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Nutrition > Intro Lecture > Flashcards

Intro Lecture Flashcards

1
Q

What needs to be done for every pt?

A

Nutrition screening within 24 hrs of admission

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2
Q

Definition of screening

A

A process to identify an individual who is malnourished or who is at risk for malnutrition to determine if a detailed nutrition assessment is needed

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3
Q

Screening outcomes

A

Not at risk- rescreen at specified individuals
At risk- plan carried out according to ordinary ward routines
At risk but metabolic or functional problems prevent a standard plan being carried out

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4
Q

Nutrition screening criteria

A 
Height
Weight
Change in weight
Food allergies
Diet
Lab data
Change in appetite
Nausea or vomiting
Bowel habits
Chewing/swallowing ability
Dx
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5
Q

NRS-2002

A

Medical-surgical and acute hospitalized

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6
Q

MNA-SF

A

Ambulatory and sub-acute

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7
Q

MST

A

Acute hospitalized and oncology outpatients

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8
Q

MUST

A

Medical and surgical hospitalized

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9
Q

NST/BAPEN

A

Acute, hospitalized

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10
Q

Simple, two-part screen

A

Acute, hospitalized

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11
Q

NRS

A

Acute care, medical and surgical

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12
Q

Screen-II/AB

A

Seniors in the community/geriatric clinics

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13
Q

Rapid screen

A

Sub-acute care (rehab center)

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14
Q

Tool #1

A

Elderly in acute care and long-term care

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15
Q

SNAQ

A

Not evaluated against a reliable standard

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16
Q

What is assessed in the NRS?

A

Weight loss, BMI, food intake
Dx and severity of dz
Best predictor of postsurgical complications
Predicted length of stay (LOS), morbidity and mortality in acute care
In GI surgery, predicted morbidity, complications, LOS

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17
Q

What is assessed in mini-nutritional assessment (MNA)

A 
Weight and height data
Food intake hx and appetite
Dz
Self-perception of health status
-Mobility
-Psychological stress/problems
Predicted post-operative outcomes in elderly
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18
Q

What are the advantages of the MST?

A

Accurately predicts malnutrition
Promotes early nutritional therapy with most appropriate pts
Simple, quick and easy to implement

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19
Q

What is screened in the MUST?

A

BMI, weight change, illness severity
Predicted mortality in the elderly
Identified oncology pts at risk for longer length of stay (LOS)

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20
Q

Screening vs assessment

A 
Screening: Brief
Assessment: Comprehensive
Screening: Non-invasive
Assessment: Can include invasive testing
Screening: Inexpensive
Assessment: More expensive
Screening: Goal is to identify need for assessment
Assessment: Goal is to identify need for intervention
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21
Q

Definition of nutrition assessment

A 
Food/nutrition hx
Client hx
PE findings
Anthropometric measurements
Biochemical data, medical tests, and procedures
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22
Q

What does pt hx include in an assessment?

A

Diet
Medical
Surgical
Social

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23
Q

What does a diet hx include

A

24-hr recall
Usual dietary intake or hx
Food frequency questionnaire
Food diary or record

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24
Q

Components of diet hx

A 
Current diet order
Days of inadequate intake
Dietary restrictions
Recent dietary change
Food consistency
Appetite assessment
Alcohol consumption
Food intolerances, aversions, allergies
Fad diets
Vitamin, mineral or herbal supplements
Commercial dietary supplements
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25
Q

Components of medical/surgical hx

A 
CC
Current health status
Chronic dz states
Psychiatric hx
Diagnostic procedures
Medical therapies
Past hx of operations
Family health hx
Oral health hx
Medications with potential drug-nutrient interactions
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26
Q

Components of pt social hx

A

Degree of physical activity
Extent of family support
Housing situation
Socioeconomic issues

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27
Q

Anthropometric data

A 
Height
Weight
BMI
Arm circumference and triceps skinfold measurements
Waist: hip ratio
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28
Q

BMI greater than or equal to 40

A

Grade III obesity (morbid)

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29
Q

BMI 35-39.9

A

Grade II obesity

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30
Q

BMI 30-34.9

A

Grade I obesity

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31
Q

BMI 25-29.9

A

Overweight

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32
Q

BMI 18.5-25

A

Nl

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33
Q

BMI 17-18.4

A

Grade I protein energy malnutrition

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34
Q

BMI 16-16.9

A

Grade II protein energy malnutrition

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35
Q

BMI <16

A

Grade III protein energy malnutrition

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36
Q

General components of a nutrition-focused physical exam

A

Overall appearance
Muscle mass and tone
Adipose stores/tissue (skinfold thickness)

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37
Q

Oral components of a nutrition-focused PE

A

Tongue
Gums
Lips
Mucous membranes

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38
Q

Skin components of a nutrition-focused PE

A 
Color
Scars
Edema
Turgor
Temp
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39
Q

