A. Screening and Assessment Flashcards
Screening tools include _______, ______, and _____.
Subjective Global Assessment, Mini Nutritional Assessment, and Nutrition Screening Initiative
Nutrition screening tool evaluating PMH, intake, GI symptoms, functional capacity, physical appearance, edema, weight change. Involves physical examination
Subjective Global Assessment
Nutrition screening tool evaluating independence, medications, number of meals consumed/day, protein intake, fruit and vegetable intake, and mode of feeding.
Mini Nutritional Assessment
Nutrition screening tool for the elderly.
Nutrition Screening Initiative
3 components of the nutrition assessment are:
Review, Cluster, and Identify
Review data for factors that affect nutritional health an status
Review
Assessment data clustered for comparison with characteristics of a suspected diagnosis
Cluster
Indicators are compared to identified standards for interpretation
Identify
Dietary intake assessment
Present patterns of eating. (do not ask leading questions i.e. You eat 3 servings of vegetables/d don’t you?)
Diet history
Journal kept by the patient recording everything eaten in given period of time
Food record (journal)
Client relays from memory their intake over past day. Produces best information when dietitian is involved to clarify exact types and amounts of foods consumed. Best for clinical setting.
24-hour recall
Asks how often client eats certain foods. Quick way of obtaining intake information from large groups. Dietitian assist not needed. Works well in community setting.
Food frequency questionnaire
Measures body fat reserves.
Standard-
Male: 12.5 cm
Female: 16.5 cm
Triceps skinfold thickness (TSF)
Measures skeletal muscle mass. *Indicator of somatic protein. Important to measure in growing children as it is useful in identifying protein-energy malnutrition.
Standard-
Male: 25.3 cm
Female: 23.2 cm
Arm muscle area (AMA)
Compares weight to height.
*Healthy adult: 18.5-24.9.
Body mass index (BMI)
Independent risk factor for disease when out of proportion to total body fat. (
Waist circumference
Differentiates between android (apple) and gynoid (pear) obesity.
*Value >1.0 (males) or 0.8 (females) indicative of android obesity and increased risk for obesity-related diseases.
Waist/hip ratio (WHR)
Thin, sparse, dry and brittle hair may indicate deficiencies in:
Vitamin C or Protein
Easily pluckable hair may indicate deficiencies in:
Protein
Pale, dry eyes and poor vision may indicate deficiencies in:
Vitamin A, Zinc, or Riboflavin
Swollen, red, cry, and cracked lips may indicate deficiencies in:
Riboflavin, Pyridoxine, or Niacin
Smooth, slick, purple tongue with white coating may indicate deficiencies in:
Iron, or vitamins
Sore, red, swollen, bleeding gums may indicate deficiency in:
Vitamin C
Missing teeth or loss of enamel may indicate deficiency in:
Calcium
Pale, dry, and scaly skin may indicate deficiencies in:
Iron, Folate, or Zinc
Brittle, thin, spoon-shaped nails may indicate deficiencies in:
Iron or Protein
This visceral proteins’ major function is to maintain colloidal osmotic pressure. It has a long half-life, so does not reflect current protein intake.
Albumin
Normal: 3.5-5 g/dl
This visceral protein transports iron to the bone marrow for the production of hemoglobin. It’s level is controlled by the iron storage pool - synthesis increases when iron stores decrease. Therefore, an increase in this lab value is indicative of anemia.
Transferrin
This visceral protein has a short half-life of 2-3 days. It picks up changes in protein status quickly, and is considered the *best visceral protein to evaluate nutritional status. This value decreases in inflammation, as the liver synthesizes CRP at its expense.
Prealbumin
(Normal: 16-40 mg/dL)
This protein binds and transports retinol. It has the shortest half-life of 12 hours.
Retinol-binding protein
______ and _____ together evaluate iron status. _____ measures the volume of RBCs compared to the total blood volume. ______ is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. It is the iron-containing pigment of RBCs.
Hematocrit, Hemoglobin
Hematocrit, Hemoglobin
Indicates size of iron storage pool (amt of storage iron).
Ferritin
This value is related to muscle mass and measures somatic protein. It is released by the muscle and excreted by the kidney. The value alone measures somatic protein. In combination with BUN, assesses kidney function.
Creatinine
(Normal: 0.6-1.4 mg/dL)
The ratio of creatinine excreted in 24 hours to height. This value estimates lean body mass and measures somatic protein.
Creatinine height index
This value is related to protein status and renal function. It is related to protein intake, and is an indicator of renal disease.
*A renal patient should keep this value under 100.
