Domain 2: Nutrition Care for Individuals and Groups Flashcards
What part of the Nutrition Care Process is reviewed during ALL steps of the NCP?
Assessment
What is the difference between specificity and sensitivity?
Specificity: Can it ID patients without a condition
Sensitivity: Can it ID those who have the condition
If no nutrition problem exists upon screening, what do you document?
Discharge from nutrition care is appropriate
What does The Joint Commission mandate for nutrition screening?
Nutrition risk identified in hospitalized patients within 24 hours of admission, but does NOT mandate a method of screening
What is the Subjective Global Assessment (SGA)?
Screening tool that combines medical record review with direct patient client involvement. Based on client history, physical examination, and their perceived ability to accomplish self care. Includes history, intake, GI symptoms, functional capacity, physical appearance, muscle wasting, loss of subcutaneous fat, and edema (good for renal patients). Rated as well-nourished (A), mild-moderately malnourished (B), or severely malnourished (C).
What is the Mini Nutritional Assessment (MNA)?
Screening tool for older adults (65 and over) that consists of 18 questions on independence, medications, number of meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding, etc.
What is the Malnutrition Universal Screening Tool (MUST)?
A 5-step tool used to identify malnutrition (or those at risk of developing malnutrition) in adults. Includes BMI, unintentional weight, effect of acute disease on intake for more than 5 days.
What is the Nutrition Screening Initiative (NSI)?
A national collaborative committed to the identification and treatment of nutritional problems in the elderly.
What is the Geriatric Nutritional Risk Index (GNRI)?
A nutrition-related risk index that evaluates the risk of morbidity and mortality in elderly hospitalized patients. Includes serum albumin and weight changes.
What is the Malnutrition Screening Tool (MST)?
A 2 question screening tool to identify malnutrition risk in acute hospitalized adults.
Q1: Have you lost weight recently without trying?
Q2: Have you been eating poorly because of decreased appetite?
(time frame: past 6 months)
Score of 0-1: low risk
Score of 2: moderate risk
Score of 3-5: high risk
What is the Nutrition Risk Screening (NRS-2002)?
Identifies nutrition risk (usually in medical-surgical hospitalized patients) through two criteria: impaired nutritional status and disease severity. Includes % weight loss, BMI, intake, and for patients over the age of 70 an additional point is added (age-adjustment factor). Scored from 0-7, with a score of 3 or greater indicating nutrition problems.
What is the antecedent to initiate the first step in the NCP (assessment)?
Referral/screening
What critical thinking skills are needed for the nutrition assessment?
- Observe verbal/nonverbal cues (can guide effective interviewing)
- Determine appropriate data to collect
- Select tools and procedures
- Distinguish relevant from irrelevant data
- Validate, organize and categorize the data
What are the components of the nutrition assessment and what is included in each?
- REVIEW: Review data for factors that affect nutritional and health status
- CLUSTER: assessment data is clustered for comparison with characteristics of a suspected diagnosis: food/nutrition related history, anthropometrics, lab/medical tests, NFPE, client history.
- IDENTIFY: These indicators are compared to identified standards and criteria for interpretation and decision-making. Indicators are markers that can be observed and measured and are compared against nutrition care criteria (used during monitoring and evaluation).
What is included in the documentation for a nutrition assessment?
- Date and time
- Pertinent data and comparison with standards
- Patient’s perception, values and motivation related to a problem
- Changes in patient’s level of understanding, behaviors, outcomes
- Reason for discharge
What diet assessment tool is best for a clinical setting and which is best for the community setting?
Clinical: 24 hour recall
Community: Food frequency questionnaire/list
What equation is used to determine ideal body weight and what are the equations for men and women?
Hamwi formula
Men: 106 lb. for the first 5’, add 6 lb. for each additional inch. Subtract 6 lb. for each additional inch under 5’.
Women: 100 lb. for the first 5 ‘, add 5 lb for each additional inch. Subtract 5 lb for each inch under 5’.
Note: for small frame subtract 10% and for large frame add 10%
How do you adjust ideal body weight for amputations?
