Domain II: Nutrition Care for Individuals and Groups: Screening and Assessment Flashcards
The ___ ___ ___ is a standardized, consistent structure and framework used to provide nutrition care
Nutrition care process
What are the steps of the nutrition care process?
-Assessment
-Diagnosis
-Intervention
-Monitoring/evaluation
____ ____ integrates facts, informed opinions, active listening, and observations; it is a reasoning process where ideas are produced and evaluated that includes the ability to conceptualize, think rationally, think creatively, be inquiring, and think autonomously
Critical thinking
____ reviewed during the assessment is reviewed during all steps of the NCP
Data
Nutrition ____ is the use of preliminary nutrition assessment techniques to identify people who are malnourished or who are at risk for malnutrition
Screening
All health care team members can participate in screening as it is a brief, ___-___ minute assessment
5-10
What is reviewed during a nutrition screening?
-Client’s history
-Lab results
-Weight
-Physical signs
For screening to be effective, the mechanism must be accurate based on ____ and ____
Specificity and sensitivity
Specificity means that the tool can correctly identify patients ____ a condition
Without
Sensitivity means that the tool can correctly identify patients ____ a condition
With
Cultural ____ is the ability to provide care to patients with diverse values, beliefs, and behaviors and tailor delivery to meet their social, cultural, and linguistic needs
Competence
The ____ ____ requires that nutrition risk is identified in hospitalized patients, but it does not mandate a method of screening
Joint Commission
The Subjective Global Assessment assesses what data?
-History
-Intake
-GI symptoms
-Functional capacity
-Physical appearance
-Edema
-Weight change
The Mini Nutritional Assessment (MNA) assesses what data?
-Independence
-Medications
-Number of full meals consumed each day
-Protein intake
-Fruits and vegetable intake
-Fluid
-Mode of feeding
The MNA is used for those age ____ and older
65
The Nutrition Screening Initiative is used in what age group?
Elderly
The Geriatric Nutrition Risk Index assesses what data?
-Serum albumin
-Weight change
The Malnutrition Screening Tool (MST) is used in what population?
Acutely hospitalized adults
The MST assesses what data?
-Recent weight loss
-Recent poor dietary intake
The Nutrition Risk Screening (NRS) is used in what population?
Med-surg hospitalized pts over 70 years old
The Nutrition Risk Screening assesses what data?
-% weight loss
-BMI
-Intake
The Malnutrition Universal Screening Tool assesses what data?
-BMI
-Unintentional weight loss
-Effect of acute disease on intake for more than 5 days
Nutrition ____ is initiated by referral/screening of individuals or groups for nutritional risk factors
Assessment
Nutrition assessment makes comparisons between data collected and reliable _____
Standards
Assessment is an on-going, dynamic, process that involves continual reassessment and ____ and patient/client/group needs
Analysis
Nutrition assessment provides the basis for the nutrition _____
Diagnosis
What are some critical thinking skills that are needed during a nutrition assessment?
-Observe verbal/non-verbal cues that can 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
-Validate, organize, and categorize the data
What are the three components of a nutrition assessment?
-Review
-Cluster
-Identify
During an assessment, review data for factors that affect ____ and health status
Nutrition
Data is then clustered with characteristics of a ____ like food and nutrition-related history, lab/medical tests, NFPE findings, anthropometrics, and client history
Diagnosis
These indicators are compared to identified ____ (nutrition care criteria) and criteria for interpretation and decision-making; indicators are clearly defined markers that can be observed and measured
Standards
Nutrition indicators are used to ___ and ___ progress toward nutrition outcomes
Monitor and evaluate
What should be documented from an assessment?
