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FN 3344 > Lecture 4 - Nutrition Assessment and Screening > Flashcards

Lecture 4 - Nutrition Assessment and Screening Flashcards

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1
Q

Why do we use screening?

A

To see if you need to conduct a compete assessment

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2
Q

What are the characteristics on an ideal nutrition assessment method?

A 
Validity
Reproducibility
Accuracy
Sensitivity
Specificity
Ethical
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3
Q

What tis validity?

A

Adequacy to reflect what is intended to measure

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4
Q

What is reproducibility?

A

Degree to which repeated measurements of a variable give the same value

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5
Q

What is accuracy?

A

Extent to which a measurement is close to the correct value

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6
Q

What is sensitivity?

A

Extend to which an index or indicator correctly reflects a current status of predicts changes

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7
Q

What is important to note about accuracy?

A

A test can be reproducible but inaccurate

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8
Q

How do we determine if a test has good reproducibility?

A

If the coefficient is less than 15 than it is a good reproducible test

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9
Q

How is sensitivity expressed?

A

In terms of proportion or % of individuals

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10
Q

What does 100% sensitivity identifies?

A

Correctly identifies all those who are genuinely malnourished

  • No malnournide persons are classified as well
  • NO FALSE POSITIVES
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11
Q

What is a true positive/true negative and false positive.false negative?

A

TP: Is malnourished and identified as malnourished

TN: Not malnourished and not identified as malnourished

FP: Not malnourished but identified as malnourished

FN: malnourished but not identified as malnourished

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12
Q

What is analytical sensitivity?

A

Minimum detection limit of ability of an analytical method to detect the smallest amount of the substance of interest

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13
Q

What is specificity?

A

Ability of an index or indicator to correctly identify or classify individuals as having a characteristic

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14
Q

How is specificity expressed?

A

IN terms of proportions of % of individuals

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15
Q

What does 100% specificity mean?

A

All genuinely well nourished individuals will be correctly identified

  • No well nourished individuals will be classified as ill
  • NO FALSE POSITIVES
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16
Q

What does it mean when we have a specificity of 75-80% or higher?

A

Is considered a good specificity

-hard to 100%

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17
Q

How are ethical in screening and assessments?

A

Making sure you have informed consent

  • explain measurement & procedure
  • give risk and benefit
  • Respecitna nd documenting choice of individual
  • Allow to change their mind freely (can quit whenever)
  • answer questions

Ensuring protection of confidentiality and safety

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18
Q

Why I nutrition screening a good thing?

A

Good for identifying those at risk

Prevention is better than treatment

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19
Q

Why is nutrition screening necessary?

A
  • Many patients in healthcare setting are eat risk for malnutrition
  • Complication of malnutrition (increased morbidity, mortality, health care costs)
  • Timely screening can frequent improve outcomes
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20
Q

What is Iatrogenic Malnutrition?

A

Malnutrition resulting from medical causes: effect of meds or complications from medical. treatment

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21
Q

What causes iatrogenic malnutrition?

A

Negligenc amount medical personnel

  • NPO
  • Feeding tube
  • Calorie count
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22
Q

When we see a patient with NPO on their chart what does this mean for us?

A

Nothing by mouth
-we need to figure out why they are like this -
how long they have been like this
-if there is a plan for getting them out of NPO

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23
Q

What are the ethology based definitions?

A

Based on starvation related, chronic disease related or acute disease related and whether their inflammation is sever and the top of inflammation they have

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24
Q

Why is nutrition screening necessary?

