Midterm Flashcards
1
Q
MNT definition
A
in-depth, individualized nutrition assessment and a duration and frequency of care using NCP to manage disease
2
Q
scope of practice
A
- range of roles, activities, regulation in which RDNs perform
- determined by professional licensure (states)
- individual scope: your capabilities
3
Q
purpose of NCP
A
- systematic problem solving method used to critically think and make decisions to address nutrition-related problems and provide safe, effective, high-quality nutrition care
- provides consistent structure and framework, systematic and consistent steps
- EBP, scientific principles, protocals
- outcome is improved quality of care and health status
4
Q
4 steps of NCP
A
assessment, diagnosis, intervention, monitoring and evaluation
5
Q
purpose of nutrition screening process
A
- “on ramp” to the NCP
- quickly identifies those who may benefit from NCP
- identifies level of nutrition risk
- high risk -> complete nutrition assessment by RD
6
Q
feature of a good nutrition screening tool
A
- quick, easy to use, valid, and reliable for patient population or setting
- can be carried out by any trained personnel
- no lab measurements
7
Q
when must nutritional screening be completed on patients admitted to a hospital
A
JCAHO requires within 24 hours
8
Q
EBP definition
A
rigorous systematic methods to:
- define clinical questions
- acquire relevant research literature and evidence
- apply findings as a graded/rated clinical guidelines or recommendation
9
Q
EBP components
A
- best available scientific research
- clinical expertise of the practitioner
- patient values and preferences
10
Q
why EBP
A
- clinical judgement can be lacking
- research, best practices, and clinical guidelines can change
- scientific evidence isn’t always definitive. critical thinking, clinical judgements, and patient values are needed to guide decisions
- allows for patient focused care
11
Q
research vs EBP
A
research: systematic investigation. designed to develop or contribute to generalizable knowledge. findings can contribute to EBP lit review
EBP: synthesize research with clinical expertise and patient preferences to inform a clinical decision. clinical problem can lead to a research question
12
Q
nutrition assessment purpose
A
-systematic method for obtaining, verifying, and interpreting data needed to identify nutrition related problems, their cause, and significance
- review, cluster into domains, and compare to reliable standards
13
Q
nutrition screening vs assessment
A
screening identifies those who require a complete assessment
14
Q
5 domains of nutrition assessment
A
- food/nutrition related history
- anthropometric measurements
- biochemical data, medical tests, and procedures
- physical exam findings
- client history
15
Q
food and nutrition related history domain
A
- food and nutrient intake
- energy, protein, and fluid requirements
- medication, supplements
- knowledge, beliefs, behaviors, physical activity
- access of foods/supplies
16
Q
anthropometric measurements domain
A
- body size, weight, height, circumferences
- body shape, proportions, rations
- BMI
- body compositions
17
Q
BMI equation
A
703 (lb/in^2) or kg/m^2
18
Q
biochemical data, medical tests, and procedures domain
A
- measurement of nutrition markers and indicators found in blood, urine, feces, and tissue samples
- protein assessment
- immunocompetence
- hematological
- vitamin and mineral asessment
19
Q
physical exam domain
A
- assess for signs and symptoms consistent with malnutrition or specific micronutrient deficiencies
- techniques of inspection, palpation, percussion, and auscultation are used
20
Q
client history domain
A
- age, sex, gender, education, food security, socioeconomic data
- previous medical history and testing
- family medical history
21
Q
sensitivity
A
- test’s ability to correctly identify people with a disease
- highly sensitive test has few false negatives
22
Q
specificity
A
- test’s ability to correctly identify people without a disease
- highly specific test has few false positives
23
Q
validity
A
- how well an assessment measures what it’s supposed to measure
24
Q
reliability
A
how reliable or consistent are the measures
25
methods to obtain height on a patient who cannot stand
- half arm span x2
- knee height with equation
26
calorie count
- best for assessing actual food intake in an inpatient setting
- food weighed before and after intake, or % consumed visually estimated
- 3 day calorie count typically used
27
1 kg
2.2 lb
28
1 in
2.54 cm
29
ABW
actual body weight used in most situation/calculations
30
UBW
usual body weight used when a person has experienced significant weight fluctuations
31
IBW
ideal body weight used with certain protein recommendations validated using IBW
32
%UBW
CBW/UBW
33
% weight loss
(UBW - CBW)/UBW
34
adjusted body weight for amputations
subtract prosthetic weight
CBW/(1-%) x 100
35
somatic protein status indicators
- (muscle stores)
- creatinine height index (CHI)
- nitrogen balance