-Date and time
-Pertinent data and comparison with the standards
-Patient’s perceptions, values, and motivation related to the problem
-Changes in a patient’s level of understanding, behaviors, and outcomes
-Reason for discharge
A diet ___ can give information on present patterns of eating (should avoid using leading questions)
History
A food ____ shows everything eaten in a specific period of time
Record/diary
A ____-____ ____ is a mental recall of everything eaten in that amount of time; it is a quick tool to estimate a sample daily intake in a clinical setting
24-hour recall
_____ and ____ are concerns with 24-hour food recalls
Underreporting and overreporting
A ____ ____ list asks how often an item is consumed; used in a community setting
Food frequency
Food frequency lists are a quick way to determine intake on ____ numbers of people
Large
Pertinent medical and family _____ provides insight into nutrition-related problems
History
_____ measurements are focused on body structure
Anthropometrics
Hamwi method for women:
100 lbs for the first 5 feet + 5 lb for every inch over 5 ft (+/- 10% for small or large frame) (if under 5 feet, subtract 5 lb for each inch)
Hamwi method for men:
106 lbs for the first 5 feet + 6 lbs for every additional inches (+/- 10% for small or large frame) (if under 5 feet, subtract 6 for each inch)
If someone has an entire leg amputation, subtract ____% of body weight from IBW
16
If someone has an amputation of the lower leg with foot (BKA), subtract ____% from IBW
6
If someone has a full arm amputation, subtract ____% from IBW
5
If someone has an amputation of the forearm with hand, subtract ____% from IBW
2.3
For a quadriplegic, subtract ____-____% from IBW; for a paraplegia, subtract ____-___%
10-15; 5-10
____ ____ ____ stresses the significance of weight change and can be used to assess nutritional risk
Percent weight change
Formula for calculating percent weight change?
[(Usual body weight - current body weight)/(usual body weight)] x 100
Significant weight loss is ____% within 6 months
10
____ ____ thickness measured body fat reserves and calorie reserves
Triceps skinfold
Standard male triceps skinfold measurement is ____ mm, for females it is ____ mm
12.5; 16.5
Arm muscle area measures skeletal ____ ____ (somatic protein)
Muscle mass
In order to determine arm muscle area, you must have measures for what two things?
-Triceps skin fold
-Midarm circumference
Standard male arm muscle area is ____ cm, for females it is _____ cm
25.3; 23.2
____ ____ ____ (Quetlet index) compared weight to height
Body mass index
Formula for calculating BMI:
(Weight in kg) / (height in m2)
Categories for BMI:
-Underweight: <18.5
-Normal weight: 18.5-24.9
-Overweight: 25-29.9
-Obese (class I): 30-34.9
-Obese (class II): 35-39.9
-Obese (class III, morbidly obese): 40+
BMI for age charts are used starting at age ____, when accurate stature can be obtained
2
Waist circumference of over ___ for men and over ____ for women is an independent risk factor for disease when out of proportion to total body fat (with BMI over 25)
40; 35
Waist circumference is best for assessing _____; it predicts central adiposity (lower torso around abdominal area)
Risk
EAL recommends measurement of BMI and waist circumference during _____ visit to determine risk of of CVD and type 2 diabetes
Annual
Waist/hip ratio differentiates between ____ and ____ obesity
Android; gynoid
A waist/hip ratio of ____ or greater in men or ____ or greater in women is indicative of android obesity and increased risk for obesity-related diseases like diabetes and hypertension
1; 0.8
____ ____ ____ is used at bedside to evaluate fat=free mass and total body water (usefulness in critical illness may be limited)
Bioelectrical impedance analysis (BIA)
What conditions must be met for accurate BIA results?
-Must be well-hydrated
-No caffeine, alcohol, or diuretics in the past 24 hours
-No exercise in the past 4-6 hours
What things may affect the reliability of BIA results?
-Fever
-Electrolyte imbalance
-Extreme obesity
The ___ ___ measures air displacement plethysmography
Bod Pod
The bod pod measures body composition by determining body _____; it is determining the amount of air displaced and this is as accurate as underwater weighting
Density
The ___-___ ____ ___ is a visual assessment using sight, sense of smell and hearing to observe textures, sizes, colors, shapes, and sounds
Nutrition-focused physical exam
What information can be obtained from NFPE?
-Obesity
-Cachexia
-Fluid status
-Skin integrity
-Wound healing
-Feeding devices
-Jaundice
-Ascites
What two types of deficiencies could cause thin, sparse, dull, dry hair?
-Vitamin C
-Protein
If hair is easily pluckable, it indicates a ____ deficiency
Protein
What three deficiencies may cause eyes that are pale and dry with poor vision?
-Vitamin A
-Zinc
-Riboflavin
What deficiencies may cause lips that are swollen, red, dry, and cracked?
-Riboflavin
-Pyridoxine
-Niacin
What two deficiencies could cause a tongue that is smooth, slick, purple, or has a white coating?
-Vitamin(s)
-Iron
What deficiency could cause sore, red, swollen, or bleeding gums?