Blood urea nitrogen (BUN)
(Normal: 10-20 mg/dL)
*Renal patient
Assesses renal function. Compares the creatinine level in urine with the creatinine level in blood.
Creatinine clearance
Measures immunocompetency. Decreased in protein-energy malnutrition
Total lymphocyte count (TLC)
This acute-phase protein is a marker of acute inflammatory stress. As this value declines, it indicates when nutrition therapy would be most beneficial. Increases with inflammation. Once elevated value begins to decrease, Prealbumin increases.
C-Reactive Protein (CRP)
Detects lead poisoning. Lead depletes iron, leading to anemia. Lead also displaces calcium in the bone, leading to a zinc deficiency. (calcium x zinc)
Free erythrocyte protoporphyrin (FEP)
Evaluates blood clotting. Anticoagulants prolong this time, alteration in vitamin K intake will also alter this rate.
Prothrombin time (PT)
Activity Factors
Sedentary: BEE x ___
Active: BEE x ___
Stressed: BEE x ___
Sedentary: BEE x 1.2
Active: BEE x 1.3
Stressed: BEE x 1.5
Megestrol acetate is an _____ _____.
Appetite stimulant
Oral contraceptives decrease ____, vitamin ____ and _____.
Folate, vitamin C and vitamin B6
Loop diuretics (ie. Furosemide (Lasix)) deplete _____, ____, ____, ____, an ____.
Thiamin, Potassium, Magnesium, Calcium, and Sodium
Thiazide diuretics decrease ____ and ___, but ABSORB ____.
Decrease Potassium and Magnesium, but absorb Calcium.
Methotrexate (chemotherapeutic agent) decreases _____.
Folate
Lithium carbonate (antidepressant) causes increased appetite and weight gain. Lithium and ____ are absorbed at the same site in the kidney, therefore decreased ____ intake leads to retention of both ____ and lithium (toxic). Maintain consistent ____ intake to stabilize levels.
Sodium
________ antagonize vitamin K. Consistent intake is essential. Avoid black cohosh, ginger, ginseng, gingo and garlic.
Anticoagulants
This drug is administered in oil. Calories from fat must be considered (1.1 kcal/cc).
Propofol
This drug Cyclosporine (immunosuppressant) may cause: _____, _____, _____, and ______.
Hyperlipidemia, Hypergylcemia, Hyperkalemia, and Hypertension
Isoniazid, a drug used to treat TB, depletes _____, leading to peripheral neuropathy. Interferes with vitamin D, so calcium supplement may be needed.
Depletes pyridoxine, leading to peripheral neuropathy.
This antidepressant drug causes increased appetite and weight gain.
Elavil
Vitamin B6 and Protein both decrease effectiveness of _____, which controls symptoms of Parkinson’s disease. Take drug with limited protein as it competes for absorption sites.
L-Dopa (Levedopa)
______ is an amino acid. It causes hypertension if taken with MAOI (monoamine oxidase inhibitor-antidepressant). Restriction necessary when taking MAOIs. Avoid aged, fermented foods. Best Advice is to buy, cook, and eat fresh foods.
Tyramine
How to teach depends on NEEDS and READINESS of the learner.
Based on _______ level, ______ level, experience, etc.
Motivational level, education level, experience, economics, time needed, availability, environmental
Community nutrition status indicators-
Obtain overview to determine:
Whether nutritional resources are adequate, what groups are at high nutritional risk, how well needs are being met by existing programs.
Problems commonly found in areas that are socially, economically, educationally and/or medically deprived.
Most widely used screening tool in health promotion. health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life. Incorporates a questionnaire, a risk calculation or score, and feedback i.e. face-to-face with a health advisor.
A systematic approach to collecting information from individuals that identifies risk factors, provides individualized feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.
Health risk appraisal (HRA)
Examines a group at one particular point in time. Cross-sectional. Provides info about prevalence of a condition at a specific time.
Nutrition survey
Continuous collection of data to evaluate nutrition status. Detects changes in trend over time. On-going system linked to active health program (i.e. WIC/CDC). Data is produced by health program and identifies type of intervention needed. System is based on HEIGHT, WEIGHT, HCT, HGB, CHOLESTEROL.
Nutrition surveillance
Nutrition screening tool that focuses on the elderly. Uses the DETERMINE checklist to identify nutrition problems early. Based on disease, tooth loss, economic hardship, reduced social interaction, # of medications, unintentional weight change, need for assistance in self-care, and elder above age 80.
Nutrition Screening Initiative (NSI)
A ______ ____ is a small group of people brought together to discuss concerns, beliefs and problems. *Contributes attitudinal data.
