RD Domain II - Screening and Assessment

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whenry2
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RD Domain II - Screening and Assessment
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2015-09-08 22:05:16
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RD Domain2 Screening Assessment
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  1. What is the NCP
    A standardized, consistent structure and framework used to provide nutrition care
  2. What are the steps for NCP?
    • Assess
    • Diagnose
    • Intervene
    • Monitor
    • Evaluate
  3. NCP differs from standardized care which infers what?
    all patients receive the same care
  4. Preliminary nutrition assessment techniques in nutrition screening is used to....
    identify people who are malnourished or who are at risk for malnutrition.
  5. Who can participate in the nutrition screening?
    All health care team members (not part of the 4-step process, but serves a supportive role)
  6. About how long should a nutrition assessment take?
    5-10 minutes
  7. During the nutrition assessment, you review...
    client's history, labs, weight, physical signs
  8. During the nutrition assessment, if no emerging nutrition problems exist what should be documented?
    discharge from nutrition care is appropriate
  9. Who mandates that nutrition risk is identified in hospitalized patients within ___ hours of admission?
    • The Joint Commission (TJC)
    • 24 hours
  10. Nutrition assessment screening tools:
    • Subjective Global Assessment
    • Mini Nutritional Assessment
    • Nutrition Screening Initiative
  11. The nutrition assessment of individuals is initiated by....
    referral/screening of individuals or groups for nutritional risk factors
  12. Nutrition assessment makes comparisons between....
    data collected and reliable standards
  13. The nutrition assessment of individuals is....
    on-going, dynamic process involving continual reassessment and analysis of patient/client/group needs
  14. The nutrition assessment provides the basis for....
    the Nutrition Diagnosis
  15. What are the critical thinking skills needed for the Nutrition Assessment?
    • Observe verbal/nonverbal cue that guide effective interviewing methods
    • Determine appropriate data to collect
    • Select tools and procedures and apply in valid, reliable ways
    • Distinguish relevant from irrelevant, and important from unimportant data
    • Validate, organize and categorize the data
  16. Components of Nutrition Assessment
    • Review
    • Cluster
    • Identify
  17. Components for Nutrition Assessment: Review what?
    data for factors that affect nutritional and health status
  18. Components for Nutrition Assessment: Cluster what?
    assessment data for comparison with characteristics of a suspected diagnosis
  19. Types of assessment data
    • Food/nutrition related history
    • Anthropometrics
    • Lab/medical tests
    • Nutrition-focused physical findings
    • Client history
  20. Components for Nutrition Assessment: Identify what?
    standards and criteria for interpretation and decision-making and compare to patient indicators
  21. What are indicators?
    clearly defined markers that can be observed and measured
  22. what are indicators used for?
    to monitor and evaluate progress towards nutrition outcomes
  23. Indicators can be compared to....
    nutrition care criteria
  24. What all should be documented during the assessment?
    • Date and time
    • Pertinent data and comparison with standards
    • Patients perceptions, values and motivation related to the program
    • Changes in patient's level of understanding, behaviors, outcomes
    • Reason for discharge
  25. What are the parts to the Clinical Assessment?
    • Physical assessment
    • Signs, symptoms
    • Medical hx
    • Activity patterns
    • Drug- medication- nutrition interactions
    • Medical terminology
  26. Types of Dietary Intake Assessments?
    • Diet history- present pattern of eating
    • (Don't ask leading questions)
    • Food record- exact record of everything eaten in specific time period
    • 24 hour recall- mental recall of everything eatenin previous 24 hours; quick tool to estimate sample daily intake; clinical setting
    • Food frequency list- how often an item is consumed; community setting; quick way to determine intake on large numbers of people
  27. Dietary Intake Assessment consists of....
    • Interviews
    • Analysis of dietary information
    • Oral dietary supplements (vitamin, herbs, complementary medicines)
    • Calorie counts should include protein needs
    • Dietary intolerances, allergies
  28. Medical/Family history shows
    insight into nutrition-related problems
  29. Economic/Social history consists of....
    • SES
    • Access to food
    • Cultural/religious food patterns
    • Psychological or behavioral lifestyles/preferences
    • Food fads/cultism
    • Level of education
    • Nutrition knowledge/interest
  30. Which religions do not eat meat?
    Jewish, Muslim
  31. Kosher foods:
    halibut allowed, but not shrimp, catfish, lobster; preparation methods
  32. DBW for medium frame women:
    100 lbs for first 5' and 5 lbs per additional inch
  33. DBW for medium frame man:
    106 lbs for first 5' and 6 lbs per additional inch
  34. DBW for small frame:
    subtract 10%
  35. Large frame:
    add 10%
  36. DBW amputations: entire leg
    16%
  37. DBW amputations: lower leg with foot
    6%
  38. DBW amputations: entire arm
    5%
  39. DBW amputations: forearm with hand
    2.3%
  40. DBW amputations formula:
    (100 - % amputation) / 100 X IBW for original ht
  41. % weight change formula
    usual wt - actual wt / usual wt X 100
  42. What the Triceps skinfold thickness (TSF) measures?
    measures body fat and calorie reserves
  43. standard Triceps skinfold thickness (TSF) for male and female:
    • Male: 12.5 mm
    • Female: 16.5 mm
  44. What does the Arm muscle area (AMA) measure?
    measures skeletal muscle mass (somatic protein)
  45. How to determine arm muscle mass
    Use triceps skinfold thickness (TSF) and arm circumference (AC) to determine
  46. Standard arm muscle area (AMA) for male and female:
    • Male: 25.3 cm
    • Female: 23.2 cm
  47. When is it important to measure arm muscle area (AMA)
    in growing children
  48. Body Mass Index is also known as what?
    Quetetlet index
  49. What does BMI compare?
    weight to height
  50. BMI formula:
    • Kg/m2
    • lbs/in2 X 703 (lbs/in/in X 703)
  51. BMI of a healthy adult:
    18.5-24.9
  52. BMI of healthy elderly:
    24-29
  53. Waist circumference >____Males and >_____ Females is independent risk factor for disease when BMI is 25-34.9
    • M: >40
    • W: >35
  54. Waist/hip ratio differentiates between:
    android and gynoid obesity
  55. What is android obesity?
    Central obesity (apple shape) with fat excess primarily in the abdominal wall and visceral mesentery.
  56. What is android obesity associated with?
    • glucose intolerance
    • diabetes
    • decreased sex hormone-binding globulin
    • increased levels of free testosterone
    • increased cardiovascular risk
  57. What is gynoid obesity?
    Fat distribution mainly to the hips and thighs (pear shape).
  58. ____ or greater in men and ____ or greater in women in waist/hip ratio indicates android obesity and increases risk of obesity related disease
    • M: 1.0
    • W: 0.8
  59. Weight loss assessment technique:
    get diet history then initiate calorie count
  60. Nutrition focused physical exam: Hair:

