Domain II Flashcards

1
Q

SGA

A

Subjective Global Assessment

  • history
  • intake
  • GI symptoms
  • functional capacity
  • physical appearance
  • edema
  • weight change
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2
Q

MNA

A

Mini Nutritional Assessment

  • evaluates independence, medications, number of full meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding
  • 65+
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3
Q

NSI

A

Nutrition Screening Initiative

- elderly

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4
Q

GNRI

A

Geriatric Nutritional Risk Index

  • serum albumin
  • Weight changes
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5
Q

MST

A

Malnutrition Screening Tool

  • acute hospitalized adult population
  • recent weight loss, recent poor dietary intake
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6
Q

NRS

A

Nutrition Risk Screening

  • medical-surgical hospitalized
  • % wt. loss, BMI, intake
  • > 70 yeras old
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7
Q

MUST

A

Malnutrition Universal Screening Tool

- BMI, unintentional weight loss, effect of acute disease on intake for more than 5 days

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8
Q

Nutrition Indicators

A

clearly defined markers that can be observed and measured

also used to monitor and evaluate progress toward nutrition outcomes

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9
Q

Nutrition Care Criteria

A

what indicators are compared against

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10
Q

24 hour recall

A

best tool for a clinical setting when the dietitian is involved because the RD can clarify amounts and other factors

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11
Q

Critical Thinking - Nutrition Care Process

A

Integrates facts, informed opinions, active listening, and observations.

A reasoning process where ideas are produced and evaluated.

Includes ability to conceptualize, think rationally, think creatively, be inquiring, and think autonomously

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12
Q

Joint Commission

A

Nutrition risk in hospitalized patients should be identified within 24 hour of admission, but no mandate of a method for screening

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13
Q

Critical thinking skills needed for nutrition assessment

A
  1. observe verbal/nonverbal cues that can guide effective interviewing methods
  2. determine appropriate data to collect
  3. select tools and procedure sand apply in valid, reliable ways
  4. distinguish relevant from irrelevant and important from unimportant data
  5. validate, organize and categorize data
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14
Q

amputation percentages for IBW adjustment

A

entire leg = 16%
lower leg = 6%
entire arm = 5%
forearm = 2.3%

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15
Q

spinal cord injury IBW adjustment

A

quadriplegic: reduce by 10-15%
paraplegic: reduce by 5-10%

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16
Q

TSF

A

tricep skinfold thickness

measures body fat and calorie reserves

Male: 12.5mm
Female: 16.5mm

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17
Q

AMA

A

arm muscle area

Measures skeletal muscle mass = somatic protein
Use TSF and AC (arm circumference)

Male: 25.3cm
Female: 23.2cm

*Important for growing children

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18
Q

Waist circumference

A

M: >40
F: >35

independent risk factor for disease when out of proportion to total body fat (with BMI 25-34.9)

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19
Q

WHR

A

waist/hip ratio

1.0 or greater in men
0.8 or greater in women
indicative of android obesity and increased risk for obesity-related diseases

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20
Q

BIA

A

measures fat-free mass and total body water

well hydrated, no caffeine, alcohol, or diuretics in past 24 hours
no exercise in past 4-6 hours