36
visceral protein status indicators
- (non skeletal muscle proteins)
- albumin
- transferrin
- prealbumin
- retinol binding protein (RBP)
- C reactive protein (CRP)
- not reliable indicators of nutritional protein status or malnutrition
37
acute phase protein
- proteins produced by liver in response to inflammation, infection, or damaged tissue
- inflammation markers
38
negative acute phase proteins
- decrease in response to inflammation, not valid indicators of malnutrition
- albumin
- transferrin
- prealbumin
- RBP
39
positive acute phase proteins
- C reactive protein
- ferritin
- hepcidin
40
starvation related malnutrition
pure chronic starvation, anorexia
41
acute disease or injury related malnutrition
major infection, burns, trauma, closed head injury
42
chronic disease related malnutrition
organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity
43
6 AAIM criteria
- insufficient energy intake
- weight loss
- loss of muscle mass
- loss of subcutaneous fat/body fat
- fluid accumulation
- hand grip strength
- need 2/6
44
muscle loss assessment
- temple
- quads, patellar
- calves
- clavicle, pectoral, deltoid
- scapular
- dorsal hand
45
fat loss assessment
- orbital
- cheek
- triceps, biceps
- thoracic, lumbar, ribs
46
how is fluid retention related to malnutrition
- pitting edema may be a sign of hypoproteinemia (low protein)
- edema can mask signs of fat and muscle loss
- legs, arms, ascites
47
how is metabolism affected by stress
- everything ramps up
- inflammation
- increase in metabolic rate, energy needs, body temp, blood glucose
- catabolism of lean mass
- major fuel source: protein -> gluconeogenesis
48
how is metabolism affected starvation
- everything slows down
- no inflammation
- decrease in metabolic rate, energy needs, body temp, blood glucose (normal-low)
- preservation of lean mass, protein stores are protected
- major fuel source: fat -> ketones
49
3 phases of the metabolic stress response
ebb, flow, recovery
50
ebb phase
- immediately after injury (2-48 hours)
- shock hypovolemia
- tissue hypoxia
- decreased cardiac output, urinary output, oxygen consumption, body temperature
- hemodynamically unstable
51
flow phase
- 36-48 hours after injury until 7-10 days
- catabolism
- increase positive acute phase proteins, decrease negative
- hormonal and immune responses
- increased cardiac output, oxygen consumption, body temperature, energy expenditure, protein catabolism
- hemodynamically stable
- hypermetabolic
- provide enough energy and protein substrates to protect function and repair tissue damage
52
recovery phase
- 7-10 days after injury until months
- lost tissue is restored
- body restores to normal function
- anabolism
53
purpose of MNT during metabolic stress
- important to consider the patient's primary medical diagnosis along with accommodations for the metabolic changes that have occurred
- establishing hemodynamic stability
glycemic control
- balance between prevention of malnutrition and prevention of the possible complications of providing nutrition support
54
purpose of nutrition diagnosis
- direct link between nutrition assessment and nutrition intervention
- identifies a specific nutrition problem that can be resolved/improved by the RD with nutrition intervention
- not a medical diagnosis
55
three domains of nutrition diagnosis
intake (preferred), clinical, behavioral-environmental
56
when would an intake domain diagnosis not be the preferred domain
when the primary nutrition problem is clearly related to a clinical condition or a behavioral factor
57
three parts of PES statement
problem, etiology, signs and symptoms
58
problem in PES
- diagnositic eNCPT term that describes an alteration in the client's nutritional status
- "altered" "excessive" "inadequate"
- RDN must be able to impact this problem
59
etiology in PES
- factors related to root cause or existence of problem
- intervention is aimed at adressing/resolving or minimizing this underlying cause
- causes the problem
60
signs and symptoms in PES
- defining characteristic obtained from subjective and objective nutrition assessment data
- data used to determine a problem exists and provides evidence
- intervention is directed at improving this
- provides rationale for ideal goals and outcomes. measuring will indicate if the problem is improved
- specific enough to be measured
61
PES format
P related to E as evidenced by S
62
factors that make a strong PES
- clear and concise
- select the most urgent problem
- intake domain preferred
- specific to the patient
63
purpose of nutrition intervention
- purposeful, planned action intended to improve or resolve a nutrition problem by addressing the underlying cause (etiology)
- if the RDN cannot impact the etiology through nutrition intervention, then the intervention is directed toward improving the signs and symptoms
64
two stages of the nutrition intervention
planning, implementation
65
planning stage of nutrition intervention
- prioritize nutrition diagnosis (PES)