Adjusted IBW = (100 - % amputation) / 100 x IBW for original height)
Entire leg: 16%
Lower leg with foot: 6%
Entire arm: 5%
Forearm with hand: 2.3%
How do you adjust ideal body weight for a spinal cord injury?
Quadriplegic: reduce by 10-15%
Paraplegic: reduce by 5-10%
How do you calculate % weight change and what is considered signficant?
(UBW-ABW)/UBW x 100
Significant weight loss: 10% loss within 6 months or 5% within 1 month
Note: has to be involuntary
What does triceps skinfold thickness (TSF) measure and what are the standard measurements for men and women?
TSF measures body fat reserves; calorie reserves
Male: 12.5mm
Female: 16.5 mm
What does arm muscle area (AMA) measure and what are the standard measurements for men and women?
AMA measures skeletal muscle mass (somatic protein). To determine use TSP and AC (arm circumference)
Male: 25.3 cm
Female: 23.2 cm
Note: MUAC important to measure in growing children 6 months-5 years due to little change occurring during this time period.
MUAC > 13.5 cm is normal
MUAC < 12.5 cm indicated malnutrition
What is the equation to calculate BMI?
Weight in kg / height in meters ^ 2
or
Weight in lb / height in inches ^2 x 703
Conversions:
1 cm = 0.01 m
1 inch=2.54 cm
What are the BMI categories?
Underweight: < 18.5
Normal weight: 18.5 - < 25
Overweight: 25 - < 30
Obese: 30 or greater
Class 1: 30 - < 35
Class 2: 35 - < 40
Class 3: 40 or greater
What is a healthy BMI for most elderly individuals?
24-29
At what age can you start using BMI for age charts?
Starting at age 2, when accurate stature can be obtained
What anthropometric measurement is an independent risk factor for disease with BMI of 25-34.9?
Waist circumference; predicts central adiposity
> 40 in. in males
35 in. in females
What are the parameters for waist/hip ratio (WHR) in men and women?
WHR differentiates between android and gynoid obesity.
WHR of 1.0 or greater in men, or 0.8 or greater in women indicates android obesity and an increased risk for obesity-related disease (diabetes, hypertension).
What does BIA measure, what are the contraindications, and what factors can affect reliability?
Measures fat free mass and total body water (usefulness in critical illness may be limited)
Must be well hydrated, no caffeine, no alcohol or diuretics x 24 hours, no exercise x 4-6 hours prior
Fever, electrolyte imbalance, and extreme obesity may affect reliability
Similar to DEXA
What is the gold standard for measuring body composition?
Underwater weighing (also called hydrodensitometry and water displacement)
Bod pod is as accurate as underwater weighing. Measures body composition by determining body density by measuring amount of air displaced.
What physical examination technique is not usually performed by the RD?
Percussion (tapping with fingers and hands)
Techniques that RD’s perform are inspection (observation), palpation (touch; ex: edema), and auscultation (heart and bowel sounds).
What are the possible nutrient deficiencies for HAIR: thin, sparse, dull/dry/brittle or easily pluckable?
Vitamin C or protein
(easily-pluckable only for protein deficiency, NOT vitamin C)
What are the possible nutrient deficiencies for EYES: pale, dry, poor vision?
Vitamin A, zinc or riboflavin
What are the possible nutrient deficiencies for LIPS: swollen, red, dry, cracked?
Riboflavin, pyridoxine or niacin
What are the possible nutrient deficiencies for TONGUE: smooth, slick, purple, white coating?
B vitamins or iron
What are the possible nutrient deficiencies for GUMS: sore, red, swollen, bleeding?
Vitamin C
What are the possible nutrient deficiencies for TEETH: missing, loose, loss of enamel?
Calcium or poor intake
What are the possible nutrient deficiencies for SKIN: pale, dry, scaly?
Iron, folic acid or zinc
What are the possible nutrient deficiencies for NAILS: brittle, thin, spoon-shaped?
Iron or protein
What are the 5 labs that test visceral protein?