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21
Q

Bod Pod

A

air displaced

accuracy = underwater weighting

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22
Q

NFPE - hair

A

thin, sparse, dull dry brittle, easily pluckable

vitamin C, protein deficiency

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23
Q

NFPE - eyes

A

pale, dry, poor vision

Vitamin A, zinc or riboflavin

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24
Q

NFPE - lips

A

swollen, red, dry, cracked

riboflavin, pyridoxine, niacin

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25
NFPE - tongue
smooth, slick, purple, white coating vitamin or iron
26
NFPE - gums
sore, red, swollen, bleeding vitamin c
27
NFPE - teeth
missing, loose, loss of enamel calcium deficiency, poor intake
28
NFPE - skin
pale, dry, scaly iron, folic acid, zinc
29
NFPE - nails
brittle, thin, spoon-shaped iron or protein
30
Serum albumin
3.5 - 5.0 g/dL maintains colloidal osmotic pressure hypoalbuminemia a/w edema (fluid travels into interstitial space) high albumin = dehydration
31
serum transferrin
> 200 mg/dL - transports iron to bone marrow (visceral protein) - when iron pool decreases, transferrin synthesis increases - can be determined from TIBC - Used to detect anemia
32
TTHY, PAB | transthyretin, prealbumin
16-40 mg/dL - picks up changes in protein status (half-life 2-3 d) - during inflammation, liver synthesizes CRP at expense of PAB - limited usefulness in screening or assessment
33
RBP | retinol-binding protein
3-6 mg/dL 12 hour half life circulates with prealbumin binds and transports retinol
34
Hct
Men 42-52% Women 37-47% Pregnant women 33% Newborn 44-64% *volume of packed cells in whole blood
35
Hgb
Men 14-17 gm/dL Women 12-15 gm/dL Pregnant <11 gm/dL iron-containing pigment of RBC erythrocytes are produced in bone marrow
36
Serum ferritin
10-150 ng/mL - female 12-300 ng/mL - male indicates size of iron storage pool
37
Serum creatinine
0.6-1.4 mg/dL related to muscle mass, measures somatic protein may indicate renal disease and muscle wastage Use with BUN
38
CHI | Creatinine height index
normal = 80% ratio of creatinine excreted / 24 hours to height estimates LBM - somatic protein 60-80% = mild muscle depletion
39
BUN
10-20 mg/dL related to protein intake indicator of renal dz BUN:creatinine ratio normal = 10-15:1
40
Urinary creatinine clearance
115 +/- 20 mL/minute measures GFR estimate includes BSA
41
TLC | total lymphocyte count
> 2700 cells/cu mm measures immunocompetency decreased in protein-energy malnutrition moderate depletion = 900-1800 severe depletion = <900
42
CRP | c-reactive protein
marker of acute inflammatory stress as it declines, indicates when nutritional therapy would benefit when elevated CRP decreases, PAB increases
43
FEP | Free erythrocyte protoporphyrin
direct measure of toxic effects of lead on heme synthesis increased in lead poisoning lead depletes iron leading to anemia
44
PT | prothrombin time
11.0-12.5 seconds 85-100% of normal anticoagulants prolong PT change in vitamin K intake will alter rate
45
Activity Factors and BEE
BEE x 1.2 sedentary BEE x 1.3 active BEE x 1.5 stressed
46
megestrol acetate
appetite stimulant
47
orlistat
decrease fat absorption by binding lipase | vitamin / mineral supplement needed
48
marinol
appetite stimulant
49
Statins (HMG CoA reductase inhibitors)
decreased LDL, TG | Increase LDL
50
Chemotherapy
malabsorption
51
mineral oil, cholestyramine
decrease absorption of fat and fat-sol vitamins
52
glucocorticoids
protein deficits
53
oral contraceptives
decrease folate, B6, C
54
loop diuretics
deplete thiamin, K, Mg, Ca, NaCl
55
thiazide diuretics
decrease K and Mg | ABSORB Ca
56
antibiotics
decrease vitamin K | protein deficits
57
steroids
decrease bone growth, CHO intolerance
58
methotrexate
*chemotherapy agent* | decrease folate
59
lithium carbonate (anti-depressant)
increased appetite, weight gain maintain consistent sodium and caffeine intake to stabilize level restricted Na or caffeine - lithium excretion decreases, leading to toxicity - 2g Na is too low
60
anticoagulant (warfarin)
antagonizes vitamin K avoid high dose vitamin A and E
61
phenobarbital
decreased folic acid, vitamins B12, D, K, B6
62
cyclosporine (immunosuppressant)
hyperlipidemia, hyerglycemia, hyperkalemia, HTN
63
Isoniazid (treats TB) | INH
depletes pyridoxine, causing peripheral neuropathy Don't take with food, interferes with vitamin D, Ca, and P
64
Elavil (anti-depressant)
sedative effect, weight gain, increased appetite
65
Vitamin B6 and protein
decrease effectiveness of L-dopa (levodopa) which is used to control PD symptoms take drug in morning with limited protein (competes with drug for absoprtion sites)
66
Cyramine
HTN if taken with MAOI 1. eliminate dopamine and restrict tyramine. MAOI interact, releasing norepinephrine, which elevates BP 2. restrict aged, fermented, dried, pickled, smoked and spoiled foods 3. avoid hard, aged cheese (cheddar, swiss), sauerkraut, some sausages, luncheon meats, tofu, miso, chianti wine. Limit sour cream, yogurt, buttermilk. 4. OKAY: cottage cheese, cream cheese