- write nutrition prescription
- set goals
- select nutrition intervention
66
domains of nutrition intervention
- food and/or nutrient delivery
- nutrition education
- nutrition counseling
- coordination of nutrition care
67
nutrition prescription
- essential first component of the nutrition intervention
- concisely communicates the RD's diet recommendation based on a nutrition assessment
- includes recommendations for energy, selected nutrients, and/or selected foods
68
first thing you do in the planning stage of nutrition intervention
prioritize the nutrition diagnosis (PES)
69
nutrition education
- instruction or training intended to lead to nutrition related knowledge
- group classes, individual instruction, written instruction, or via phone/electronic communication
- outpatient setting is more conducive to education
- in acute-care setting, more content focused
- quickly useable content and straight forward instructions
70
nutrition counseling
- supportive process, characterized by a collaborative counselor-client relationship
- establishes goal setting and individualized action plans
71
purpose of monitoring and evaluation
- determine the degree of progress being made and whether the client's goals or desired outcomes of nutrition care are being achieved
- is the nutrition intervention strategy working to resolve the nutrition diagnosis, its etiology, and/or its signs or symptoms
- involves reassessment
72
resolved
the nutrition problem no longer exists
73
improvement shown
nutrition problem still exists but with positive progress toward goal
74
unresolved
no improvement shown in the nutrition problem
75
no longer appropriate
change in condition where the nutrition problem and intervention is no longer appropriate/relevant
76
examples of therapeutic diets found in the hospital setting
texture modified diets, fluid restricted diets, clear liquid diet, full liquid diet, high fiber diet
77
diet liberalization
- modified therapeutic diet that relaxes restrictions to allow people to eat food they enjoy while still remaining healthy
- potentially leads to improved nutritional intake
78
some ways a hospital diet could be modified to include more energy
- add butter, margarine, jam, jelly, honey, whole milk, cream, sour cream, yogurt, nut butters, cream cheese
79
some ways a hospital diet could be modified to include more protein
add powdered milk, liquid egg substitutes, nuts, nut butters, chopped meats, cooked eggs, cheese, yogurt, tofu, soy crumbles
80
purpose of texture modified diets in the hospital
- for people with chewing and swallowing difficulties
- reduce risk of choking and aspiration
81
IDDSI framework
- international set of descriptors describing texture modified foods and thickened liquids for people with eating, drinking, and swallowing problems (dysphagia) across the lifespan
82
clear liquids
- intended to supply fluid and energy in a form that requires minimal digestion and stimulation of the GI tract
- not nutritionally adequate
- should be limited to 24-48 hours unless supplements are added
- research evidence does not support long term use
83
purpose of fasting prior to surgical operations
minimize risk of aspirations
84
current best evidence based guideline for feeding post operatively? rationale?
- improved patient recovery with initiation of a general diet post operatively without transitional clear and full liquid diets
- helps maintain gut function, reduce complications, and improve overall recovery by minimizing the stress response to surgery and promoting faster return to normal eating habits
85
enteral nutrition
- aka tube feeding
- providing nutrition directly into the GI tract
86
parental nutrition
- intravenous (IV) nutrition
87
when is EN needed
- inability eat/eat enough
- impaired digestion, absorption, metabolism
- inadequate oral intake 7-14 days
- gut works
88
benefits of EN
- cost effective
- reduced length of hospital stay
- reduced need for surgical interventions
- reduced incidence of infectious complications in critically ill patients
- improved wound healing
- maintenance of GI function
89
contraindications of EN
- illeus: lack of movement of the intestines
- complete obstruction of small or large bowel
- severe diarrhea without response to medication
- intractable vomiting
- high output external fistula
- hypovolemic or septic shock
- very poor prognosis
- patient's wish
90
why is EN preferred to PN
- safer, more cost effective, easier on the body
- if the gut works, use it
91
short term vs long term for EN
4 weeks
92
short term access routes
NG tube through nose, OGT through mouth
93
long-term access routes
PEG through stomach, jejunostomy through small intestine
94
prepyloric feeding
- delivering nutrition into stomach
- standard method
- NG tube, PEG
95
post-pyloric feeding
- delivering nutrition past the pyloric valve, into the small intestine
- used when gastric emptying is impaired, high risk of aspiration, severe gastric reflux, intestinal surgery history
- ND tube, jejunostomy
