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clinical nutrition > Chapter 13 book notes > Flashcards

Chapter 13 book notes Flashcards

1
Q

estimates of malnutrition in hospital patients
range from ?? to ?? percent

A

-20 to 50%

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2
Q

Poor nutrition status weakens the immune function and compromises a person’s healing ability, influencing both the course of:

A

-illness and the body’s response to treatment.

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3
Q

Malnutrition often lengthens hospital stays and may lead to:

A

-muscle wasting, higher infection rates, and increased risks of morbidity and mortality

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4
Q

nausea caused by some illnesses or treatments can:

A

-diminish appetite and reduce food intake

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5
Q

medications can cause ??? (loss of appetite) or ?? discomfort or interfere with nutrient
function and metabolism:

A

-anorexia
-gastrointestinal (GI)

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6
Q

Prolonged bed rest can lead to:

A

-pressure sores which increases metabolic stress and raises protein and energy needs

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7
Q

dietary changes required during an acute illness are usually

A

-temporary and can be tailored to accommodate an individual’s preferences and lifestyle.

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8
Q

chronic illnesses (those lasting three months or longer) may require:

A

-long-term dietary adjustments
-ex: diabetes

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9
Q

clinical pathways:

A

-coordinated programs of treatment that merge the care plans of different health practitioners;
-also called care pathways, care maps, or critical pathways

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10
Q

Physicians role in nutrition care:

A

-responsible for all medical needs and nutrition
-prescribe diet orders, referrals for nutrition assessment and dietary counseling

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11
Q

Nurses role in nutrition care:

A

-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

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12
Q

Nurses provide direct nutritional care such as:

A

-encouraging patients to eat
-finding practical solutions to food related problems
-recording patients food intake
-answering questions about special diets

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13
Q

Nurses are responsible for administering..

A

-tube and intravenous feedings

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14
Q

In facilities that do not employ registered dietitians, who assumes responsibility for much of the nutrition care?

A

-nurses

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15
Q

Responsibilities of RND:

A

-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

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16
Q

Registered dietitians may also manage

A

-foodservice operations in health care institutions.

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17
Q

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

A

-nutrition screening
-24 hours

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18
Q

A nutrition screening involves collecting health-related
data that can indicate the presence of ?? or other nutrition problems.

A

-protein energy malnutrition (PEM)

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19
Q

protein-energy malnutrition (PEM):

A

-a state of malnutrition characterized by depletion of tissue proteins and energy stores, -usually accompanied by micronutrient deficiencies

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20
Q

The screening should be sensitive enough to identify patients who require
nutrition care but simple enough to be completed within ??

A

-10 to 15 minutes

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21
Q

The information collected in a nutrition screening varies according to the patient
population,

A

-the type of care offered by the health care facility,
-and the patient’s medical problem

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22
Q

Criteria for identifying malnutrition risk(6)

A

-admission data
-anthropometric data(height, weight, BMI)
-functional assessment data(impaired mobility, general weakness, hand grip strength)
-historical information
-lab results
-signs and symptoms

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23
Q

Subjective goal assessment

A

-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)

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24
Q

Medical history of SGA:

A

-body weight changes
-dietary changes
-GI symptoms
-functional ability
-degree of disease related metabolic stress