67
Motivation and Attention Span
High: keen interest, presence is voluntary, has high expectations as to applicability of subject to life Low: mandatory attendance, little interest in topic, may feel there are more important things to do
68
Assessing Community Needs
whether nutritional resources are adequate what groups are potentially at high nutritional risk how well health needs are being met by existing programs
69
HRA
Health Risk Appraisal Survey categorizing a populations general health status - used in worksites, gov agencies as a health education or screening tool - questionnaire, calculations predicting risk of dz, educational messages to the participant
70
Incidence
( # of NEW cases of a disease in a period of time / total number of people at RISK ) x 100,000
71
Prevalence
( total # of people with dz during a period of time / average number of people) x 100,000
72
Food Security
access by ALL PEOPLE at all TIMES to sufficient food for an active and healthy life. ready availability of nutritionally adequate and safe foods and an assured ability to acquire them in a socially acceptable manner
73
Community Food Security Initiative
Development of sustainable, community-based strategies to ensure that all have access to culturally acceptable, nutritionally adequate food at all times - farmer's markets - food recovery and gleaning programs - Prepared and Perishable Food Programs (PPFP's) - nonprofit programs that link sources of unused, cooked, and fresh foods with social service agencies that serve the hungry
74
Food Insecurity
prevalent among emergency food recipients affects all ages, ethnicities and locations impacts working poor extends to government food assistance recipients and those with poor health status
75
Nutrition Survey
examination of a population group at a particular point of time cross-sectional, pin-points problems
76
Nutrition Surveillance
Continuous collection of data identifies problems, sets baseline, sets PRIORITIES, detects changes in trends height, wt. hct, hgb, serum Chol. on-going system linked to active health program: WIC, CDC, EPSDT
77
NSI
Nutrition Screening Initiative promotes nutrition & improved nutrition care for ELDERLY to identify nutritional problems early - DETERMINE checklist: identifies risk factors - LEVEL 1: identifies those who need more comprehensive assessments - LEVEL 2: provides more specific diagnostic info on nutritional status **RD's work in level 2**
78
NNMRRP
National Nutrition Monitoring and Related Research Program includes all data collection and analysis activities of the FEDERAL GOV'T related to measuring health & nutritional status, food consumption, and attitudes about diet and health HHS and USDA
79
PedNSS
Pediatric Nutrition Surveillance System HHS low income, high risk children, birth - 17 y.o., emphasis on birth - 5 y.o. ht, wt., birth-wt, hct, hgb, chol, breast-feeding monitors growth, nutritional status, infant feeding practices
80
PNSS
Pregnancy Nutrition Surveillance System HHS low income, high risk pregnant women maternal wt gain, anemia, pregnancy behavioral risk factors, birth-wt, # of breast feeding women identify and reduce pregnancy-related health risks
81
NHANES
National Health and Nutrition Examination Survey Ongoing survey to obtain info on health of American people chemical (hgb, hct, chol), clinical, anthropometric, nutritional data
82
WWEIA
What We Eat in America aka NFNS = National Food and Nutrition Survey Dietary intake component of NHANES 2 days of 24 hour recall over-sampling of adults >60, african americans, hispanics
83
NFCS
USDA Nationwide Food Consumption Survey food intake in households from entire US 7 nutrients: pro, Ca, Fe, Thiamin, Riboflavin, Vitamin C, A intake > RDA = good intake < 2/3 RDA for 1 or more nutrient = poor
84
BRFSS
Behavioral Risk Factor Surveillance System HHS phone interviews: ht, wt, smoking, alcohol, food freq for fat, F/V, preventable health problems, diabetes measures changes in health risk factors over time - use to make targeted health ads to high risk populations
85
YRBSS
Youth Risk Behavior Surveillance Systems HHS Grades 9-12 smoking, alcohol use, wt control, exercise, eating habits
86
Health and Diet Survey
FDA, HHS phone survey of randomly selected adults self-perception of relative nutrient intake levels use of food labels knowledge of fat/chol, prev. of supp'l use awareness of diet and dz (Hi BP and Na)
87
TANF
Temporary Assistance to Needy Families STATES determine eligibility & benefits
88
Commodity Food Donation and Distribution Program
USDA food - to meet nutritional needs - children and adults helps American farmers
89
CSFP
Commodity Supplemental Food Program USDA administered by STATE health agencies monthly commodity low income women (preg, breast-feeding, & post-partum), infants, children up to 6, some elderly; at nutritional risk
