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Medical Nutrition > Chapter 17 - Nutrition Care And Assessment > Flashcards

Chapter 17 - Nutrition Care And Assessment Flashcards

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USMLE® Step 1 flashcards
1
Q

What is malnutrition?

A

Malnutrition is a condition where a person’s diet lacks the necessary nutrients required for proper health and growth.

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2
Q

What percentage of hospitalized patients are malnourished?

A

15-60% of hospitalized patients are malnourished

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3
Q

How does poor nutritional status affect a person’s healing ability?

A

Poor nutritional status weakens immune function and compromises a person’s healing ability, affecting the course of disease and the body’s response to treatment, which lengthens hospital stays and increases cost.

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4
Q

What are some ways illness and treatments can lead to malnutrition?

A

Illness and treatments can lead to malnutrition by reducing food intake, interfering with digestion and absorption, and altering nutrient metabolism and excretion.

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5
Q

What is an example of how prolonged bed rest can affect a person’s nutritional status?

A

Prolonged bed rest can result in pressure sores/ulcers, increase metabolic stress, and raise protein and energy needs

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6
Q

What is the difference between dietary changes during acute illness and chronic illnesses?

A

Dietary changes during acute illness are usually temporary and tailored to individual preferences and lifestyle, while dietary changes for chronic illnesses may require long-term modifications, such as in the case of diabetes.

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7
Q

What are critical pathways in nutrition care?

A

Coordinated programs of treatment.

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8
Q

What is the role of physicians in nutrition care?

A

They prescribe diet orders, rely on other health professionals to alert them to nutritional problems, and provide nutrition assessment and diet counseling

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9
Q

What is the role of registered dietitians in nutrition care?

A

They provide medical nutrition therapy, conduct nutrition/dietary assessments, diagnose nutritional problems, develop, implement and evaluate nutrition care plans, plan and approve menus, and provide dietary counseling.

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10
Q

What is the role of registered dietetic technicians in nutrition care?

A

They work with dieticians, assist in implementation and monitoring of nutrition services, and screen.

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11
Q

What are some challenges health professionals face when recommending dietary changes for chronic illnesses?

A

They may require long-term dietary modifications and may need to help patients appreciate potential benefits of treatment and accept dietary changes that can improve their health.

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12
Q

What is the role of Registered Dietetic Technicians in nutrition services?

A

They assist in implementation and monitoring of nutrition services, screen patients for nutritional problems, provide patient education and counseling, develop menus and recipes, ensure appropriate meal delivery, monitor patients’ food choices and intakes, and sometimes supervise foodservice operations (inventory, safety etc.).

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13
Q

What is the role of Nurses in nutrition care?

A

They screen patients for nutrition problems, provide direct nutrition care, encourage patients to eat, find practical solutions to food-related problems, record patient’s food intake, answer questions about specific diets, administer tube and intravenous feedings, assume much responsibility of nutrition care in facilities without a registered dietician, and develop nursing diagnoses related to nutritional problems.

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14
Q

Which other health care professionals may assist with nutrition care?

A

Pharmacists, physical therapists, occupational therapists, social workers, speech therapists, nursing assistants

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15
Q

What healthcare professionals may assist with nutrition care?

A

Pharmacists, physical therapists, occupational therapists, social workers, speech therapists, nursing assistants.

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16
Q

What is nutrition screening?

A

It is a process that can identify malnutrition and involves collecting health-related information.

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17
Q

When is nutrition screening conducted?

A

It is conducted within 24 hours of admission to the hospital.

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18
Q

Who can conduct nutrition screening?

A

It can be conducted by a nurse, nursing assistant, registered dietician, or dietetic technician.

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19
Q

What are the screening tools used for nutrition screening?

A

SGA & MNA (>65 years)

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20
Q

What is the Mini Nutrition Assessment (MNA)?

A

It is a two-step process that involves screening and assessment and is used for the elderly population (over 65 years).

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21
Q

What are the steps involved in the Nutrition Care Process?

A

Nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring & evaluation.

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22
Q

What is the purpose of revisiting the steps in the Nutrition Care Process?

A

To re-assess and revise diagnoses and intervention strategies.

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23
Q

What is nutrition assessment?

A

It involves the collection and analysis of health-related information for the purpose of identifying specific nutrition problems and their underlying causes.