Focus group
Contributes attitudinal data.
Includes all data collection and analysis activities of the federal government related to: measuring health and nutritional status, food consumption, and attitudes about diet and health. Jointly run by HHS and USDA.
National Nutrition Monitoring and Related Research Program (NNMRRP)
(HHS, USDA)
Monitors growth, nutritional status and infant-feeding practices in low income, high risk children (emphasis on 0-5 years). Uses HEIGHT, WEIGHT, BIRTHWEIGHT, HCT, HGB, CHOLESTEROL, BREAST-FEEDING. Run by HHS.
Pediatric Nutrition Surveillance System (PedNSS)
HHS
Goal is to identify and reduce pregnancy-related health risks in low income, high risk pregnant women. Uses MATERNAL WEIGHT GAIN, ANEMIA, RISK FACTORS (smoking, alcohol), BIRTHWEIGHT, # BREAST FEEDING. Run by HHS.
Pregnancy Nutrition Surveillance System
HHS
Ongoing (repeated) survey obtaining information on health of the American people. Evaluates CLINICAL, CHEMICAL (Hgb, Hct, Chol), ANTHROPOMETRIC, NUTRITIONAL (24 hr recall, food freq) DATA.
NHANES 3 surveyed large sample >65 y/o - data collected useful in studying aging related to nutrition.
National Health and Nutrition Examination Survey (NHANES)
The dietary intake component of the NHANES survey. Includes 2 days of 24 hour recall data with times and sources of meals. Run by HHS-USDA.
What We Eat in America (WWEIA)
HHS-USDA
Nationwide survey of food consumption. Evaluates 7 nutrients - PROTEIN, CALCIUM, IRON, THIAMIN, RIBOVLAVIN, VITAMIN A, VITAMIN C. Run by USDA.
USDA Nationwide Food Consumption Survey (NFCS)
USDA
Telephone interviews to evaluate health risk in adults. Collect info on HEIGHT, WEIGHT, SMOKING, ALCOHOL USE, FOOD FREQUENCY FOR FRUITS AND VEGETABLES, HEALTH PROBLEMS in adults. Run by HHS.
Behavioral Risk Factor Surveillance System (BRFSS)
HHS
Evaluates risk in youth (grades 9-12). Collects info on SMOKING, ALCOHOL USE, WEIGHT, EXERCISE, EATING HABITS. Run by HHS.
Youth Risk Behavior Survey (YRBS)
HHS
Surveys randomly selected adults. Tracks self-perception of NUTRIENT INTAKE, USE OF FOOD LABELS, KNOWLEDGE OF FATS AND CHOLESTEROL, AND PREVALENCE OF SUPPLEMENT USE. Run by FDA and HHS.
Health and Diet Survey
FDA and HHS
Emergency food programs (i.e. food bank) can only provide food that is donated them. Do NOT provide ____ meals.
Do not provide balanced meals.
_____ _____ and _____ natives are associated with higher risks of poverty. Obesity is epidemic and associated with increased prevalence of heart disease and hypertension.
Strong Heart Diet Study: Found that this population consumed less calories, yet had significant increases in heart disease and diabetes - possibly related to genetics or low physical activity.
Native Americans and Alaskan natives
A Federal program where the STATE determines the eligibility of needy families AND the services those families will receive. Run by HHS.
Temporary Assistance for Needy Families (TANF)
HHS
Program that helps meet nutritional needs of children and adults while strengthening the agricultural market for products of American farmers.
USDA Commodity Food Donation/Distribution Program
Part of the commodity food donation/distribution program. MONTHLY commodity canned or packaged foods to low income WOMEN at nutritional risk. (USDA)
Commodity Supplemental Food Program (CSFP)
USDA
Part of the commodity food donation/distribution program. QUARTERLY distribution of commodity foods to supplement the diets of low income households. (USDA)
The Emergency Food Assistance Program (TEFAP)
USDA
Program to improve nutrition in children, especially from low income families. Involves reimbursement based on # of meals served. LUNCH must provide weekly, on average, ONE THIRD (1/3) of RDA for PROTEIN, IRON, CALCIUM, VITAMIN A AND VITAMIN C. (Run by USDA Food and Nutrition Services (FNS)) This is an entitlement program.
National School Lunch Program (NSLP)
Run by USDA Food and Nutrition Services (FNS)
Provides balanced breakfast to low income children in schools. BREAKFAST must provide weekly, on average, ONE FOURTH (1/4) of RDA for PROTEIN, IRON, CALCIUM, VITAMIN A AND VITAMIN C. (USDA) This is an entitlement program.