Nail components of a nutrition-focused PE

A

Color
Shape
Texture

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40
Q

Nose components of a nutrition-focused PE

A

Feeding devices

Symmetry

41
Q

Chest components of a nutrition-focused PE

A

Muscle wasting
Barrel chest
IV devices

42
Q

Abdomen components of a nutrition-focused PE

A

Wounds
Scars
Distention or tenderness
Bowel sounds

43
Q

Neurological components of a nutrition-focused PE

A 
Motor skills
Weakness
Coordination
Paralysis
Acuity
44
Q

SGA

A

Weight and diet hx
Diagnosis and level of stress
Physical sx
Functional capacity
Predicted
-Length of stay in acute care (medical) and GI dz
-Morbidity and mortality in critically ill
-Outcomes in elective surgery and stroke (elderly)

45
Q

Nl albumin levels

A

3.5-5.0 mg/dL

46
Q

Nl prealbumin levels

A

16-40 mg/dL

47
Q

What electrolytes are measured in lab?

A 
Na
K
Phos
Mg
Ca
Cl
48
Q

Nl glucose level

A

70-110 mg/dL

49
Q

What micronutrient levels are measured in lab?

A

Fe
B12
Folate
Zn

50
Q

What other things are measured in lab?

A

Hemoglobin/hematocrit
Lipid panel
Acid-base disorders

51
Q

Acute-phase response

A

Increased temp
Increased WBC count
Increased CRP
-Measures presence, intensity, and recovery from an inflammatory process
-Other nutrition related proteins WILL NOT return to nl until the APR resolves

52
Q

Acute phase proteins-ceruloplamin

A

Pos

Binds copper- antioxidant

53
Q

Acute phase proteins- albumin

A

Neg

Binds Ca and other molecules; antioxidant; plasma oncotic pressure

54
Q

Acute phase proteins- prealbumin

A

Neg

Thyroxine transport; forms complex with RBP

55
Q

Acute phase proteins- transferrin

A

Neg

Iron absorption and transport

56
Q

Acute phase proteins: CRP

A

Pos

Scavenger of cell membrane debris; complements DNA activation

57
Q

Acute phase proteins- IGF

A

Neg

Promotes protein synthesis in liver and muscle; inhibits lipolysis

58
Q

When does hepatic status change?

A

Trauma
Infections
Cancer
Surgery
Low serum hepatic concentrations are not necessarily caused by nutrient deficit
Low concentrations associated with illness will not normalize just with nutritional intervention

59
Q

Negative acute phase proteins

A

Excellent indicators of the severity of illness NOT nutritional status
-Correlate with morbidity and mortality
Decrease may predict those at risk of malnutrition
Indicates the need for a more comprehensive nutritional assessment by RD

60
Q

When is the malnutrition risk increased?

A

Older adults
Critically ill pts
Pts with comorbid chronic dzs
-CA, COPD, CKD

61
Q

Physiologic impact of malnutrition

A 
Increased morbidity and mortality
Declining function and mobility
Decreased quality of life
Increased frequency and length of stay
Higher health care costs
62
Q

Protein-calorie malnutrition criteria in the 20th century

A

Albumin less than or equal to 3.0 g/dL OR
Prealbumin less than or equal to 12 mg/dL
Wt loss >10% usual body weight and hx of poor intake
Current wt <90% of IBW OR BMI <18 kg/m squared
Pressure older greater than or equal to stage 2 OR
a non-healing wound
RD clinical judgment of PCM

63
Q

Severe protein calorie malnutrition

A

Required presence of 3 criteria

64
Q

Moderate protein calorie malnutrition

A

Required presence of 2 criteria

65
Q

Inflammation and malnutrition

A

Consider when conducting nutrition assessment, intervention, and monitoring
Nutrition support alone is ineffective in prevention of muscle protein loss in the inflammatory state
Indicators of inflammation:
-Biomarkers
-Obesity
-Hyperglycemia
-Organ failure syndromes

66
Q

Starvation-related malnutrition

A

Chronic starvation without inflammation (anorexia nervosa)

67
Q

Chronic disease-related malnutrition

A

Inflammation is chronic and of a mild to moderate degree (RA, organ failure, pancreatic CA)

68
Q

Acute dz-or injury-related malnutrition

A

Inflammation is acute and of a severe degree (major infection, burns, trauma, or closed head injury)

69
Q

Clinical characteristics that the clinician can obtain and document to support a dx of malnutrition

A 
Energy intake
Interpretation of weight loss
Physical findings
Body fat
Muscle mass
Fluid accumulation
Reduced grip strength
70
Q

What is required for a malnutrition dx?