Serum albumin, serum transferrin, transthyretin (TTHY)/prealbumin (PAB)/thyroxine-binding prealbumin (TBPA), retinol-binding protein (RBP), C reactive protein (CRP)
Serum Albumin
Normal value: 3.5-5.0 g/dl
Tests visceral protein (blood and organs)
- maintains colloidal osmotic pressure
- Low: edema, surgery
- High: likely dehydration
- Long half-life; does not reflect current protein intake
Serum transferrin
Normal value: > 200 mg/dl
Tests visceral protein (transports iron to bone marrow)
- level controlled by iron storage pool
- Low: liver disease, vitamin A deficiency
- High: iron deficiency
- Can be determined from TIBC
- not useful measure of protein status
- acute phase response
Transthyretin TTHY, Prealbumin PAB, sometimes called TBPA (thyroxine-binding protein)
Normal range: 16-40 mg/dl
- short half-life; picks up changes in protein status quickly
- Low: liver disease (Liver synthesizes CRP at expense of PAB)
- Responds to recent dietary protein intake (2-3 days)
Retinol-binding protein (RBP)
Normal range: 3-6 mg/dl
- circulates with prealbumin; shortest half-life (12 hours)
- binds and transports retinol
C Reactive Protein (CRP)
Normal value: 0
- Marker of acute inflammatory stress; increases dramatically
- As it begins to decline, anabolic period has started and more intensive nutrition therapy can begin
- When elevated levels decrease, TTHY/PAB levels increase
Hemoglobin (Hgb)
Men: 14-17 gm/dl
Women: 12-15 gm/dl
Pregnant: > or equal to 11 (decreased due to increased plasma volume; hemodilution)
Newborns: higher levels
- iron-containing pigment of red blood cells
- eythrocytes are produced in red blood cells
Note: Black and african americans tend to have lower levels
Hematocrit (Hct)
Men: 42-52%
Women: 37-47%
Pregnant women: 33% (lower due to change in blood volume)
Higher in newborns: 44-64%
- volume of packed cells in whole blood
Mean Cell Volume (MCV)
Normal range: 80-94 cu/microns or fL
- volume of average red blood cell
- High: Macrocytic anemia (folate or B12 deficiency)
- Low: Microcytic anemia (iron deficiency)
Serum ferritin
Males: 12-300 ng/ml
Women: 10-150 ng/ml
- indicates size of iron storage pool/total amount of iron stored in the body
Total iron-binding capacity (TIBC)
Normal range: 240-450 mcg/dL
- Total amount of iron that can be carried by transferrin
- Levels above 450 indicate iron deficiency
Serum creatinine
Normal range: 0.6-1.4 mg/dl
- related to muscle mass, measures somatic protein
- may indicate renal disease, muscle wastage
Creatinine Height Index (CHI)
Normal: 80%
- ratio of 24 hour creatinine excretion / standard amount excreted in 24 hours (similar age, sex)
- estimates lean body mass
- 60-80% indicates mild muscle depletion
Blood urea nitrogen (BUN)
Normal range: 10-20 mg/dl
- related to protein intake
- indicator of renal disease
- BUN/creatinine ratio normal value: 10-15:1
Urinary Creatinine Clearance
Normal: 115 (+- 20) ml/min
- measures GFR- renal function
- estimate includes body surface area (heigh and weight)
Total Lymphocyte Count (TLC)
Normal: > 2700 cells/cu mm
- Measures immunocompetency
- decreased in protein-energy malnutrition
- moderate depletion: 900-1800
- severe depletion: < 900
Free Erythrocyte Protoporphyrin (FEP)
- Direct measure of toxic effects of lead on heme synthesis
- Increased in lead poisoning
- Lead depletes iron stores leading to anemia
Prothrombin time (PT)
Normal: 11-12.5 seconds; 85-100% of normal
- anticoagulants prolong PT
- evaluates clotting adequacy
- Change in Vitamin K intake will alter rate
What are the different PAL factors?
Sedentary: BEE x 1.2
Active: BEE x 1.3
Stressed: BEE x 1.5
What class of medications are megestrol acetate and marinol?