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24
Q

What are the components of nutrition assessment?

A

Medical, personal, social, and food/nutrition histories, anthropometric data, biochemical analyses, medical tests, and physical examination.

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25
Q

What is nutrition diagnosis?

A

It is the identification of the nutrition problem by analyzing information obtained from the assessment.

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26
Q

What are the components of a nutrition diagnosis?

A

The specific problem, etiology or cause, and signs and symptoms that provide evidence of the problem.

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27
Q

What are the three main categories of nutrition diagnosis?

A

Intake (E, fluid, alcohol, supplements), clinical, and behavioral-environmental.

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28
Q

What are the three categories of factors that can disrupt nutritional status?

A

Clinical, Behavioral-environmental, and Medical or physical conditions.

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29
Q

What is the purpose of nutrition diagnosis?

A

To identify a nutrition problem and plan an appropriate nutrition care.

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30
Q

What is the goal of nutrition interventions?

A

To target the cause of the problem identified in the diagnosis and achieve measurable outcomes or positive changes in dietary behaviors and lifestyle.

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31
Q

What is the purpose of nutrition monitoring and evaluation?

A

To periodically evaluate the effectiveness of the nutrition care plan by reviewing the original goals and outcome measures and comparing them with updated assessment data.

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32
Q

What is the purpose of periodically evaluating a care plan?

A

To review original goals and outcome measures and compare them with updated assessment data, and to carefully monitor progress.

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33
Q

What should be done if the goals of a care plan are not met?

A

The care plan must be redesigned, and may include motivation techniques or additional patient education.

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34
Q

What are some components of a patient’s historical information that should be included in a nutrition assessment?

A

Medical/health history (including family history and age), medication/supplement history (including diet-drug interactions), personal and social histories (including financial, cultural, and religious factors), and food/nutrition history (including diet history).

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35
Q

What are some components of a patient’s historical information that should be included in a nutrition assessment?

A

Medical/health history (including family history and age), medication/supplement history (including diet-drug interactions), personal and social histories (including financial, cultural, and religious factors), and food/nutrition history (including diet history).

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36
Q

What are some methods for gathering food intake data?

A

The 24-hour recall, food frequency questionnaire, food record, and direct observation.

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37
Q

What is the multiple pass method for conducting a 24-hour recall?

A

The first pass involves a quick list of foods consumed without prompts from the interviewer, the second pass helps the patient remember forgotten foods and beverages, and the third and fourth passes gather details such as amount and preparation method.

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38
Q

What is the purpose of the 3rd and 4th passes in gathering details about food and beverages?

A

To gather details such as amount and preparation method.

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39
Q

What do anthropometric measurements reveal about the body?

A

They reveal over nutrition and PEM

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40
Q

What is the significance of measuring height/length and weight in children and adults?

A

Height/length and weight can help evaluate growth in children and nutrition status in adults.

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41
Q

What is the difference between measuring length and height?

A

Length is measured in infants and children younger than 24 months, while height is measured in older children and adults.

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42
Q

What should be used to measure the height of adults who are unable to stand?

A

Knee height (top of knee to heel) or full arm span.

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43
Q

Why should self-reported height be avoided when measuring anthropometric measurements?

A

Self-reported height is less accurate

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44
Q

What is the formula for calculating Body Mass Index (BMI)?

A

BMI = weight (kg)/height (m)2.

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45
Q

What is the significance of involuntary weight loss?

A

It is a sign of PEM

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46
Q

What are the requirements for obtaining a valid weight measurement?

A

Same calibrated scales, same time of day, same amount of clothing, remaining still during weight, and after the patient has voided.

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47
Q

What is the purpose of using Demi-span measurement in the clinical setting?

A

It requires no special equipment and is particularly useful for patients with lower limb dysfunction.

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48
Q

How is Demi-span measurement taken?

A

Using the left arm if possible, measure the distance from the notch between the middle and the ring fingers to the middle of the sternal notch, making sure the patient’s arm is horizontal and in line with the shoulders

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49
Q

What is the purpose of measuring head circumference in children up to 3 years old?

A

To assess brain growth and malnutrition.

50
Q

What is the method for measuring head circumference in children?

A

Encircle the largest circumference measure of a child’s head with a non-stretchable measuring tape just above the eyebrows and ears, and around the occipital prominence at the back of the head.