School Breakfast Program (SBP)
USDA
Provides healthy snacks to children after school. Receive cash subsidies for each snack served. Same eligibility as NSLP.
After School Snack Program (ASP)
USDA
The purpose of this program is to encourage the consumption of milk by children - provide subsidy for milk served in participating schools, care centers, etc. (USDA)
Special Milk Program
USDA
The purpose of this program is to expand foodservice programs and provide meals and snacks to low income children at participating institutions when school is not in session. This is an entitlement program. (USDA)
Summer Food Service Program (SFSP)
USDA School Lunch
This program supports public and non-profit foodservice programs for both child and adult day care centers. Reimburses operators for meals served that meet dietary guidelines. Same eligibility as NSLP. (USDA)
Child and Adult Care Food Program (CACFP)
USDA
This program introduces children to fruits and vegetables. Free in selected schools.
Fresh Fruit and Vegetable Program (FFVP)
This program provides food for low income mothers at nutritional risk (pregnant, post-partum, breast-feeding women, children up to 5). Uses HEIGHT, WEIGHT, HEAD CIRCUMFERENCE, HGB, HCT.
Health exam is required. Must meet income standards, be at nutritional risk, and in need of foods offered (ie. formula, cereal, milk, cheese, juice).
*NOT an entitlement program - cap on federal $ allocated.
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
(USDA)
This program is designed specifically for nutrition education. Works with small groups to educate the public/low income homemakers - how to shop and cook. (USDA)
Expanded Food and Nutrition Education Program (EFNEP)
USDA
This program is concerned exclusively with the health of mothers, infants, and children. It fosters public health nutrition programs at the state and local levels. It is a block grant. (HHS)
Maternal and Child Health Block Grant
HHS
This program funds programs in communities with high infant mortality rates.
Healthy Start
HHS
This program is run by the Administration on Aging (AoA). They develop services to foster independent living.
Nutrition Services Incentive Program (NSIP)
AoA
This program is part of the Nutrition Services Incentive Program. It provides one hot meal/day, 5 days/week meeting 1/3 of RDA. **All aged 60 and older plus spouse are eligible. This include Congregate Meals for those that are ambulatory, and Meals on Wheels for those that are home bound. (HHS)
Older Americans Act Nutrition Program (OAA)
HHS
This is the largest food assistance program. It is an entitlement program run by the USDA. Provides low income households with monthly benefits (not for non-food items). Net income must be at or below certain % of poverty line.
Supplemental Nutrition Assistance Program (SNAP)
USDA
This is a health insurance program for people over 65, or of any age with ESRD. It is comprised of two parts. Part A covers hospital insurance, and Part B covers supplemental benefits.
Centers for Medicare and Medicaid Services (CMS)
-Medicare-
(HHS)
This program provides payment for medical care for all eligible needy - all ages, blind, disabled, dependent, etc. State and federal program.
Centers for Medicare and Medicaid Services (CMS)
-Medicaid-
(HHS)
This program provides health health coverage to uninsured children whose families earn too much to qualify for Medicaid, but too little to afford private coverage.
Children’s Health Insurance Program (CHIP)
This program introduces new foods and teaches good eating habits to low income children (ages 3-5). Emphasis on childrens participation in food activities. (HHS)
Headstart
HHS
Provides nutrition education training to teachers and school foodservice personnel. Amendment to School Lunch Act. (USDA)
Nutrition Education Training Program
USDA
This program provides grants to states to provide low income seniors with coupons to be exchanged for eligible foods at farmers markets. May be limited to specific and locally grown foods. (USDA)
Senior Farmers Market Nutrition Program (SFMNP)
USDA
This is a type of assistance program (not government sponsored), that receives both federal and private funding. (ie. American Red Cross)
Quasi-governmental agencies
These are types of assistance programs that are non-governmental agencies.
Voluntary health agencies (ie. American Heart Association)
Professional organizations (ie. ADA)
Foundations
These are international agencies.
Food and Agricultural Organization (FAO)
World Health Organization (WHO)
This international agency works to raise word-wide levels of nutrition by increasing efficiency in production and distribution of foods.
Food and Agricultural Organization (FAO)
This international agency developed RDAs for developing countries.
World Health Organization (WHO)
An award of financial or direct assistance. Anyone can apply for this type of assistance. Recipients have great flexibility in distributing funds.
5 federal block \_\_\_\_ areas: Maternal and Child Health Community Services Social Services Preventative Health Services Primary Care
Grant
An assistance program that requires payment of benefits to all eligible people as established by law.
I.e. SNAP, Medicare. NOT WIC.
Entitlement