Appetite stimulants
Orlistat
Weight loss medication; treats obesity.
- Decreases fat absorption by binding lipase
- May need supplementation of fat-soluble vitamins and beta-carotene
Dextroamphetamine (Adderall) and Methylphenidate (Ritalin)
- appetite suppressant
- anorexia
- weight loss
- nausea
Statins (HMG CoA reductase inhibitors)
Lipid lowering/reduce cholesterol
- decrease LDL and TG
- increase HDL
- grapefruit
Chemotherapy
May cause malabsorption
Mineral oil/Cholestyramine
Reduces cholesterol
- Decrease absorption of fat
- May need supplementation of fat soluble vitamins
Corticosteroids/Glucocorticoids (cortisone, hydrocortisone, prednisone)
Anti-inflammatory
- Increase blood glucose and sodium
- Decrease calcium (bone loss), potassium, and protein stores (poor wound healing)
- Decrease insulin sensitivity causing CHO intolerance
May require low-sodium, high potassium, high-calcium diet + vitamin D supplementation
Antiobiotics
- Decrease gut microbiota and vitamin K
- Decrease protein synthesis
- Certain antibiotics (ex: tetracycline) should not be taken with calcium rich foods (milk, yogurt) + high acid foods (grapefruit, chocolate, tomatoes) + antacids (contain nutrients that interfere with absorption Mg, Ca, Al, Zinc, Iron); separate by 2-3 hours
- Common side effect: diarrhea
- Recommend bland foods (BRAT diet) and fermented food/probiotics to increase intestinal bacteria
Oral contraceptives
Decrease folate, B6, vitamin C
Loop diuretics (furosemide/LASIX, torsemide, ethacrynic acid, bumetadine)
Deplete thiamin, potassium, magnesium, calcium, sodium
Thiazide diuretics
Decrease potassium and magnesium, absorb calcium
Potassium sparing diuretics
Amiloride (Midamor)
Eplerenone (Inspra)
Spironolactone (Aldactone, Carospir)
Triamterene (Dyrenium)
Methotrexate
Decreases immune function and treats inflammation; commonly prescribed for rheumatoid arthritis
- decreases folate
Antidepressants (lithium carbonate)
- Increased appetite and weight gain
- Maintain consistent sodium and caffeine intake; if sodium or caffeine are restricted–> lithium is retained in the body and can lead to toxicity.
Anticoagulants (warfarin)
- Maintain consistent Vitamin K intake
- Avoid Gingko biloba extract, garlic, ginger
- Avoid high doses of vitamin A and E
Propofol
1.1 kcals/cc (fat calories)
- Check TG levels
Phenobarbital (anti-convulsant/anti-seizure/sedative)
- Decreases folic acid, vitamin K, Vitamin D and vitamin B6 & B12
Cyclosporine (immunosuppressant)
- Hyperlipidemia
- Hyperglycemia
- Hyperkalemia
- Hypertension
Isoniazid (treats TB)
- Depletes pyridoxine (Vit. B6)–> peripheral neuropathy
- interferes with vitamin D, calcium and phosphorous
- Don’t take with food
Levodopa (controls symptons of Parkinson’s disease)
- Vitamin B6 and protein decrease effectiveness/compete for absoprtion
- Take in the morning with limited protein
MAOI (monoamine oxidase inhibitor)
Separate class of anti-depressants, sometimes treats other disorders such as Parkinsons
- Tyramine may cause hypertension with MAOIs
- Eliminate dopamine and restrict tyramine (monoamines). Drug can interact and release norepinephrine which raises blood pressure.
- Restrict aged, fermented, dried, pickled, smoked and spoiled foods. Avoid hard, aged cheese (cheddar, swiss), sauerkraut, some sausages, lunch meats, tofu, miso, Chianti wine. Limit sour cream, yogurt, buttermilk.
- OK: cottage cheese, cream cheese. Recommend to buy, cook and eat fresh foods
Curcumin (turmeric)
May reduce inflammation; antioxidant
What is a Health Risk Appraisal (HRA)?