    Assessment: Thin, sparse, dull, dry, easily pluckable
    Consideration: chemotherapy, vitamin C or protein deficiency
  61. Nutrition focused physical exam: Eyes:

    Assessment: Pale, dry, poor vision
    Consideration: Vitamin A, Zn, or riboflavin deficiency
  62. Nutrition focused physical exam: Lips:

    Assessment: Swollen,red, dry, cracked
    Considerations: Riboflavin, pyridoxine, niacin deficiency
  63. Nutrition focused physical exam: Tongue:

    Assessment: smooth, slick, purple, white coating
    Considerations: vitamin or iron deficiencies
  64. Nutrition focused physical exam: Gums:

    Assessment: sore, red, swollen, bleeding
    Considerations: vitamin C deficiency
  65. Nutrition focused physical exam: Teeth:

    Assessment: missing, loose, lose of enamel
    Considerations: Ca deficiency, poor intake
  66. Nutrition focused physical exam: Skin:

    Assessment: pale, dry, scaly
    Considerations: iron, folic acid, Zn deficiency
  67. Nutrition focused physical exam: Nails:

    Assessment: brittle, thin, spoon-shaped
    Considerations: iron or protein deficiency
  68. What is the most accurate measure of nutritional status?
    Biochemical analysis
  69. Labs indicative for dehydration
    BUN, Na
  70. Lab indicative for pressure ulcers
    Alb, pre-Alb
  71. Labs for anemia screening
    Hct, Hgb
  72. Serum albumin normal levels:
    3.5-5.0 g/dl
  73. Where is serum albumin made?
    Located?
    • Liver @ 9-12 g/day
    • ~60% is located in extravascular space
  74. What does albumin do?
    Maintain colloid osmotic pressure, facilitates transportation of substances, and functions as afree-radical scavenger
  75. Serum albumin levels are related to
    visceral protein levels (blood and organs)
  76. What does serum albumin have to do with colloid osmotic pressure?
    A form of osmotic pressure exerted by proteins, notably albumin, in a blood vessel's plasma (blood/liquid) that usually tends to pull water into the circulatory system.  Proteins are the only dissolved substance in the plasma (2-3 x higher) and interstitial fluid (lower levels) that do not diffuse readily through the capillary membrane exerting osmotic pressure
  77. Hypoalbuminemia is associated with
    edema
  78. Serum albumin levels above normal range are likely due to
    dehydration
  79. Serum albumin has a long or short half life
    Long
  80. Serum albumin levels ______ reflect current protein intake
    does not
  81. Serum transferrin normal levels:
    >200 mg/dl
  82. Serum transferrin levels are related to
    visceral protein levels
  83. What is the serum transferrin level controlled by
    iron storage pool
  84. Serum transferrin levels rise with
    iron deficiency
  85. Serum transferrin levels can be determined from
    TIBC -- total iron binding capacity
  86. TTHY transthyretin, PAB prealbumin normal levels:
    16-40 mg/dl
  87. TTHY transthyretin, PAB prealbumin has a long or short half life
    short
  88. TTHY transthyretin, PAB prealbumin picks up changes in protein status _______
    quickly
  89. What is the best protein lab to evaluate?
    TTHY transthyretin, PAB prealbumin
  90. Retinol-binding protein (RBP) normal levels:
    3-6 mg/dl
  91. Retinol-binding protein (RBP) circulates with...
    PAB
  92. Retinol-binding protein (RBP) has a half life of how long
    shortest half life: 12 hours
  93. What does Retinol-binding protein (RBP) do?
    Binds and transports retinol
  94. What is Hematocrit (Hct)?
    volume of packed cells in whole blood
  95. What is the normal Hematocrit (Hct) for men, women, and pregnancy?
    • M: 44%
    • W: 38%
    • Pregnancy: 33%
  96. What is Hemoglobin (Hb)?
    Iron-containing pigment in RBC
  97. Normal levels of Hemoglobin (Hb) for men. women, and pregnancy?
    • M: 14-17 mg/dl
    • W: 12-15 mg/dl
    • Pregnancy: 11 mg/dl or less
