Exam #1: Supplemental Nutrition Flashcards
(36 cards)
What patient populations are at risk for malnutrition?
- Poor diet
- Recent weight loss
- Increased need
- Iatrogenic
- Nutrient loss
- Global assessment
What patients are at risk for a poor diet?
1) Low income
2) Institutionalized
3) Age
What patients are at risk for malnutrition b/c of recent weight loss?
- Intentional weight loss due to dieting
- Unintentional– multifactorial
What patients are at increased need for nutritional support?
- Disease process
- Surgery
- Physiologic stress
What are some of the iatrogenic causes for nutritional support?
- Medications
- Roux-en-Y or other bariatric surgery procedures
What are the different methods for measuring body fat?
- Underwater weighing
- Whole-body air displacement plethysmography
- DEXA
- Near-infrared interactance
- Bioelectrical impedence analysis (bathroom scale)
What are the anthropometric methods of determining body fat?
- Skinfold methods
- US
- BMI
- Waist to hip ratio*****
*****Best correlation for cardiac risk
What is the “american” formula for determining BMI?
Weight (lb)/height^2 x 703
Outline the BMI interpretation for underweight, normal, overweight, and obese patients.
Below 18.5= underweight
- 5-24.9= normal
- 0-29.9= overweight
- 0= obese
For the weight to hip ratio, where do you measure?
Waist= 1 inch above the navel or narrowest point
Hip= widest portion of the buttocks/ greater trochanters
What is an excellent WHR for males? Females?
Males= less than 0.85 Females= less than 0.75
What is a good WHR for males? Females?
Males= 0.85-0.89 Females= 0.75-0.79
What is an average WHR for males? Females?
Males= 0.90-0.95 Females= 0.80- 0.86
What WHR ratio places on “at risk” for males? Females?
- Males= greater than 0.95
- Females= greater than 0.86
What are the pros and cons of the WHR?
Pros= best for detecting the health risks of obesity (cardiac)
Cons= Not good for malnutrition
What are the pros and cons of BMI?
Pros= good standard for over and under weight
Cons=
- Less accuracy in v. fit and poorly fit
- Less accurate in elderly
What are the lab tests used to assess for malnutrition?
1) CBC= decreased RBC and TLC (Total Lymphocyte Count)
2) BMP= decreased protein and albumin
3) Prealbumin
4) Micronutrient levels (K+, Mg++ and phosphorus)
5) Lipid panel
What are the nutritional screening tools?
NRS-2002= Nutritional Risk Screening*
MUST= Malnutrition Universal Screening Tool
What are the red flags in a nutritional risk screening?
- BMI less than 20.5
- Weight loss in 3 months
- Reduced dietary intake in last week
- Requires ICU admission
*****If any of these are positive, patient requires more in-depth screening
What do 0-3 correspond with in the NRS-2002?
0= Normal 1= Mild 2= Moderate 3= Severe
What should you do if a patient is at high risk for malnutrition?
- Refer: dietitian, nutritional support team, and implement local policy
- Set goals and improve overall nutritional intake
- Monitor and review care
If a patient has bad teeth e.g. from chronic methamphetamine use, what should you recommend?
Mechanical soft food i.e. that patient doesn’t actually have to chew the food
*****These are food that are easy to chew
If a patient has poor teeth and dysphagia, what should you recommend?
Pureed food
*****This is a smooth, cohesive, pudding-like food (baby food)
If a patient can’t swallow, what should you recommend?
Tube feeding