Survey categorizing a populations’ general health status. Used in worksites, government agencies as a health education or screening tool. Consists of questionnaire, calculations that predict risk of disease, educational message to the participant. Part of community needs assessment.
What is term for the development of sustainable, community-based strategies to ensure that all have access to culturally acceptable, nutritionally adequate, food at all times?
Community Food Security Initiative
What are the 3 strategies that strengthen local food systems?
- Farmers markets
- Food recovery and gleaning programs
- PPFPs: Prepared and Perishable Food Programs-nonprofit programs that link sources of unused, cooked and fresh foods with social services agencies that serve the hungry
What data is included in nutrition surveillance?
- Height
- Weight
- Hematocrit
- Hemoglobin
- Serum cholesterol
Who is entitled to EPSDT?
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. It is a federal law but each state’s Medicaid agency determines what is deemed medically necessary.
What age group is the NSI used for?
The elderly.
The Nutrition Screening Initiative (NSI) promotes nutrition and improves nutritional care for the elderly to identify nutrition problems early; use the DETERMINE checklist-identifies nutrition risk factors (disease, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight changes, self-care, elder years above age 80)
Level I screen identifies those who need more comprehensive assessments
Level II screen provides more specific diagnostic info on nutritional status
What is the NNMRRP and who runs it?
National Nutrition Monitoring and Related Research Program; includes all data collection and analysis of activities of the federal government related to health and nutrition status, food consumption, attitudes about diet and health.
Jointly run by the USDHHS and USDA
What are the 4 national systems/surveys used to measure nutritional status?
- PedNSS: Pediatric Nutrition Surveillance System - low income, high risk children (birth-5 years). Measures height, weight, birth weight, hematocrit, hemoglobin, cholesterol, breast-feeding. Monitors growth and nutritional status and infant feeding practices.
- PNSS: Pregnancy Nutrition Surveillance System - low income, high risk pregnant women. Maternal weight gain, anemia, pregnancy behavioral risk-factors (smoking/alcohol), birth weight, counts # of women who breast-feed. Identifies and reduces pregnancy related health risks.
- NHANES: National Health and Nutrition Examination Survey - ongoing survey to obtain info on the health of Americans. Evaluates clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometric, nutritional data (24 hour recall, FFQ).
- NHANES III: oversampling of adults 65 and older with NO upper age limit.
-WWEIA: What We Eat in America (also known as National Food and Nutrition Survey NFNS) - dietary intake component of NHANES. 2 days of 24 hour dietary recall (times and foods eaten away from home). USDA over samples 60 and older, African Americans and Hispanics.
NHANES is a program of the Department of Health Statistics (DHS) under the CDC. The WWEIA survey is administered by the USDA and the DHHS.
- USDA Nationwide Food Consumption Survey (NFCS) - food intake of individuals and household across US. 7 nutrients (protein calcium, iron, thiamine, riboflavin, vitamins C and A). Good: intakes > or equal to RDA or Poor: intakes < 2/3 of RDA for one or more nutrients
Who conducts PedNSS and PNSS?
US Department of Health and Human Services (USDHHS)
What 3 national systems/surveys evaluate knowledge, attitudes and behaviors?
BRFSS: Behavioral Risk Factor Surveillance System - adults 18 and older with telephones. Telephone interviews collect height, weight, smoking, alcohol use, FFQ for fat, fruits and vegetables, preventable health problems and diabetes
YRBSS: Youth Risk Behavior Surveillance System - Grades 9-12. Smoking, alcohol, weight control, exercise, eating habits. Prevalence of health risk behaviors among young people.
Health and Diet Survey: telephone survey of randomly selected adults. Tracks self-perception of relative nutrient intake levels, use of food label. knowledge of fats and cholesterol, prevalence of supplement use, awareness of diet and disease (High blood pressure = sodium intake). Survey results help inform FDA’s efforts aimed at improving consumer diet and nutrition-related knowledge and behaviors.
All fall under USDHHS
Who determines eligibility for TANF (Temporary Assistance for Needy Families)?
