Chapter 4: Nutrition Screening/Asessment Flashcards
T/F: Both cancer itself & its treatment can lead to malnutrition
True
Define malnutrition
A state of nutrition in which a deficiency OR excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form (shape, size, composition) & functional + clinical outcomes
In cancer setting “the presence of undernutrition & changes in body composition due to the cancer itself of the impact of oncology treatment”
What are consequences of malnutrition? (7)
- Reduced muscle strength
- Impaired immune response
- Increased fatigue
- Impaired wound healing
- Reduced QOL
- Reduced response to oncology treatment
- Potential increase in healthcare and hospital LOS
*increased risk for toxicities, thus fewer doses may be received
_____ - _____% of patients with GI. pancreatic, H&N, and colorectal cancers have already signs of nutritional impairment, even in early stages of their disease
40-80%
Weight loss as little as _____% predicts a recued response to oncology treatment, reduced survival, and reduced QOL
6%
Define “Nutrition Screening”
The process of identifying patients who may have a nutrition diagnosis & benefit from nutrition assessment/intervention by an RDN
In oncology, can help w/ early identification of patients who are experiencing malnutrition or who are at risk for malnutrition
When should malnutrition screening occur for oncology patients?
- Upon admission to oncology services
- Repeated throughout treatment
Usually repeated prior to physician visits: weekly for radiation, 2-3 weeks during chemo, every follow-up visit
Tools used to screen patients with cancer should be valid identifiers of those experiencing _________________ &__________________
Nutrition impact symptoms & clinical characteristics of malnutrition
*should be valid & reliable. may help to justify need for additional oncology RDNs
Screening tools include some or all of these data points (5)
- BMI (Height & wt)
- Weight change
- Presence of nutrition impact symptoms
- Comorbidities
- Disease severity
T/F: Malnutrition in the oncology patient may or may not be associated with cancer cachexia syndrome
True
Cancer cachexia may be present in up to _____% with advanced cancer & is indicated as a factor in the cause of death in ___ - ____% of all cancer patients
80%
30-50%
Pathophysiology of cancer cachexia
A negative protein & energy balance driven by reduced food intake and/or abnormal metabolism
A patient’s chief complaint & PMH are evaluated by the RDN to identify the presence of absence of __________________
Inflammatiton
What are 2 questions to ask patients about their efforts regarding food & nutrition-related history?
What current strategies have you been trying to overcome difficulty with nourishments?
What IS working? Willingness to modify behaviors?
Whare are the 5 domains of the oncology-related nutrition assessment?
- Anthropometric measurements
- Food and nutrition-related history
- Biochemical data, medical tests, procedures
- Nutrition focused physical findings
- Client history (medical, social, personal)
What 7 types of meds are important to ask about during nutrition assessment?
- Steroids
- Stool softeners/laxatives
- Anti-emetics
- Probiotics/fiber supplements
- Narcotics
- Digestive enzymes
- Herbal products
Also, marijuana & appetite stimulants
Grip strength & tricep skin fold should be included in which domain?
Anthropometrics
How should baseline weight be obtained?
UBW from MR
Admission to onc service as a back-up
Self-report of UBW if the above not available
For elderly patients, there is an association between increased mortality & BMI < ____________ OR weight loss of _________% in 30 days
20
5%
T/F: The shortest survival times are found among obese patients with sarcopenic weight loss
True (decrease muscle masked by a mantle of fat)
A CRP of >/= __________ can be used as an indicator of inflammation
10
What is the Glasgow Prognostic Score/Modified Glasgow Prognostic score?
A combination of CRP + albumin levels used to measure systemic inflammatory response & provide a prognostic value
*poor prognosis w/ albumin <3.5 & CRP > 10
Which part of the nutrition assessment do nutrition impact symptoms fall under?
Nutrition Focused Physical Findings
This section also covers vital signs, micronutrient deficiencies, and other things related to appearance
Deficiency of these 2 nutrients may be related to angular chielitis
B2 (Riboflavin) & iron
Karnofsky scale & Eastern Cooperative Oncology Group Status are scales that fit within this part of the nutrition assessment
Comparative standards
ECOG general numbers
0 - fully active, no issues compared to pre-disease
1. restrictive in strenuous activity but still able to do house work/office work
2 - capable of self-care but no work-activities
3 - bound to bead or chair 50% of time
4 - completely bedbound/disabled
5 - dead
General Karnofsky Score #s
100 - no complaints/evidence of illness
80 - able to do normal activities but with greater effort
60 - requires occasional assistance
40 - disabled, requires special health and assistance
20- very sick, needs hospitalization
0 - dead
What are the 3 types of malnutrition
- Social/environmental
- Acute illness/injury
- Chronic disease
What is the difference between non-severe & severe malnutrition
Presence of inflammation
Severe malnutrition = inflammation present
Nonsevere malnutrition = inflammation not rpsent
____ or more or the 6 characteristics must be met to make a malnutrition diagnosis
2, but documentation regarding all 6 must be present to create a full nutrition diagnosis
What are 3 areas of subcutaneous fat loss to assess for?
Tricep, orbital, over the ribs
A chronic disease is defined as lasting ___________ months or longer
3
Grip strength is not applicable when diagnosing ____________________
Non-severe (moderate) malnutrition
