Chapter 13 book notes Flashcards
estimates of malnutrition in hospital patients
range from ?? to ?? percent
-20 to 50%
Poor nutrition status weakens the immune function and compromises a person’s healing ability, influencing both the course of:
-illness and the body’s response to treatment.
Malnutrition often lengthens hospital stays and may lead to:
-muscle wasting, higher infection rates, and increased risks of morbidity and mortality
nausea caused by some illnesses or treatments can:
-diminish appetite and reduce food intake
medications can cause ??? (loss of appetite) or ?? discomfort or interfere with nutrient
function and metabolism:
-anorexia
-gastrointestinal (GI)
Prolonged bed rest can lead to:
-pressure sores which increases metabolic stress and raises protein and energy needs
dietary changes required during an acute illness are usually
-temporary and can be tailored to accommodate an individual’s preferences and lifestyle.
chronic illnesses (those lasting three months or longer) may require:
-long-term dietary adjustments
-ex: diabetes
clinical pathways:
-coordinated programs of treatment that merge the care plans of different health practitioners;
-also called care pathways, care maps, or critical pathways
Physicians role in nutrition care:
-responsible for all medical needs and nutrition
-prescribe diet orders, referrals for nutrition assessment and dietary counseling
Nurses role in nutrition care:
-interact more closely with patients so are in ideal position to identify people who would benefit from nutrition services
-screen patients for nutrition problems and participate in nutrition and dietary assessments
Nurses provide direct nutritional care such as:
-encouraging patients to eat
-finding practical solutions to food related problems
-recording patients food intake
-answering questions about special diets
Nurses are responsible for administering..
-tube and intravenous feedings
In facilities that do not employ registered dietitians, who assumes responsibility for much of the nutrition care?
-nurses
Responsibilities of RND:
-conduct nutrition and dietary assessments
-diagnose nutrition problems
-develop and implement and evaluate nutrition care plans
-order patients diets, plan and approve menus
-provide dietary counseling and nutrition education services
Registered dietitians may also manage
-foodservice operations in health care institutions.
To identify patients who are malnourished or at risk for malnutrition, a ?? is conducted within ?? hours of a patient’s admission to a hospital or other extended-care facility
-nutrition screening
-24 hours
A nutrition screening involves collecting health-related
data that can indicate the presence of ?? or other nutrition problems.
-protein energy malnutrition (PEM)
protein-energy malnutrition (PEM):
-a state of malnutrition characterized by depletion of tissue proteins and energy stores, -usually accompanied by micronutrient deficiencies
The screening should be sensitive enough to identify patients who require
nutrition care but simple enough to be completed within ??
-10 to 15 minutes
The information collected in a nutrition screening varies according to the patient
population,
-the type of care offered by the health care facility,
-and the patient’s medical problem
Criteria for identifying malnutrition risk(6)
-admission data
-anthropometric data(height, weight, BMI)
-functional assessment data(impaired mobility, general weakness, hand grip strength)
-historical information
-lab results
-signs and symptoms
Subjective goal assessment
-evaluates a person’s risk of malnutrition by ranking key variables of the medical history and physical examination.
-Given a A,B,C rating
A=well nourished, B=mild malnutrition(5-10% weight loss), C= severe malnutrition(more than 10% weight loss)
Medical history of SGA:
-body weight changes
-dietary changes
-GI symptoms
-functional ability
-degree of disease related metabolic stress
Physical examination of SGA:
-subcutaneous fat loss
-muscle loss
-ankle edema
-sacral edema
-ascites (abdominal edema)
Registered dietitians use a systematic approach to medical nutrition
therapy called the-
nutrition care process.
4 steps of process:
1)nutrition assessment & reassessment
2)nutrition diagnosis
3)nutrition intervention
4)nutrition monitoring and evaluation
The assessment data is used to develop what?
-a plan of action to prevent or correct energy or nutrient imbalances
-or to determine if POC is working
Each nutrition problem identified by the
nutrition assessment receives a separate ?? , which is formatted as a ?? statement,
-diagnosis
-PES
PES statement is a statement that includes…
(P): problem
(E): etiology or cause
(S):signs and symptoms that provide evidence to problem
To be successful, the intervention should consider the individual’s:
-food habits, lifestyle, and other personal factors
Goals are stated in terms of
-measurable outcomes
-EX:goal of overweight person with diabetes might include improvements of blood glucose levels
If the patient remains unwilling to modify behaviors despite the expected benefits, the health practitioner can try -
again at a later time when the patient may be more receptive
The nutrition care plan must be flexible enough to adapt to the new
-situations
-EX: new medication that patient will take
a nutrition assessment provides the information needed for:
-diagnosis and POC
follow-up assessments can determine whether the care plan has been -
effective.
4 types of historical information used in nutrtion assessment:
1)medical history
2)medication and supplement history
3)personal/social history
4)food and nutrition history
Procedures to obtain food and nutrition history:
-interview about recent food intake (24 hours dietary recall)
-survey about usual food choices
24-hour dietary recall is a
- guided interview in which an individual recounts all of the foods and beverages consumed in the past 24 hours or during the previous day.
-interview includes questions about the times when meals or snacks were eaten, amounts consumed, and ways in which food were prepared.
multiple-pass method is considered the most effective approach for conducting
a 24-hour dietary recall. In this procedure, the interview includes
-four or five separate passes through the 24-hour period of interest