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25
Physical examination of SGA:
-subcutaneous fat loss -muscle loss -ankle edema -sacral edema -ascites (abdominal edema)
26
Registered dietitians use a systematic approach to medical nutrition therapy called the-
nutrition care process.
27
4 steps of process:
1)nutrition assessment & reassessment 2)nutrition diagnosis 3)nutrition intervention 4)nutrition monitoring and evaluation
28
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
29
Each nutrition problem identified by the nutrition assessment receives a separate ?? , which is formatted as a ?? statement,
-diagnosis -PES
30
PES statement is a statement that includes...
(P): problem (E): etiology or cause (S):signs and symptoms that provide evidence to problem
31
To be successful, the intervention should consider the individual’s:
-food habits, lifestyle, and other personal factors
32
Goals are stated in terms of
-measurable outcomes -EX:goal of overweight person with diabetes might include improvements of blood glucose levels
33
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
34
The nutrition care plan must be flexible enough to adapt to the new
-situations -EX: new medication that patient will take
35
a nutrition assessment provides the information needed for:
-diagnosis and POC
36
follow-up assessments can determine whether the care plan has been -
effective.
37
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
38
Procedures to obtain food and nutrition history:
-interview about recent food intake (24 hours dietary recall) -survey about usual food choices
39
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.
40
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
41
1st pass:
-respondent provides a "quick list" of foods consumed without prompts by interviewer.
42
2nd pass:
-conducted to help the respondent remember foods that are often forgotten such as beverages, bread, additions, savory snacks, etc.
43
3rd and 4th passes elicit:
-additional details about the foods consumed such as amounts eaten, prep methods, and places where foods were obtained.
44
the entire multiple pass interview can be conducted in about
-30 to 45 minutes
45
After the day’s intake is recounted, the interviewer can ask whether the intake that day was -
fairly typical and, if not, how it varied from the person’s usual intake
46
Disadvantage of the 24 hours dietary recall
-does not take into account fluctuations in food intake or seasonal variations -relies on individuals memory and reporting accuracy
47
food frequency questionnaire:
- a survey of foods routinely consumed often in a one year time period
48
Qualitative only info: semiqualitative info:
-food lists containing common foods, organized by each food group and checking boxes to indicate frequency of consumption -includes portion sizes
49
Because the respondent is often asked to estimate food intakes over a one-year period, the results should not be affected by
- seasonal changes in diet
50
Disadvantage of food frequency questionnaire
-inability to determine recent changes in food intake -only lists common food items, so accuracy of food intake is reduced if individual consumes atypical foods.
51
Some brief versions of food frequency questionnaires focus on food categories relevant to a person’s
-medical condition -EX; questionnaire designed to evaluate calcium intake may include milk products, fortified foods, and certain fruits and veggies and a computer analysis can be done to estimate an individuals calcium intake and compare recommendations
52
food record:
-a detailed log of food eaten during a specified time period, usually several days; -also called a food diary. -does not rely on memory
53
A food record may also include information about:
-the types and amounts of foods and beverages consumed, times of consumption, and methods of preparation -medications, disease symptoms, and physical activity
54
Disadvantages of food record:
-recording process itself influences food intake -time consuming and burdensome -underreporting and portion size errors are common -ability to read and write
55
direct observations
-Observation of meal trays or shelf inventories before and after eating; -possible only in residential facilities.
56
Nurses use direct observation to conduct patients’:
calorie counts, which are estimates of the food energy
57
To perform a calorie count, the nurse records the
-dietary items that a patient is given at meals and subtracts the amounts remaining after meals are completed
58
disadvantages of direct observations:
-requires regular and careful documentation -labor intensive and costly
59
anthropometric measurements:
-height, weight, BMI, and percentage of body fat.
60
Poor growth in children can be a sign of
-malnutrition.
61
In adults, height measurements alone do not reflect current nutrition status but can be used for estimating a person’s -
appropriate body weight or energy needs.
62
Length is measured in:
-infants and children younger than 24 months of age
63
In adults who are bedridden or unable to stand, height can be estimated using equations that include either the ?? or the ??, both of which correlate well with height.
knee height or the arm span
64
How is knee height measured?
-extends from the heel to the top of the knee when leg is bent in 90 degree angle. -can be measured in sitting or supine position with knee height caliper
65
How is arm span measured?
-arm span is the distance from the tip of one middle finger to the other while the arms are extended horizontally.
