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