A 
A minimum of 2 out of the 6 clinical characteristics
Severe or moderate malnutrition
Identify the setting:
-Acute illness or injury
-Chronic illness (>3 mos)
-Social/environmental circumstances
71
Q

REE (resting energy expenditure)

A

Energy expended for nl body functions

72
Q

BEE (basal energy expenditure)

A

Minimal energy expended required for life

73
Q

BMR (basal metabolic rate)

A

Measured in morning before eating and activity

74
Q

RMR (resting metabolic rate)

A

May include energy for digestion and oxygen consumption of tissues

75
Q

Indirect calorimetry

A 
Considered the gold standard
When used in the appropriate pt population, <4% error rate
Limitations:
-Increased cost of care
-Trained personnel needed
76
Q

Conditions for accurate testing

A

Body position

Restrictions for critically ill pts

77
Q

Respiratory quotient (RQ)

A 
Physiological range: 0.67-1.3
-If <0.7
--Prolonged fast >16 hrs
--Underfeeding
--Ethanol metabolism
-If >1.0
--Recent, excessive caloric intake
--Overfeeding
RQ is a good marker of test validity
78
Q

Interpretation of respiratory quotient (RQ)

A

Substrate utilization assumes the subject is burning one substrate at a time
-Carbohydrate = 1.0
-Protein = 0.8
-Fat = 0.7
-Mixed fuel = 0.8-0.85
RQ should NOT be used to determine a specific nutrition regimen

79
Q

Harris-Benedict

A

Commonly used
Higher error rate, esp with obese pts
Subjective use of stress factors
BEE x 1.1 may be more accurate

80
Q

Ireton-Jones

A

Tailored to pts that are ventilator dependent and to pts that are spontaneously breathing
Considers factors such as trauma, burns and the presence of obesity

81
Q

Frankenfeld and Swinamer

A

Equations that use dynamic parameters associated with greater correlation to measured REE
Parameters: Temp, min ventilation, presence of sepsis, hemoglobin, RR
Less accurate in obese pts

82
Q

MIfflin-St. Jeor Equation

A

Accurate estimate of actual resting metabolic rate in obese and non-obese populations with a low rate of overestimation
Not reliable in the critically ill pt population

83
Q

American College of Chest Physicians (ACCP) targets

A

Critically ill pts
-25 kcal/kg
Systemic inflammatory response syndrome (SIRS)
-27.5 kcal/kg

84
Q

Hypocaloric feedings in pts with acute illness, stress of injury, or sepsis- nutrien(t requirements

A

20-25 kcal/kg body weight

85
Q

Obesity nutrient requirements

A

> 120% of ideal weight for height

20 kcal/kg body weight

86
Q

Morbid obesity nutrient requirements

A

8-14 kcal/kg body weight

87
Q

Stable pt with marasmus nutrient requirements

A

37 kcal/kg body weight

88
Q

What tools are recommended for estimating the nutritional needs of critically ill pts?

A

Ireton-Jones equation
Penn State equation
20-25 kcal/kg recommendation by the ACCP

89
Q

Adult Maint protein requirements

A

0.8-1.0 g/kg

90
Q

Critical illness protein requirements

A

1.5-2.0 g/kg

91
Q

Renal dz protein requirements

A

0.6-2.0 g/kg

92
Q

Liver dz protein requirements

A

0.5-1.5 g/kg

93
Q

CA protein requirements

A

1.0-1.5 g/kg

94
Q

GI dz protein requirements

A

1.0-2.0 g/kg

95
Q

Obesity, stressed protein requirements

A

1.5-2.0 g/kg ideal

96
Q

Other protein requirements

A

0.8 g/kg/day for healthy individuals
If stressed and <120% ideal weight for height: 1.5 g/kg/day actual weight
If stressed and >120% ideal weight for height: 1.5 g/kg/day ideal weight
Head injury/CVA/bleeds: 1.8 g/kg/day actual weight
Renal failure: 1.5-2.0 g/kg/day dry weight with dialysis

97
Q

Fluid requirements

A

30-35 mL/kg for maintenance
100 cc for the 1st 10 kg of body weight. 50 cc fort he 2nd 10 kg of body weight. Any weight >20 kg: Add 20 cc/kg/day if under 50 yoa and 15 cc/kg/day if > 50 yoa
Monitor adequacy of provision when IVF and meds reduced or discontinued

98
Q

RDA method of estimating fluid needs

A

1 cc fluid per 1 kcal of estimated needs

99
Q

Holliday-Segar method of estimating fluid needs

A

<10 kg: 100 mL/kg
11-20 kg: 1,000 mL + 50 mL/kg for each kg >10
>20 kg: 1500 mL + 20 mL/kg for each kg >20

Nutrition (3 decks)

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