States determine eligibility and services provided
What 2 programs fall under the USDA Commodity Food Donation/Distribution Program?
- CSFP: Commodity Supplemental Food Program - administered by state health agencies. Monthly commodity canned or packaged foods. Low income women (pregnant, breast-feeding, postpartum), infants and children up to 6 years of age and some elderly (at nutritional risk)
- TEFAP: The Emergency Food Assistance Program - -quarterly distributions of foods by local, public or private nonprofit agencies, food banks, soup kitchens, homeless shelters. Supplements diets of low income households.
These programs also strengthen the agricultural market for products produced by American farmers.
What USDA nutrition assistance programs are entitlement programs?
- NSLP: National School Lunch Program (FNS branch of USDA)
- NSBP: National School Breakfast Program
- SFSP: Summer Food Service Program
- SNAP: Supplemental Nutrition Assistance Program (largest food assistance program)
Note: WIC is NOT an entitlement program
What are the nutrition requirements for meals served via NSLP?
- Implement the Dietary Guidelines
- Lunch must provide on average, over each school week: 1/3 recommended intake for protein, vitamins A and C, iron, calcium
- Grades 9-12: 2 ounces meat serving; nuts must be combined and only used for half the requirement.
- Graham flour is considered a whole grain
- K-5: 3/4 cup vegetables is one serving
- 100% full-strength fruit juice may be used as 1/2 of weekly servings of fruit.
Note: School Meals Initiative for Healthy Children provides recipes, training and support
Note: Cash grants and food donations: dollars reimburse schools on basis of number of meals served
What are the nutrition requirements for the USDA National School Breakfast Program (NSBP)?
- Must meet Dietary Guidelines
- Breakfast must provide on average over each school week: 1/4 daily recommended levels for protein, calcium, iron, vitamins A and C
What nutrition assistance program receives cash subsidies for each snack served?
ASP: After School Snack Program (USDA)
What is the objective of the Special Milk Program (SMP)?
To provide subsidy for milk served to children in participating schools, residential child care centers, summer camps not participating in other federally subsidized meal programs and free milk to the needy. Purpose is to encourage milk consumption by children.
What is the objective of the Summer Food Service Program (SFSP)?
Objective is to provide meals or snacks to children at participating institutions in poor areas. The purpose is to maintain and expand foodservice programs to children when school is not in session. Administered by FNS, state educational agencies, and public or private nonprofit residential summer camps.
What USDA program supports public and nonprofit food service programs for family day care centers, neighborhood houses, homeless shelters, and nonresidential adult daycare centers?
Child and Adult Care Food Program (CACFP)
(meals must meet guidelines; must offer free or reduced price to eligible)
-Eligibility standards same as NSLP
What are the eligibility criteria for free/reduced price lunch for the National School Lunch Program?
Children in households with incomes below 130 percent of the poverty level or those receiving SNAP or TANF qualify for free meals. Those with family incomes between 130 and 185 percent of the poverty line qualify for reduced-price meals.
What are the required meal component offerings for both school breakfast and lunch?
The meal patterns require daily and weekly amounts of five food components for lunch (milk, fruits, vegetables, grains, and meat/meat alternates) and three food components for breakfast (milk, fruits, and grains).
To be reimbursable lunch a child must include 3 of the 5 components with 1 of the 3 components being 1/2 cup fruit or vegetable.
What is the Fresh Fruit and Vegetable Program (FFVP)?
Introduces children in high need elementary schools to fresh fruits and vegetables that they otherwise wouldn’t have access to; help develop eating habits that improve health, prevent obesity and chronic disease. Free to children nationwide in selected schools.
What is the eligibility criteria for WIC?
- For pregnant, postpartum, breast-feeding women; infants and children up to 5
- Provides food for low income mothers at nutritional risk (abnormal weight gain, history of high risk, LBW, underweight, overweight, anemia)
- Risk: weight, height, head circumference in infants, hemoglobin, hematocrit.