51
Q

What is the significance of measuring waist circumference?

A

It correlates with intra-abdominal fat and can help in assessing overnutrition.

52
Q

What is the association between waist circumference and heart disease and diabetes?

A

Increased waist circumference is associated with an increased risk of heart disease and diabetes.

53
Q

What is the best location to measure waist circumference?

A

At the narrowest point or midway between the 10th rib and top of the iliac crest.

54
Q

What is the best way to measure abdominal fat?

A

It is best measured at the narrowest point or midway between the 10th rib and top of the iliac crest.

55
Q

What are the cut off values for abdominal fat in men and women?

A

Adult cut off values are Men >102 cm and women >88 cm.

56
Q

What is the waist to hip ratio?

A

It is an indication of body fat distribution/body shape and is used in adults.

57
Q

How do you calculate the waist to hip ratio?

A

Calculate waist to hip ratio by dividing both measurements Waist/Hip

58
Q

What are the adult cut off values for waist to hip ratio in men and women?

A

Adults cut-offs are 0.95 for men and 0.80 for women.

59
Q

What is the Mid Upper Arm Circumference?

A

It is measured halfway between the olecranon and acromial processes.

60
Q

What is the Calf Circumference?

A

It is measured at the widest part between the olecranon and acromial.

61
Q

What is Skinfold thickness?

A

It measures subcutaneous fat at several sites of the body by “pinching” the skin with callipers.

62
Q

What are the four main sites for skinfold thickness measurement?

A

Triceps, Biceps, Subscapular, and Supra-iliac.

63
Q

How many measurements are taken for skinfold thickness, and what is done with them?

A

Three measurements are taken, and an average is calculated.

64
Q

What are the disadvantages of skinfold thickness measurement?

A

It is difficult to measure in overweight and obese individuals, and it varies between assessors.

65
Q

What is frame size adjustment, and why is it necessary?

A

It is necessary to adjust for differences in body build when calculating IBW.

66
Q

What are the two ways to determine frame size?

A

Wrist Circumference and Elbow Breadth.

67
Q

How is elbow breadth measured?

A

The subject should stand and extend the arm forward so that it is horizontal and parallel to the ground.

68
Q

What is the most accurate way to determine frame size?

A

Elbow Breadth

69
Q

What is adjusted body weight (ABW) used for in amputations?

A

ABW is used to assess nutritional status (BMI/ equations).

70
Q

How is adjusted body weight (ABW) calculated in amputations?

A

ABW = actual measured weight divided by (100-% amputation) x 100.

71
Q

What is the formula to measure Ideal Body Weight (IBW) for amputations?

A

IBW = (100-% amputation)/100 x IBW for original height

72
Q

What percentage of body weight is contributed by an entire arm in amputations?

A

An entire arm contributes 5.0% of body weight in amputations.

73
Q

What is the percentage of body weight contributed by the entire leg?

A

16.0%.

74
Q

What are the three methods for estimating fluid requirements for a normal person?

A

(a) body weight, (b) kilocalorie intake, or (c) body surface area.

75
Q

What is the formula for calculating fluid requirements based on body weight?

A

30-40 mL/kg/day.

76
Q

What is the formula for calculating fluid requirements for a 20-year-old who weighs 60 kg?

A

1800-2400 mL/day.

77
Q

What is the formula for calculating fluid requirements for a 12 kg baby?

A

100 mL/kg/day

78
Q

What is the formula for calculating energy requirements using the Harris Benedict equation?

A

BMR x activity factor x stress factor.

79
Q

What is the energy requirement for a normal person?

A

25-30 kcal/kg/day.

80
Q

What is the energy requirement for a person experiencing mild stress?

A

30-35 kcal/kg/day.

81
Q

What is the energy requirement for a person experiencing moderate to severe stress?

A

35-45 kcal/kg/day

82
Q

What is the significance of weight loss of over 10% within a 6 month period?

A

It suggests a risk of Protein-Energy Malnutrition (PEM).

83
Q

What is the significance of weight gain in a person with heart failure, liver cirrhosis, or kidney failure?

A

It suggests fluid retention and worsening of the disease state.

84
Q

What is the purpose of anthropometric assessment in adults?

A

To assess the degree of nutritional risk associated with illness.