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A
  • Allows to identify nutritional tis and the need for nutritional intervention
  • Required by law in healthcare institutions (patients must be see 24-48hr after admission) (SIM, screen, intervene, monitor)
  • Document they value of nutritional care and its outcomes
25
What are some of the effective nutrition screening tools?
``` Quick and simple Based on data routinely gathered Performed by any HCP Efficient Inexpensive/cost effective Reproducible or reliable Valid Accurate& sensitive Specific Ethical ```
26
What are some of the criteria often used in nutrition screening?
History data -diagnosis, bowel habits Anthropometric finding's -Ht, Wt, Wt change, BMI Biochemical findings -Serum (albumin), Hb Clinical findings - Nausea/vomiting - chewing/swallowing ability Dietary findings - Change in appetite - Dietary habity - dietary supplants
27
Why do a variety of screening tools exist?
For different stages of the life cycle For general population or various disease states Some have scoring/point system -Identify degree of nutrition risk. The greater the severity of nutritional risk the earlier that intervention should take place "triage")
28
What is the SGA test?
Subjective global assessment - Developed in torotnto initialy for cancer patients - can be used for adult hospitalized patients - needs trained health professionals to perform - Needs more times - Scoring system to allow for triaging (newest one is nutritional triaging)
29
What are the parameters used for SGA?
``` Med history Physical exam Weight loss Reduced physical function Appetite ```
30
What re the advantages of a PG SGA?
``` Validated tool Standardized Reproducible Little $ Quick Easy to teach to HCP Sensitivity and specificity superior Direct patient participation ```
31
In the PG SAG what is it sensitivity and specificity superior too?
Serum (albumin) and transferrin Delayed hypersensitivity skin test Anthropometry Creatinine heigh index
32
What can the PG SAG be used to rate?
1. Overall nutrition status into: - well nourished or anabolic A - Moderate or suspected malnutrition B - Severely malnourished C 2. Outcomes of nation care plan
33
In PG SAG/SAG which category is hardest to determine?
B | -usually these ones that need to investigate thoroughly
34
What are the limitations of PG SAG?
Not be the only nutrition assessment tool used Patient participation not always possible Not validated for all age groups Large subjective component in assessment Training of health care professionals required
35
What is the MST?
Malnutrition Screening Tool - simple - quick to administer - 2 question tool
36
What are the parameters of the MST?
Unintentional weight loss Appetite
37
How do you catacgorize a MST score?
0 or 1 they are not at risk 2 or more at risk
38
What is the NRS?
Nutrition Risk Screening - developed by ESPEN - Preferred tool to screen for malnutrition in European hospital settings
39
What are the parameters of NRS?
``` Unintentional weight los BMI Appetite/food Intake Disease severity Age Impaired general condition ```
40
What is SNAQ?
Short nutritional assessment Questionnaire - simple - easy administration - 3 question tool - developed in the Netherlands for hospital screening
41
What are the parameters used in SNAQ?
Unintentional weigh loss Appetite Use of oral supplement or tube feeding
42
What is MUST?
Malnutrition Universal Screening Tool - simple - easy administraiton - few questions - developed for hospital in and out patient screening
43
What re the parameters of MUST?
Unintentional weight loss BMI Appetite/Food intake Acutely ill
44
What is CNST?
Canadian nutrition screening tool - simple - easy administration - developed in Canada for hospital screening
45
What are the parameters for CNST?
Unintentional weight loss | Appetite/food intake
46
What is the CNST used for?
The initial step int he pathway of nutrition assessment and intervention
47
How many people go and leave from hospitals malnourished?
45% admitted are malnourished (SGA) 48% leave malnourished
48
Is albumin a marker of malnutrition? Why?
No - poor specificity to nutrition status - low levels very prevalent in critically illpatient - negative acute phase reactant - pre albumin shorter half life but same limitation.
49
What is the process as to why albumin is not used as a marker of malnutrition?
Sythesis, breakdown and leakage out of vascular compartment with edema are influenced by cytokine-mediated inflammatory response -in critically ill patient liver shuts down albumin production MArker for severity of underlying disease (inflammation) not malnutrition
50
Why do we need to be nutrition champions/
Need to identify malnutrition, screening tools and intervention strategies as RD -Need to advocate for your patient
51
What is the origin of DETERMINE?
Used as a public awareness tool, developed in 1991 in Washington, especially for elderly individuals -project of the AAFP ADA, national council on the Aging
52
What does determine stand for?
``` Disease Eating poorly Tooth loss/mouth pain Economic hardship Reduced social contact Multiple medicines Involuntary weigh loss/gain Needs assistance in self care Elder years above age 80 ```
53
What is MNA?
Mini Nutritional Assessment | -used for grading the nutritional state of elderly?
54
What is the origin of MNA?
Developed in Switzerland in 1994 especially to screen elderly patients for risk of malnutrition
55
What do we use in Canada for screening elderly?
Screen 3 | -looking for the elderly population
56
What are the biases of MNA?
History data Anthropometry and dietary findings Malnutrition index score calculated based on evaluation of 18 components in 2 steps
57
Is nutrition screening a complete nutrition assessment?
NO | -need to screen, intervene and monitor to figure out if its working and if you need to make adjustments
58
What is the key difference between screening and assessment?
Screening identifies risk factors Assessment provides diagnosis
59
What is INPAC?
Integrated nutrition pathway for acute care -evidence and consensus based algotirht for identification, prevention, treatment and monitoring of malnutrition in hospitals

FN 3344 (13 decks)

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