Vitamin C
What two deficiencies could cause missing or loss teeth and loss of enamel?
-Calcium
-Poor intake
What three deficiencies may lead to skin that is pale, dry, and scaly?
-Iron
-Folic acid
-Zinc
What two deficiencies could cause nails that are brittle, thin, and spoon-shaped?
-Iron
-Protein
____ is gathering data via touch using palms and fingertips
Palpation
What information can be obtained through palpation?
-Areas of tenderness
-Muscle rigidity
-Fluid retention or pitting edema
-Skin integrity and moisture
-Body temperature
____ involves listening to bowel using a stethoscope on the right lower quadrant which is the location of the ileocecal valve
Auscultation
Normal bowel sounds should sound every ___-___ seconds and should sound like high-pitched gurgling
5-15
Hypoactive bowel sounds sound every 15-20 seconds and may indicate ____ ____ or _____
Paralytic ileus or peritonitis
Hyperactive, continuous, high-pitched tickling sounds may indicate ____ or ____ ____
Diarrhea; intestinal obstruction
_____ is not performed by the dietitian, but findings are recorded in the medical record
Percussion
Intake and output are used to assess…
-Hydration status
-Fluid balance
Normal range for serum albumin is between ___-___ g/dL
3.5-5
Albumin maintaines ____ ___ ___
Colloidal osmotic pressure
Hypoalbuminemia is associated with…
-Edema
-Surgery
Albumin levels above the normal range are likely due to ____
Dehydration
Albumin has a long-half life, so albumin levels do not reflect current ____ ____
Protein intake
Serum transferrin should be above ____ mg/dl (visceral protein)
200
Transferrin transports iron to ____ ____
Bone marrow
Serum transferrin levels are controlled by the iron storage pool; levels rise with ____ ____
Iron deficiency
Serum transferrin levels can be determined from ___ ___ ___ ____
Total iron binding capacity
Serum transferrin is not useful as a measure of ____ ____
Protein status
The normal range for transthyretin, or prealbumin, is between ___-___ mg/dl
16-40
Prealbumin has a ____ half-life, so it picks up changes in protein status quickly
Short
During inflammation, the liver synthesizes ___-___ ___ at expense of prealbumin
C-reactive protein
Prealbumin has limited ____ in screening and assessment
Usefulness
The normal range for retinol-binding protein is between ___-___ mg/dl
3-6
Retinol-binding protein circulates with ____ and has the shortest half-life of 12 hours
Prealbumin
Retinol-binding protein binds and ____ retinol
Transports
Normal hematocrit for men is ____-____%
42-52
Normal hematocrit for women is ____-____%
36-48
Normal hematocrit for a pregnant woman is ____%
33
Normal hematocrit for a newborn is ___-___%
44-64
Hematocrit measures the ____ of packed cells in whole blood
Volume
Normal hemoglobin range for men is ___-___ gm/dl
14-18
Normal hemoglobin range for women is ___-___ gm/dl
12-16
Normal hemoglobin for pregnant women is ___ or more gm/dl
11
Hemoglobin is the ____-containing pigment of red blood cells
Iron
Red blood cells, or erythrocytes, are produced in the ___ ___
Bone marrow
Normal range for serum ferritin in men is ___-___ ng/ml
12-300
Normal range for serum ferritin for women is ___-___ ng/ml
10-150
Normal range for serum creatinine in men is ___-___ mg/dl
0.6-1.2
Normal range for serum creatinine in women is ____-____ mg/dl
0.5-1.1
Serum creatinine is related to ___ ___ and measures somatic protein
Muscle mass
A high serum creatinine may indicate ___ ____ ___
Chronic kidney disease
A low serum creatinine may indicate ___ ___
Muscle wasting
A normal creatinine height index is ____% or above
80
The creatinine height index is the ratio of creatinine excreted in ____ hours related to height
24
Creatinine height index estimates ____ ____ ____ (somatic protein)
Lean body mass
Creatinine height index of 60-80% indicates mild ____ ____
Muscle depletion
The normal range for blood urea nitrogen (BUN) is ___-___ mg/dl
10-20
BUN level is related to ____ intake
Protein
BUN is also an indicator of ____ disease
Renal
A normal BUN:Creatinine ratio is _____
10-15:1
A normal urinary creatinine clearance is…
115 +/- 20 ml/minute
