lin lurine
• lMetabolic lor lkidney ldisorders
• lFull lurinalysis lincludes:
l- lAppearance lof lthe lurine
l- lResults lof ltests ldone lwith la ldipstick
l- lMicroscopic lexamination lof lurine lsediment
Schematics l- l✔✔• lA ldiagram lused lto lrepresent llab lvalues
Creatine-Height lIndex l- l✔✔• lEvaluates lfor lProtein lEnergy lMalnutrition l(PEM)
• lMeasure lof lskeletal lmuscle lmass
• lCreatine lis la lproduct lof lskeletal lmuscle; lCreatine lis lexcreted lin lurine lin la lconstant
lproportion lto lthe lmass lof lmuscle lin lthe lbody.
• lRequires lan laccurate l24-hour lcollection lof lurine
• lReference lvalues lare lavailable lfor ladults
Creatine-Height lIndex lLimitations l- l✔✔• lValues lskewed lwith lrenal ldisease lor
lexcessive lmeat lintake
• lValues lerroneous lwith lamputation/paralysis
• lNot lcommonly lused lto lassess lmuscle lmass
24-Hour lUrine lUrea lNitrogen l(UUN) l- l✔✔• lEvaluates lProtein lEnergy lMalnutrition
l(PEM)
• lSensitive lmesa lsure lof lprotein l(nitrogen) lbalance
• lRequires laccurate l24-hour lcollection lof lurine land lactual lprotein lintake
• lGenerally lonly lused lwith lTPN land ltube lfeeding
Anabolism l- l✔✔• lNitrogen lIntake l> lNitrogen lLosses
• lRepresents lnitrogen lretention
• lGrowth, lpregnancy, lheal lthing lfrom lmajor linjuries/wounds
Catabolism l- l✔✔• lNitrogen lLosses l> lNitrogen lIntake
• lRepresents lbody lnitrogen llosses
• lAssociated lwith ltrauma/severe lstress, lstarvation
24-Hour lUrine lUrea lNitrogen l(UUN) lEquation l- l✔✔• lNitrogen lBalance l= lN lIntake
l(PRO lintake/6.25) l- lN lLosses l(UUN l+ l4)
, 24-Hour lUrine lUrea lNitrogen l(UUN) lLimitations l- l✔✔• lNitrogen lbalance lformula lis lnot
laccurate lfor lpeople lwith:
l- lLarge lnon-urinary lnitrogen llosses
l- lDiureses
l- lFluid lretention
l- lRenal lfailure
l- lCertain lmedications l(e.g., lcorticosteroids)
l- lImprecise lurine lcollection
Hepatic lTransport lProteins l- l✔✔• lAlbumin, lPrealbumin, land lRetinol lBinding lProtein l
• lSynthesized lin lthe lliver
• lLow llevels lmay lprompt lyou lto lfurther lassess lfor lPEM, lbut lthey lshould lbe levaluated
lin llight lof lthe lpatient's lcondition.
• lDuring lstress land lillness lnot laccurate lindicators lof lnutritional lstatus
• l"Negative lacute lphase lproteins" l- lDecrease las lpart lof lan lacute linflammatory
lresponse
Negative lAcute lPhase lRespondents l- l✔✔• lSynthesis ldecreases lunder lstress
• lAlbumin, lTransferrin, lPrealbumin, lRetinol lBinding lProtein
Positive lAcute lPhase lRespondents l- l✔✔• lIncreases linflammatory lresponse
• lC-Reactive lProtein l(CRP) land lother lCytokines
Serum lAlbumin l- l✔✔• lMajor lprotein lin lblood
• lMaintains lcolloid losmotic lpressure l(water ldistribution)
• lMajor ltransport lprotein
• lWidely lused lnutrition lscreening ltool lin lAmerican lhospitals
• lFair lindex lof lmalnutrition lat lbest
• lLow llevels lassociated lwith lliver ldamage
Serum lAlbumin lNormal lRange l- l✔✔• l3.5 l- l5 lg/dL
Serum lAlbumin lLimitations l- l✔✔• lLong lhalf-life l(14-20 ldays) l- lNot la lsensitive lindicator
lof lrecent lnutrition
• lInflammation, linfection, lburns, lor ltrauma lmay lcause llow lalbumin llevels lindependent
lof lnutritional lstatus.
• lLow llevels lseen lwith lfluid lretention l(hemodilution), lESLD, land lheart lfailure.
• lLevels lmay lbe lnormal l(or leven lelevated) lin lpatients lwith lstarvation l(e.g., lmarasmus,
lanorexia lnervosa)
• lLevels lmay lbe lfalsely lhigh lwith lblood ltransfusions lor ldehydration.
Serum lPrealbumin l(Transthyretin) l- l✔✔• lSensitive lindex lof limproving lnutritional lstatus
lin lthe labsence lof linflammation
• lShort lhalf-life l(~ l2 ldays)
• lBecoming lmore lcommon lscreening ltool lin lhospitals
• lA llittle lbetter lindicator lthan lAlbumin