85
Q

What is the formula for calculating percent of ideal body weight (%IBW)?

A

(Actual body weight / Ideal body weight) x 100

86
Q

What is the formula for calculating percent of usual body weight (%UBW)?

A

(Actual body weight / Usual body weight) x 100.

87
Q

What is the formula for calculating ideal body weight (IBW)?

A

IBW= 22*ht(m)^2

88
Q

What is the percentage of IBW if the weight is 55kg?

A

% IBW=55/55.6 * 100=98.9%.

89
Q

What is the percentage of usual body weight (UBW) if the weight is 55kg and the usual weight is 62kg?

A

% UBW= 55/62 * 100= 88.7%

90
Q

What is the percentage of weight loss if the usual weight is 62kg and the current weight is 55kg?

A

% weight loss=(62-55)/62 *100=11.3%.

91
Q

What is the expected outcome of limiting foods high in cholesterol and saturated fat?

A

1.Limit foods high in cholesterol, saturated fat.

92
Q

What is the ideal percentage of total kcal from fat?

A

Consume 25%–35% of total kcal from fat.

93
Q

What is the ideal percentage of saturated fat consumption?

A

Consume <7% saturated fat.

94
Q

What is the purpose of biochemical analyses in nutrition assessment?

A

Provides information about PEM, vitamin & mineral status, fluid & electrolyte balance, organ function.

95
Q

What are the different factors that can affect the results of biochemical analyses?

A

fluid imbalances, pregnancy, infections, medications.

96
Q

How are blood tests reported in terms of plasma and serum?

A

Plasma: yellow fluid that remains.

97
Q

What is the difference between plasma and serum?

A

Plasma is the yellow fluid that remains after the cells are removed and contains clotting factors, while serum is the fluid remaining after both cells and clotting factors are removed.

98
Q

What are plasma proteins?

A

Plasma proteins are synthesized in the liver and reflect liver function.

99
Q

What is albumin?

A

Albumin is the most abundant plasma protein.

100
Q

What is transferrin?

A

Transferrin transports iron, and its concentrations respond to both protein-energy malnutrition and iron status.

101
Q

Evaluating PEM status using transferrin is difficult if iron deficiency is present.

A

Its levels rise as iron status gets worse and fall as iron status improves;

102
Q

What is the half-life of transferrin?

A

8-10 days.

103
Q

What happens to transferrin levels as iron status worsens?

A

They rise

104
Q

What happens to transferrin levels in PEM?

A

They fall.

105
Q

What are the two proteins used to evaluate PEM status?

A

Pre-albumin and retinol-binding protein (RBP).

106
Q

What happens to pre-albumin and RBP levels during PEM?

A

They decrease rapidly.

107
Q

Are pre-albumin and RBP more sensitive to changes in protein status than albumin?

A

Yes.

108
Q

What is the half-life of pre-albumin?

A

2-3 days.

109
Q

What is the half-life of RBP?

A

12 hours.

110
Q

Why are pre-albumin and RBP not routinely included during nutritional assessment?

A

They are more expensive to measure than albumin.

111
Q

What are the clinical signs of malnutrition?

A

They appear most often where cell replacement occurs at a rapid rate (hair, skin, digestive tract - including mouth and tongue).

112
Q

What physical examination can reveal B vitamin deficiency?

A

Lips

113
Q

What are the causes of hair loss?

A

Medical conditions, medication, physical/emotional shock, hair pulling syndrome, and hairstyles.

114
Q

What is the normal amount of hair shed per day?

A

Most people normally shed 50 to 100 hairs a day.

115
Q

What is the mechanism behind fluid retention (edema)?

A

; Impaired blood circulation caused by diseases of the heart, kidney, liver, and lungs

116
Q

What are the physical signs of fluid retention?

A

Weight gain, facial puffiness, swelling of limbs, abdominal distention, and tight clothing.

117
Q

How does hydration state affect blood tests?

A

It is important to consider when interpreting blood tests.

118
Q

What is ion-Lips?

A

A B vitamin deficiency.

119
Q

What is the significance of examining nails during a physical examination?

A

They can provide hidden clues about a person’s health.

120
Q

What is the significance of examining hair during a physical examination?

A

It can help identify medical conditions, medication side effects, and nutritional deficiencies.

Medical Nutrition (1 decks)

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