Deconstructing the Clinical Nutrition Patient Encounter

Question 1

Nutritional Screening

“Is the process of identifying characteristics known to be associated with nutritional problems. It’s purpose is to pinpoint individuals who are ____________ or at ________________”

Answer 1

malnourished

nutritional risk

Question 2

Screening: _________OR _________ the presence of disease in individuals/groups at risk

Answer 2

detect or predict

Question 3

MUST = Malnutrition Universal Screening Tool

A practical, reliable, validated tool for nutrition screening
•Used for adults and elderly
•Used in primary care, home, acute care, long term care

5 Step screening tool: Identifies adults who are malnourished, at risk of malnutrition or ________.

Answer 3

obese

Question 4

The mnemonic DETERMINE represents the warning signs and the questions in the screen

• D isease
• E ating poorly
• T ooth loss, mouth pain
• E conomic hardship
• R educed social contact
• M ultiple medicines
• I nvoluntary weight loss or gain
• N eed for assistance in self-care
• E lderly (age > 80)

Answer 4

KNOW

Question 5

Nutrition Care Process (NCP)

A standardized process established by ADA

mnemonic: ADIME
1. A ssessment of nutritional status
2. D iagnosis (nutritional)
3. I mplement (relevant interventions)
4. M onitor and Evaluate (outcomes)

Answer 5

KNOW

Question 6

Nutritional Assessment

“The MEASUREMENT of indicators of dietary status and nutrition related health status to identify the possible occurrence, nature and extent of impaired nutritional status”

“can range from _______to ____________”

***According to the World Health Organization (WHO):
The ultimate purpose of nutritional assessment is to IMPROVE human health.

Answer 6

deficiency to toxicity

Question 7

Nutritional assessment techniques/methods can be classified according to 4 types:

Anthropometric

Biochemical (or laboratory)

Clinical

Dietary

Mnemonic “ABCD”

Answer 7

KNOW

Question 8

Nutritional Assessment
Purpose: To obtain adequate information to identify nutrition related problems
•Systematic process of interpreting data
•Requires making ____________ between information obtained and reliable standards (ideal goals
—Provides foundation for nutrition diagnosis

Answer 8

comparisons

Question 9

Nutritional Assessment Components

Review _______ _______for factors that affect health conditions and nutrition risk

Evaluate ________ __________ related to food access, selection, preparation, physical activity, understanding of health condition

Evaluate READINESS to learn and potential for changing behavior

ID STANDARDS by which data will be compared

ID PROBLEMS that lead to diagnosis

Answer 9

dietary intake

behavioral factors

Question 10

Critical Thinking

• Observe verbal and non verbal clues
• Determine when a problem requires consultation with or _________ to another provider

Answer 10

referral

Question 11

Patient History

Includes:

Medical

Social

Medications

Supplements

Dietary

Answer 11

KNOW

Question 12

Dietary History
• ______________? (diminished or distorted taste)
• ______________? (loss of sense of taste)
• ______________? (swallowing problems)

Dental or oral problems impacting consumption
• Discomfort after eating?
• Chewing problems? Dentures?

Answer 12

Dysgeusia

Ageusia

Dysphagia

Question 13

________ ___________ (developed in 1940’s)

1. collect general info about health habits
   
   Meals eaten each day, likes, dislikes, nausea, use of supplements, appetite, lifestyle habits
   (sleep, smoking etc)
2. Question about usual eating pattern 24 hour recall
3. Perform cross check on data in step 2
   ——Ask clarifying questions
   i.e. if pt states they drink milk in the morning – inquire if they drink it daily or just that day, low fat, 2%, skim, almond, etc.
4. Have patient complete 3-day food record
   ——–Additional means of checking usual intake

Answer 13

Burke’s Method

Question 14

Food Record or Diary

Patient records the time, type of food and beverages consumed during a ____-_____ day period

DISADVANTAGE – May result in alteration in diet

Answer 14

1-7

Question 15

______ _________ ________ :
Determines the frequency of consumption of a limited number of foods known to be major sources of dietary components of interest

• Patient indicates how many times a day, week, month or year the foods are consumed

–Data may be more representative of usual intake than a few days of diet records

Answer 15

Food Frequency Questionnaire (FFQ)

Question 16

Surrogate Sources

When the patient is \_\_\_\_\_\_\_\_OR\_\_\_\_\_\_\_\_ to provide the data themselves
Potential surrogates include:
•Spouse
•Parent
•Partners
•Children
•Closes relative or friend

Answer 16

unable or unwilling

Question 17

NHANES: (National Health and Nutrition Examination Survey) Program of studies designed to assess the health and nutritional status of adults and children in the United States – began in the 19___‘S

Answer 17

1960’s

Question 18

Begin by asking ______ ended questions
“Tell me about the first thing you have to eat in the morning”
•Save _______ ended questions for later
“Do you add salt to the food at the table?” (Yes/No)
•Avoid labeling meals: breakfast/lunch/dinner

Avoid LEADING questions!!
“You don’t drink whole milk, do you?”
Do NOT ask questions that would lead the participant to feel s/he “should” have had a certain item and, thus say that they did!

Answer 18

open

close

Question 19

Don’t approve or disapprove with ______ _____ OR _______.

Once the 24 hour food recall is complete READ the list back to the patient

Answer 19

body language or words

Question 20

(Medicine) a substance, physiological characteristic, gene, etc that indicates, or may indicate, the presence of disease, a physiological abnormality or a psychological condition. Also called: ____________

Answer 20

biomarker

Question 21

Biological Markers

Approach to ___________ dietary measurements
• Compare intake to biological markers
• Accessible through urine, feces, blood, tissue samples
• Not dependant on patient’s accuracy and truthfulness

Answer 21

validating