- Health exam is REQUIRED
5.Must meet income standards, be at nutritional risk, and in need of foods offered (iron-fortified formula, cereal, milk, cheese, fruit juice) - Prioritize pregnant and breastfeeding women, infants up to 1 year
Note: Not an entitlement program; cap on the amount of federal dollars allocated
What services does WIC offer?
Food, nutrition education and referrals to other agencies.
WIC FMNP: Farmers Market Nutrition Program: coupons to purchase fresh, locally grown foods at farmers markets.
What USDA program provides grants to universities that assist in community development to train nutrition aides in educating the public?
EFNEP: Expanded Food and Nutrition Education Program
Works with small groups; teaches skills needed to obtain a healthy diet (how to budget, meal planning, shop, cook, etc.)
What nutrition assistance programs fall under the Social Security Act?
- Maternal and Child Health Block Grant (USDHHS) - fosters public health nutrition programs at the state and local levels for women of child-bearing age, infants, and children; state eligibility requirement. Provides training, consultation, funding.
- CHIP: Children’s Health Insurance Program - partnership between federal and state governments; expands health coverage to uninsured children whose families earn too much income to qualify for Medicaid but too little to afford private coverage.
What are the differences between Healthy Start and Head Start?
Both fall under USDHHS but:
Healthy Start: reduce infant mortality and improve health of low income women, infants, children and families.
Head Start: Helps low income children ages 3-5 by introducing new foods. and teaching good food habits. Child’s participation in food activities is important.
What program does the USDHHS, Administration on Aging (AoA) oversee?
OAA: Older Americans Act Nutrition Program (formerly ENP: Elderly Nutrition Program)
1. one hot meal each day, 5 days/week, provides 1/3 recommended intake
2. eligibility: all aged 60 years and older plus spouse, regardless of income
3. Congregate Meals: ambulatory; transportation essential for rural elderly
4. Home delivered meals (Meals on Wheels) - must be homebound
5. Counseling, nutrition education, referrals, social interaction (may be asked for voluntary donation but not requried)
Funded by NSIP: Nutrition Services Incentive Program- under USDA; developed to foster independent living; cash and commodities to state agencies
Describe the components of the Supplemental Nutrition Assistance Program (SNAP)?
- Largest food assistance program; entitlement
- Assist low-income with monthly benefits; net income must be at or below certain % of the poverty level; income limits vary by household size and are adjusted to the cost off living
- Designed to increase purchasing power; not for non-food items
- Figures are adjusted to reflect cost of food in Thrifty Food Plan for June of the preceding year - least costly of USDA four food plan (the thrifty, low-cost, moderate-cost, and liberal food plan)
- SNAP nutrition education program is provided to program participants
- Sales tax cannot be charged on foods purchased with SNAP
- Under USDA
Describe Medicare and Medicaid Services.
- Medicare - federal (USDHHS) health insurance program for people over 65; of any age with end-stage renal disease; employers and employees pay
-Part A: hospital insurance
-Part B: optional insurance for supplementary benefits (MNT, diabetes) - Medicaid - federal law administered by states (DHHS)
-payment for medical care for all eligible needy: all ages, blind, disabled, dependent children
-States mostly determine eligibility criteria and structure
CMS
Provided by the Affordable Care Act (ACA), what service is provided to Medicare beneficiaries?
Wellness Visit (AWV)
RDs are listed as eligible medical professionals who may screen and counsel Medicare beneficiaries.
What are the criteria to receive the Intensive Behavioral Therapy (IBT) benefit for obese in Medicare Part B?
BMI must be >30 and continued treatment is contingent upon weight loss assessed at the seventh month mark. Coverage is only granted in primary care setting and can only be provided by a physician.
What amendment to the School Lunch Act provides nutrition education training to teachers and school foodservice personnel?
NETP: Nutrition Education and Training Program (USDA)
What is provided by the Senior Farmers Market Nutrition Program (SFMNP)?
Grants to states to provide low income seniors with coupons to be exchanged for eligible foods at farmers markets, roadside stands, community supported agriculture programs (CSA). Nutrition education and information is provided (how to select, store, and prepare). Fresh, nutritious, unprepared fruits, vegetables, herbs and honey. May be limited to specific and locally grown foods. Under USDA.