  98. Hemoglobin and Erythrocyte's relationship
    Hemoglobin is found in the cytoplasm of a Erythrocyte cell (RBC).  The Hemoglobin is the protein that contains iron and transports oxygen to the body giving Erythrocytes their red color.
  99. Where are Erythrocytes produced?
    Bone marrow
  100. Serum Ferritin normal levels for males and females:
    • M: 12-300 ng/ml
    • F: 10-150 ng/ml
  101. What does the serum ferritin levels indicate?
    Size of iron storage pool
  102. Serum creatinine normal levels:
    0.6 - 1.4 mg/dl
  103. Serum creatinine is related to
    muscle mass
  104. Serum creatinine levels measure
    somatic protein
  105. Serum creatinine levels may indicate
    renal disease, muscle wasting
  106. Creatinine height index (CHI) normal %
    80%
  107. Creatinine height index (CHI) formula:
    ratio of creatinine excreted/24 hours to height
  108. What does creatinine height index (CHI) measure?
    estimates LBM -- somatic protein
  109. What does 60-80% creatinine height index (CHI) level mean
    mild muscle depletion
  110. Blood urea nitrogen (BUN) normal levels:
    10-20 mg/dl
  111. Blood urea nitrogen (BUN) related to
    related to protein intake
  112. Blood urea nitrogen (BUN) an indicator of
    renal disease
  113. BUN: creatinine ratio
    Normal: 10-15:1
  114. Blood urea nitrogen (BUN) levels need to be under _____ for renal patients
    under 100
  115. Urinary creatinine clearance levels:
    115 +/- 20 ml/minute
  116. Urinary creatinine clearance measures what?
    GFR -- glomerular filtration, renal function
  117. Total lymphocyte count (TLC) levels:
    <2700 cells/cu mm
  118. What does total lymphocyte count (TLC) measure?
    Immunocompetency
  119. Total lymphocyte count (TLC) moderate depletion levels:
    900-1800
  120. Total lymphocyte count (TLC) severe depletion levels:
    <900
  121. When do total lymphocyte count (TLC) decrease?
    in Protein-Energy Malnutrition (PEM)
  122. C-reactive protein (CRP) is the marker of what?
    acute inflammatory stress
  123. as C-reactive protein levels decline, it indicates....
    when nutritional therapy would be beneficial
  124. Free erythrocyte protoporphyrin (FEP) is the direct measure or
    toxic effects of lead on heme synthesis
  125. Free erythrocyte protoporphyrin (FEP) levels increase....
    in lead poisoning
  126. What happens during lead poisoning?
    lead depletes iron leading to anemia and displaces calcium in bone leading to zinc deficiency
  127. Prothrombin time (PT) rate:
    11.0-12.5 seconds; 85-100% of normal
  128. What prolongs Prothrombin time (PT)
    anticoagulants
  129. Prothrombin time (PT) evaluates...
    clotting adequacy
  130. What will alter rate of Prothrombin time (PT)
    Change in vitamin K intake
  131. The hair analysis is not used in the...
    nutritional assessment
  132. The hair analysis is useful for measuring...
    intake of toxic metals
  133. Assessment of energy requirements are based on...
    activity factors and BEE
  134. Sedentary energy requirements formula:
    BEE X 1.2
  135. Active energy requirements formula:
    BEE X 1.3
  136. Stressed energy requirements formula:
    BEE X 1.5
  137. Estimated energy requirements (EER) for men and women:
    for each year below 30.....
    • m: add 10 calories/day
    • w: add 7 calories/day
  138. Estimated energy requirements (EER) for men and women:
    for each year above 30.....
    • m: subtract 10 calories/day
    • w: subtract 7 calories/day
  139. Nutrition assessment of individuals -- Pediatric issues consist of...
    • growth charts
    • accuracy of measurements
    • accuracy of documentation
    • CDC definitions for overweight, obese, normal range
  140. Megestrol acetate:
    appetite stimulant
  141. Orlistat:
    decreases fat absorption by binding lipase
