4900 C7 Assessment of the Hospitalized Patient

Question 1

Four goals of nutritional assessment of the hospitalized patient:

Answer 1

ID pt at nutritional risk, determine severity & etiology of nutritional impairment, ID risk of morbidity & mortality related to the nutritional deficiency, monitor & evaluate response to therapy.

Question 2

Ways to calculate stature in bed ridden patient

Answer 2

knee height, calf circumference, age, and sex, body length while lying in bed.

Question 3

Midarm circumference (MAC)

Answer 3

Is measured at the triceps skinfold site. Indicator of muscle & subcutaneous adipose tissue. Accepted measure of nutritional status. Measured in mm.

Question 4

Arm muscle area

Answer 4

Calculated from the triceps skinfold measurement & midarm circumference. Used as an index of lean tissue or muscle in the body. Measured in mm.

Question 5

Calf circumference

Answer 5

Used in estimating body wt & indicator of muscle & subcutaneous adipose tissue.

Question 6

What is the largest component of 24-hour energy expenditure?

Answer 6

Resting energy expenditure.

Question 7

24-hour energy expenditure includes:

Answer 7

REE, thermic effect of food, PA, presence of disease or injury.

Question 8

Indirect Calorimetry

Answer 8

Measurement of body’s O2 consumption & CO2 production. Often uses a computerized metabolic monitor.

Question 9

In which pt is indirect calorimetry recommended?

Answer 9

The critically ill, pt receiving parenteral or enteral feeding.

Question 10

Mini Nutritional Assessment (MNA)

Answer 10

18-item questionnaire designed to ID elderly pt at nutritional risk who may need extensive nutritional assessment.

Question 11

MNA-SF

Answer 11

Mini Nutritional Assessment-short form. The first 6 item from the full MNA, ∿5 min to complete.

Question 12

Malnutrition Universal Screening Tool (MUST)

Answer 12

5-step screening tool to ID malnourished adults, or those at risk. Uses: BMI, hx of recent wt loss, effects of acute illness on intake. Gives malnutrition risk score.

Question 13

The four steps to assessing the nutritional status of a hospitalized pt?

Answer 13

Nutritional screening, if at risk then Nutritional assessment, if nutritionally impaired then Nutritional support plan, the monitoring and evaluation to ensure good response to support.

Question 14

Nutritional screening

Answer 14

Is the process of identifying characteristics known to be associated with nutritional problems. The purpose is to detect those at risk for malnourishment.

Question 15

Standards for nutritional care are set by?

Answer 15

the Joint Commission on the Accreditation of Health Care Organizations (JCAHO)

Question 16

Diagnoses that place at pt at particular risk for malnutrition?

Answer 16

pressure ulcers, sepsis, HIV/AIDS, diet restrictions related to: dysphagia, renal &/or hepatic disease. Malnutrition

Question 17

1st step in clinical assessment of nutritional status

Answer 17

History (hx). Can be obtained form medical record, interview, info on past and current health, medications, demographics.

Question 18

Dietary information

Answer 18

Food preferences, allergies, intolerances, eating patterns. Access to food & ability to prepare it. 24-hour recall.

Question 19

percent desirable body wt (%DBW)

Answer 19

= (Current wt/ reference wt) X 100. Comparison of some reference or “desirable” wt to current wt.

Question 20

percent usual wt

Answer 20

= (Current or admit wt / Usual wt) X 100. Assessment of recent changes in body wt.

Question 21

% wt change

Answer 21

= [(Usual wt - Current wt) ÷ Usual wt] X 100. Assessment of recent changes in body wt.

Question 22

24-EE

Answer 22

24-hr energy expenditure. = REE + TEF + TEE + TED. TEE - thermic effect of exercise. TED - thermic effect of disease & injury.

Question 23

Basal metabolic rate (BMR)

Answer 23

The lowest rate of energy expenditure of an individual. Calculated from O2 consumption measured of 6-12 minutes. Actually occurs in early morning hours of deep sleep.

Question 24

Doubly Labeled Water

Answer 24

Energy is measured using isotopes of water. Urine samples are taken to determine how long it takes to remove them from the body 1-3 weeks.

Question 25

Harris-Benedict (female)

Answer 25

REE = 655.1 + 9.6W + 1.9S - 4.7A. S in cm

Question 26

Harris-Benedict (males)

Answer 26

REE = 66.5 + 13.8W + 5.0S - 6.8A

Question 27

National Institutes of Health equation for REE

Answer 27

REE = 638 + (15.9 x FFM). FFM = fat free mass in kilograms.