What are the 3 categories of agencies that provide consumer education resources, health services and public health programs?
- Quasi-governmental agencies (receive both federal and private funds) -American Red Cross and National Research Council - Food an Nutrition Board (developed RDAs)
- Non-governmental agencies
a. Voluntary health agencies: private, nonprofit organizations chartered and licensed by a government agency, funded by contributions from citizens or organizations (ex: American Health Association)
b. Professional organizations (AND)
c. Foundations, business, industry - International agencies - FAO (Food and Agricultural Organization): raising world-wide levels of nutrition by increasing efficiency of production and distribution of foods.
What nutrition diagnostic domain would swallowing difficulty and altered GI function fall under?
NC: Clinical
What nutrition diagnostic domain would underweight, involuntary weight loss and overweight fall under?
NC: Clinical
What nutrition diagnostic domain would hypometabolism and increased energy expenditure fall under?
NI: Intake
What nutrition diagnostic domain would disordered eating pattern and undesirable food choices fall under?
NB: Behavioral-environmental
What nutrition diagnostic domain would inactivity, excessive exercise and impaired ability to prepare foods fall under?
NB: Behavioral-environmental
What part of the PES statement includes subjective data?
Symptoms: changes expressed by the patient
The signs include objective data and observable changes
What part of the nutrition diagnosis should the intervention address?
Etiology
When your intervention cannot address the etiology, your goal should be to lessen the signs and symptoms
What is the difference between the nutrition diagnoses altered GI function (NC: 1.4) and impaired nutrient utilization (NC 2.1)?
Altered GI function looks at problems inside the GI tract including exocrine functions of the liver and pancreas, with changes in DIGESTION, ABSORPTION, and/or ELIMINATION (abnormal digestive enzymes, IBS, nausea, constipation, steatorrhea)
Impaired nutrient utilization refers to problems with the METABOLISM of nutrients once they have entered the circulatory system, including endocrine function of the pancreas, liver, pituitary, and parathyroid (thin/wasted appearance, pituitary hormones, hypo/hyper glycemia, inborn errors of metabolism, abnormal LFTs. liver/renal failure)
Under which part of the NCP would you specify time and frequency of care?
Intervention
Describe the difference between primary, secondary and tertiary prevention.
Primary prevention: Health promotion. Reduced exposure to a promoter of a disease (early screening for risk factors like diabetes)
Secondary prevention: Risk reduction. Recruiting those with elevated risk factors into treatment (setting up an employee’s gym)
Tertiary prevention: Rehabilitation efforts. As disease progresses, intervention to reduce severity and manage complications.
What organizations monitor health care fraud such as food fads?
FTC: Federal Trade Commission
NCAHF: National Council Against Health Fraud
Ensuring information is fair, balanced and consistent falls under which aspect of the CARS checklist?
Reasonableness
CARS=
Credibility
Accuracy
Reasonableness
Support
In a hospital, when does the discharge plan begin?
Day 1 of a hospital stay
Under HIPPA guidelines, how would you make a correction on a written medical record?
Draw single line through error, then enter the correction, initial, date
When entering previously omitted information, write an addendum in chart sequence, identify it as an addendum, enter date and initial
What causes reactive or alimentary hypoglycemia?
Dumping syndrome: About 2 hours after the initial symptoms appear (cramps, rapid pulse, weakness, perspiration, dizziness from water being drawn into the jejunum/out of vascular compartments for CHO digestion) the CHO is rapidly absorbed and blood sugar rises, stimulating an overproduction of insulin causing a drop in blood sugar below fasting.
What are the nutrients of focus for a patient who underwent a Bilroth II?
Bilroth II: gastrojejunostomy
Calcium: most rapid absorption in duodenum
Iron: requires acid
B12: Lack of IF and bacterial overgrowth (pernicious anemia)
Folate: needs B12 for transport into cells; low serum iron (cofactor in folate metabolism)
Decreased secretion of secretin and pancreozymin by the duodenum (because its been bypassed) so there is little pancreas stimulation and secretion.