  142. Marinol:
    appetite stimulant
  143. Statins (HMG CoA reductase inhibitors):
    • decreases LDL, TG
    • increases HDL
  144. Chemotherapy:
    malabsorption
  145. Mineral oil, cholestyramine:
    decreases absorption of fat, fat-soluble vitamins
  146. Glucocorticoids, antibiotics:
    protein deficits
  147. Oral contraceptives:
    decreases folate, B6, Carbon (C)
  148. Loop diuretics:
    deplete potassium (K+), magnesium (Mg), calcium (Ca), sodium (Na), chlorine (Cl)
  149. Thiazide diuretics:
    • decreases potassium (K+), magnesium (Mg)
    • absorb calcium (Ca)
  150. Antibiotics:
    decreases vitamin K
  151. Steroids:
    decreases bone growth, CHO intolerance
  152. Methotrexate:
    decreases folate
  153. Lithium carbonate (antidepressant):
    • increase appetite, weight gain
    • maintain consistent sodium (Na) and caffeine intake to stabilize levels
    • if Na or caffeine are restricted, lithium excretion decreases leading to toxicity
  154. Anticoagulant (warfarin Na):
    • antagonizes vitamin K (consistent intake essential)
    • avoid Ginkgo biloba extract, garlic, ginger (may increase bleeding)
    • avoid high dose vitamin A and E
  155. Propofol:
    administered in oil, consider fat calories
  156. Phenobarbital:
    decreases folic acid, vitamins B12, D, K, B6
  157. Cyclosporine (immunosuppressant):
    hyperlipidemia, hyperglycemia, hyperkalemia, hypertension
  158. Isoniazed (treats TB):
    • depletes pyridoxine, peripheral neuropathy
    • don't take with food
    • interferes with vitamin D and calcium (Ca) supplements
  159. Elavil (antidepressant):
    sedative effect, weight gain, increase appetite
  160. Insulin:
    dry mouth, hypoglycemia
  161. Antipyretics/analgesics
    abdominal pain (upset stomach)
  162. Nutrient effect:
    Vitamin B6 and protein:
    • decrease effectiveness of L-dopa (levodopa) which controls Parkinson's symptoms
    • give most protein at evening meal
    • take drum in AM
  163. Nutrient effect:
    Calcium:
    binds tetracycline
  164. Nutrient effect:
    Tubefeeding:
    decreases therapeutic blood levels of anti-seizure medications (Phenytoin, Dilantin)
  165. Nutrient effect:
    Tyramine:
    Hypertension (HTN) if taken with MAOI (monoamine oxidase inhibitor)
  166. If on MAO inhibitor drug....
    interaction releases norepinephrine which raises BP
  167. Motivational level -- High:
    keen interest, presence in voluntary, has high expectations as to applicability of subject to life
  168. Motivational level -- Low:
    mandatory attendance, little interest in topic, may feel there are more important things to do
  169. Educational level -- High:
    • has some previous knowledge of topic or has broad base to which new information can be added
    • understands complex ideas and rationales
    • verbally oriented
  170. Educational level -- Low:
    lacks formal education beyond high school, probable not verbally oriented - more task oriented, reinforcement of learning is helping, allow time for learning
  171. Situational assessment - Sophistication: Inexperienced:
    young children, some adults lack nutritional training, need thorough introduction and background
  172. Situational assessment - Sophistication: Moderate Experience
    teachers, health educators, pts already instructed, emphasize review of material, recognize it for better use, move on to more complicated concepts
  173. Situational assessment - Sophistication: Very Experienced:
    "nutrition experts", limit audience participation at first, establish yourself as the expert, cite credentials, lecture format with audiovisuals
  174. A1c levels for normal, increase risk for diabetes, and indication of diabetes:
    • Normal: 4-5.6%
    • Increased risk: 5.7-6.4%
    • Indication of diabetes: 6.5%+

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