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PDAT3 > 8 - Nutritional Assessment Screening > Flashcards

8 - Nutritional Assessment Screening Flashcards

1
Q

Consequences of UnderNutrition

A

Increased MORBITY & MORTALITY

Decreased Function + QOF

Increased Hospitilazations + Length of Stay

Decreased LEAN BODY MASS

Cellular + Subcellular + Organ Function Impairment

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2
Q

Which type of Protein-Calorie MALNUTRITION

Seen in impovershed areas w/ limited food supply

LOSS of visceral protein levels
+
preservation of body muscle + FAT

RAPID ONSET

Associated with:
Catabolic Stress + Impaired IMMUNE RESPONSE

A

KWASHIORKOR

Loss of
Visceral Proteins = Albumin + Granulocyte loss
VVVV
high infection rates

FLUID SHIFT –> STOMACH DISTENTION / LEG EDEMA

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3
Q

Which type of Protein - Calorie MALNUTRITION

  • *Loss of SKELETAL MUSCLE + BODY FAT**
  • but with PRESERVATION of VISCERAL PROTEINS*

SLOW onset of weight loss

Associated with long history of POOR DIETARY HABITS

Immune system intact (unless severe)

A

MARASMUS

Less infections

SLOW / Loss of MUSCLE + BODY FAT

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4
Q

MIXED Protein-Calorie MALNUTRITION

A

Develops when:
Catabolic Stress is superimposed on

PRE-EXISTING MARASMUS

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5
Q

Nutrition Screening

A

Purpose:
to quickly ID Patients who are MALNOURISHED or @RISK

WITHIN 24 HOURS
of hosptal admission

  • *Specific Screening Tools**
  • *MUST / MST / NSI / NRS**
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6
Q

MUST

Nutritional Screening Tool

A

Malnutrition Universal Screening Tool

Based on:
BMI -> WEIGHT LOSS –> ACUTE DISEASE

SCORE of 2 = TREAT

0-2

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7
Q

MST

Nutritional Screening Tool

A

Malnutrition Screening Tool

EASIER FOR PATIENTS TO UNDERSTAND

Have you recently lost weight without trying?

Have you been eating poorly b/c of decreased appitite?

Score of 2 = AT RISK

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8
Q

NSI

Nutritional Screening Tool

A

Nutrition Screening Initiative

for ELDERLY PATIENTS

Score > 6 = HIGH RISK

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9
Q

Which Screening Tool is used for GERIATRICS?

A

NSI

Score > 6 = HIGH RISK

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10
Q

NRS 2002

Nutritional Screening Tool

A

Nutritional Risk Screening 2002

ICU PATIENTS

Score is added from 1 from each side
Impaired Nutritional Status // Severity of Disease

  • *Score > 5**
  • *= need parenteral nutrition support EARLY (48-72hrs** vs 1 week)
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11
Q

Which SCREENING TOOL is used for ICU PATIENTS?

A

NRS 2002

> 5 = need EARLY parenteral nutrition support

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12
Q

6 PARAMETERS of NUTRITION ASSESSMENT

ASPEN + ESPEN

If 2/6 –> DIAGNOSIS OF MALNUTRITION

A

Insufficient Energy Intake

Weight Loss

Loss of muscle mass

Loss of SUBQ Fat

Localized or generalized fluid accumalation

Decreased Functional Status
(hand grip strength)

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13
Q

Nutrition Assessment History
Questions to Assess if:

Insufficient Energy Intake

2/6 = malnutrition diagnosis

A

Quantity + Type of foods

CHANGE in eating habits

Compare CALORIC NEEDS vs INTAKE

EER = estimated energy requirements

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14
Q

Nutrition Assessment History
Questions to Assess if:

Weight Loss

A

Unintended Loss

HYDRATION STATUS needs to be considered

Assesss for EDEMA +/- ASCITES
= Kwashiorkor

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15
Q

Nutrition Assessment History
Physical Findings

A

Other signs of:
Specific MACRO +/ MICROnutrient DEFICIENCIES

Signs of INFLAMMATION
FEVER or HypoThermia
Non specific = TACHYcardia + HYPERglycemia

BODY FAT

MUSCLE MASS

FLUID ACCUMULATION

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16
Q

Nutrition Assessment History
Questions to Assess if:

LOSS IN SUBQ FAT

A

Loss of sub Q fat:
ORBITAL = SUNKEN EYES

Triceps

Fat Overlying Ribs

  • *Marasmus**
  • loss of SKELETAL MUSCLE + BODY FAT*
17
Q

Nutrition Assessment History
Questions to Assess if:

FLUID ACCUMULATION

A

General** or **Localized

Mild / Moderate / Severe

EDEMA = Kwashiorkor

18
Q

Nutrition Assessment History
Questions to Assess if:

LOSS IN MUSCLE MASS

A

LOSS IN TEMPLES = Sunken

Clavicles / Shoulders

Interosseous / Scapula / Calf

  • *Kwashiorkor**
  • loss in visceral PROTEINS*
19
Q

Nutrition Diagnosis
PATHWAY CHART

A

Is the patient MALNOURISHED? = 2/6 of Criteria?
VVVV
Kwashiorkor / Marasmus / or MIXED?
VVV
Determine Underlying Cause of Malnutrition
VVVV
3 groups below

DRM + Inflammation** // **DRM only** // **No Disease
DRM = Disease-Related Malnutrition

20
Q

Nutrition Diagnosis

DRM + Inflammation

A

ACUTE Disease or Injury-Related malnutrition
Major Infections / Burns
closed Head injury / SURGERY

CHRONIC DRM + inflammation
Cancer CACHEXIA + Others:
COPD / IBD / CHF / CKD
+ other END STAGE organ diseases

21
Q

Nutrition Diagnosis

DRM without inflammation

A
  • *DYSPHAGIA** due to:
  • *STROKE / Parkinsons / ALS**

ANOREXIA NERVOSA

Malabsorption Due to Intestinal Disorders

22
Q

HISTORY
Nutrition Assessment

A

Chief Complaint

Chronic Diseases
DM / Pancreatitis / Cancer / AIDS / Kidney-Liver Disease

Surgical History
Bowel resection / Liver / Pancreatic procedures

Medications
absorption altering / food-drug interactions / taste / appitite supression / nausea

Socioeconomic Factors
substance abuse

23
Q

MEDICATIONS

Nutritional Assessment HISTORY

A

CORTICOSTEROIDS
Alter glucose-fat-protein metabolism / Electrolyte disturbance / P

Protease Inhibitors
can cause HypoGlycemia

HIV Medications
Alter FAT metabolism

24
Q

LAB MEASUREMENTS
For Nutritional Assessment

A

we do NOT use Lab Values to diagnose
more of a marker for INFLAMMATION, not just malnutrition severity

Decreased synthesis of ACUTE PHASE PROTEINS
Albumin / Transferrin / PRE-ALBUMIN / retinol binding protein
used to estimate protein requirements

Increase Acute Phase Proteins
C-Reactive protein , may be useful in illness recovery period

25
Q

Anthropometrics
Nutrition Assessment

A

BOTH NOT GOOD AT DIAGNOSING FOR MALNUTRITION

  • *BMI**
  • *extremes may increase risk of malnutrition**, but not very well correlated

Actual BW vs IBW
also not well correlated, extremes may increase risk of malnutrition

26
Q

IBW Calculations

A

ADULT MEN
50kg + [2.3 x (inches over 5ft)]

ADULT WOMEN
45kg + [2.3 x (inches over 5ft)]

27
Q

Indirect Calorimetry
Other Measurements of Nutrition Assessment

A

DOES NOT WORK
only works for VENTILATED ICU PATIENTS

Assesses adequate calorie administration

Reads:
Resting Energy Expenditure = REE kca/lday
Oxygen uptake vs CO2 output
RESPIRATORY QUOTIENT** = **RQ
VCO2 / VO2

28
Q

Respiratory Quotient > 1

RQ

A

OVERFEEDING
Lipogenesis / HYPERventilation / system leak

Determined through:
Indirect Calorimetry

VCO2 / VO2
CO2 OUTPUT / Oxygen UPTAKE

Normal = 0.82 - 0.85

29
Q

Respiratory Quotient < 0.7

A

UNDERFEEDING
Primary fat oxidation / metabolic alkalosis / ethanol oxidation

Determined through:
Indirect Calorimetry

  • *VCO2 / VO2**
  • *CO2 OUTPUT / Oxygen UPTAKE**

Normal = 0.82 - 0.85

30
Q

NITROGEN BALANCE

Other Measurements of Nutrition Assessment

A

Assessed in patients in:
RECOVERY PHASE of Illness

Assessment of:
Adequate PROTEIN administraion

24 Hour collection of
URINARY UREA NITROGEN = UUN

  • *GOAL IS TO BE SLIGHTLY POSITIVE**
  • *= +1 / +2**

Negative = breaking down muscle mass

PDAT3 (23 decks)

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