# [NFS 444] - Midterm Exam Guide - Ultimate 48 pages long Study Guide!

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NFS 444
MIDTERM EXAM
STUDY GUIDE
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NFS 444 (Pharmacy) - Exam 1 Review Sheet
Starvation/Malnutrition
1. Indicators of malnutrition (IBW, %IBW, %ABW, %UBW, adjusted IBW, %wt change over time)
a. Ideal Body Weight (IBW)
i. Hamwi Method
1. Women: 100lbs. + 5lbs. for every inch over 5 feet
2. Men: 106lbs. + 6lbs. for every inch over 5 feet
b. Percent Ideal Body Weight (% IBW)
i. (Actual weight / IBW) x 100
ii. Normal is 90-109%
c. Percent Usual Body Weight (% UBW)
i. (Actual weight / UBW) x 100
ii. Important to ask patient if they were trying to lose weight!!
d. Degree of malnutrition
i. IBW + (0.25 x (ABW IBW))
f. Percent Weight Change
i. (Usual Body Weight Current Body Weight) / Usual Body Weight, Then x 100
ii. Significant Values
1. 1-2% in 1 week
2. 5% in 1 month
3. 7.5% in 3 months
4. 10% in 6 months
2. Starvation related malnutrition
a. Sources of energy during starvation
i. Fatty acids main source of energy during starvation!!
ii. Brain and neural tissue can only use glucose and ketone bodies for energy
iii. A. When a person overeats (feasting): When a person eats in excess of energy
needs, the body stores a small amount of glycogen and much larger quantities
of fat. Glucose is a major energy source. B. When a person draws on stores
(fasting): When nutrients from a meal are no longer available to provide energy
(about 2 to 3 hours after a meal), the body draws on its glycogen and fat stores
for energy. Fatty acid is major energy source C. If the fast continues beyond
glycogen depletion: As glycogen stores dwindle (after about 24 hours of
starvation), the body begins to break down its protein (muscle and lean tissue)
to amino acids to synthesize glucose needed for brain and nervous system
energy. In addition, the liver converts fats to ketone bodies, which serve as the
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alternative energy source of the brain, thus slowing the breakdown of body
protein
b. Purpose of the Ancel Keys Minnesota Study
i. 36 people participated in this study that was designed to determine the
physiological and psychological effects of severe and prolonged dietary
restriction and the effectiveness of dietary rehabilitation strategies.
ii. It was recognized early in 1944 (WWII) that millions of people were in grave
danger of mass famine as a result of the conflict, and information was needed
regarding the effects of semi-starvationand the impact of various
rehabilitation strategiesif postwar relief efforts were to be effective.
iii. These subjects were anti-war, so they decided to help in another way through
this study.
c. Know what ketosis is and consequences of it
i. When the rai’s main energy source comes from ketone bodies synthesized in
the liver from fatty acids (This occurs when glucose levels are low)
ii. Ketones serve as an alternative energy source for the brain and neural tissue
other than glucose
iii. Causes loss of appetite in starving people
d. Know clinical signs of starvation and why they occur
i. Decreased metabolic rate
ii. Decreased physical activity
iv. Preservation of LBM
v. Loss of electrolytes (intracellular K+, Mg, phosphate, water soluble vitamins,
calcium from bone, sodium and water)
vi. Weight loss (lack of caloric intake)
vii. Loss of body fat and muscle (being broken down for gluconeogenesis,
production of ketones, and basal energy expenditures)
viii. Growth failure in children
1. Wasting- low body weight
2. Stunting- Low height
ix. Amenorrhea in women
1. Need at least 10-12% body fat in order to menstruate
x. Decreased strength and fatigue due to loss of muscle
xi. Delayed wound healing
xii. Impaired immune response
xiii. Decreased organ function (risk of organ failure- often fatal!)
xiv. GI tract, heart, and kidney- loss of function and muscle surrounding organs
xv. Respiration
1. Decreased vital capacity (the greatest volume of air that can be expelled
from the lungs after taking the deepest possible breath)
2. Increased risk of pneumonia
xvi. Psychological symptoms
e. Gluconeogenesis
i. The synthesis of glucose from non-carbohydrate precursors, such as fatty acids
and amino acids (occurs in liver)
ii. Occurs about 24 hours after fasting when all glycogen stores in the liver have
been used up
iii. Mainly amino acids are converted to glucose (gluconeogenesis) and fatty acids
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