66
A measurement of head circumference helps to assess ?? and ?? in children up to ?? years of age
-brain growth and malnutrition -three
67
To measure head circumference, the assessor encircles the largest circumference measure of a child’s head with a
-nonstretchable measuring tape: -the tape is placed just above the eyebrows and ears and around the occipital prominence at the back of the head
68
The measurement is read to the nearest:
-⅛ inch or 0.1 centimeter
69
Circumferences of the waist and limbs are useful for evaluating
-body fat and muscle mass
70
The waist circumference correlates with:
-intra-abdominal fat and can help in assessing overnutrition
71
Circumferences of the mid-upper arm, mid-thigh, and mid-calf regions can help in evaluating
-illness, -aging, -PEM on skeletal muscle tissue
72
% of weight loss=
amount of weight loss/usual weight times 100
73
rate of involuntary weight loss associated with nutritional risks:
-more than 2% weight loss in a week -more than a 5% weight loss in a month -more than 7.5% weight loss in 3 months -more than 10% weight loss in 6 months
74
Weight data are often expressed as a percentage of
-usual body weight (%UBW) or ideal body weight (%IBW). -%UBW is more effective than %IBW
75
Biochemical data can help in the evaluation of (4)
-evaluation of PEM, -vitamin and mineral status, -fluid and electrolyte balances, -organ function
76
Most values are obtained by analyzing
-blood and urine samples -contain proteins, nutrients, and metabolites that reflect current health status
77
Interpreting laboratory values can be ?? because a number of factors may influence test results
-challenging
78
For example, fluid imbalances may alter the levels of substances carried in the blood, fluid retention ?? substances and therefore ?? lab values, whereas dehydration can cause an ?? in lab values
-dilutes; lowers -increase
79
Serum protein levels may be influenced by (4)
-fluid status, -infections, -inflammation, -pregnancy,
80
Serum protein levels can aid in the assessment of
-protein-energy status
81
serum proteins are synthesized in the ?? , blood levels of these proteins can reflect ?? function
-liver
82
Metabolic stress (often due to illness, injury, or infection) alters
-serum proteins because the liver responds to stress by increasing its synthesis of some proteins and reducing the synthesis of others.
83
Most abundant serum protein
-albumin -and it is easily measured, so levels are routinely monitored in hospital patients to help gauge the severity of illness.
84
Although many medical conditions influence albumin, it is slow to reflect changes in nutrition status because of its
-large body pool and slow rate of degradation
85
albumin is not a sensitive indicator of
-effective treatment -In people with chronic PEM, albumin levels remain normal for a long period despite significant protein depletion, and fall only after prolonged malnutrition. - Likewise, albumin levels increase slowly when malnutrition is treated
86
Transferrin is an iron-transport protein, and its blood concentrations respond to
-iron status, -PEM, -and various illnesses
87
Transferrin levels ?? as iron status worsens and ??as iron status improves,
-rise -fall
88
using transferrin values to evaluate protein-energy status is difficult if an ?? is also present
-iron deficiency
89
Blood concentrations of transthyretin (also called prealbumin) and retinol-binding protein ?? rapidly during PEM and respond ??? to improved protein intakes
-decrease -quickly
90
Transthyretin and retinol binding protein compared to albulim
-more sensitive to changes in protein status than albumin -more expensive to measure
91
C-reactive protein (CRP) levels rise ?? in response to inflammation, infection, or tissue injury and are often elevated in individuals with critical illness, heart disease, and certain cancers
-rapidly
92
A test for CRP may be ordered to monitor
-disease progress, -response to treatment, -or heart attack risk in patients with heart disease
93
Most physical signs of nutritional deficiencies are
-nonspecific; -they can reflect any of several nutrient deficiencies, as well as conditions unrelated to nutrition
94
For example, cracked lips may be caused by
-several B vitamin deficiencies but may also result from sunburn, windburn, or dehydration
95
What additional evidence is needed to confirm suspected nutritional deficiences?
-dietary and laboratory data
96
Signs of malnutrition tend to appear most often in parts of the body
-where cell replacement occurs at a rapid rate, such as the hair, skin, and digestive tract (including the mouth and tongue)
97
Fluid retention (also called edema) may be caused by
-PEM, severe infection or injury, and some medications -heart failure, disorders of kidneys/liver, and obstructions in veins or lymphatic system
98
Physical signs of fluid retention include
-weight gain, facial puffiness, tissue swelling, -abdominal distention, -light-colored urine, -moist skin, and tight-fitting shoes.
99
Dehydration may be caused by
-vomiting, diarrhea, fever, excessive urination, blood loss, and wounds or burns (due to fluid loss through skin lesions)
100
Why is the risk of dehydration especially high in older adulta?
-reduced thirst response
101
Signs or symptoms of dehydration include
-weight loss, -thirst, -dry skin or mouth, -dark-colored urine, and low urine volume.

clinical nutrition (26 decks)

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