90
TEFAP
The Emergency Food Assistance Program USDA quarterly distributions of commodity foods by local, public, or private nonprofit agencies, food banks, soup kitchens, homeless shelters
91
NSLP
Nat'l School Lunch Program USDA FNS entitlement cash grants and food donations lunch = 1/3 RDA for protein, vitamins A & C, iron, calcium Team Nutrition implements School Meals Initiatives for Healthy Children - motivate child to make healthy choices, help schools meet guidelines - provides recipes, training and support
92
NSBP
Breakfast USDA Entitlement 1/4 rec. protein, calcium, iron, vitamin A, vitamin C
93
ASP
After School Snack USDA cash subsidies for each snack
94
SMP
Special Milk Program USDA subsidy for milk
95
SFSP
Summer Food Service Program USDA entitlement initiate, maintain, or expand foodservice programs when school is not in session provide meals or snacks in poor areas administered by FNS, state agencies, public/private residential summer camps
96
CACFP
Child and Adult Care Food Program USDA food service nutrition education
97
FFVP
Fresh F&V Program USDA eating habits that improve health
98
WIC
USDA health exam req. not an entitlement
99
EFNEP
Expanded Food and Nutrition Education Program USDA grants to universities for community development trains nutrition aides to educate public improves food practices to low income homemakers works with small groups on health skills
100
Maternal and Child Health Block Grant
HHS | Title V of SSA
101
Healthy Start
HHS reduces infant mortality and improve health of low income women, infants, children, and families
102
NSIP
Nutrition Services Incentive Program AoA OAA
103
OAA
Older Americans Act Nutrition Program (formerly ENP) HHS Title III Congregate meals - ambulatory Home delivered meals - Meals on Wheels - homebound Counseling, ed, referrals, social interaction
104
SNAP
USDA entitlement, largest food assistance program
105
CMS
Medicare and Medicaid HHS Part A - hospital insurance Part B - optional insurance for supplementary benefits
106
AWV
Annual Wellness Visit ACA Medicare RD's are eligible medical professionals
107
Medicaid
HHS | federal administered by states
108
CHIP
Children's Health Insurance Program SSA Fed and State covers families between Medicaid and private coverage
109
Headstart
HHS low income, ages 3-5 new foods, good habits children's participation in activities is key
110
NETP
Nutrition Ed Training Program USDA 1977 Amendment to school lunch act
111
SFMNP
Senior Farmers' Market Nutrition Program USDA coupons for eligible food at farmers markets
112
FAO
Food and Agricultural Organization international agency most directly concerned with food
113
Nutrition Diagnosis
Identification and labeling that describes an actual occurrence, risk of, or potential for developing a nutrition problem that dietetics professionals are responsible for treating independently diagnosis links assessment to intervention
114
Clinical Diagnostic Domain (NC)
nutritional findings/problems that relate to medical / physical condition functional balance biochemical balance weight balance
115
Functional Balance NC
physical or mechanical change that interferes / prevents desired nutritional results swallowing / chewing or altered GI function
116
Biochemical balance NC
change in capacity to METABOLIZE nutrients due to medications, surgery, or indicated by lab values
117
Weight Balance NC
chronic or changed weight states when compared with UBW involuntary weight loss
118
Intake Diagnostic Domain (NI)
actual problems related to intake 1. caloric energy balance: hypermetabolism, hypometabolism, increased energy expenditure 2. oral or nutrition support intake: compared to goal 3. fluid intake balance 4. bioactive substances: supp., alcohol, functional foods 5. nutrient balance: intake compared to desired levels
119
Behavioral-environmental Diagnostic Domain (NB)
related to knowledge, access to food, and food safety
120
PES
Problem: adjective that describes the human response (altered, impaired, increased, risk of) Etiology: cause / contributing risk factors Signs: objective data, observable changes Symptoms: subjective changes expressed by the patient
121
Evaluating PES Statements
1. Can you resolve or improve the nutrition diagnosis for this person/group? **INTAKE diagnoses are more specific to RDs** 2. Is the etiology you selected the "root cause" that can be addressed with nutrition intervention? Or can you at least lessen the s/s? 3. Will measuring the S/S indicate if the problem is resolved or improved? Are the s/s specific enough that you can MONITOR and DOCUMENT improvement? 4. Does assessment data support a particular diagnosis with a typical etiology and s/s?
122
NC 1.4 Altered GI function
problems INSIDE the GI tract, including exocrine functions of the liver and pancreas, with changes in digestion, absorption, and/or elimination Some indicators: - abnormal digestive enzyme and fecal fat studies - abdominal distention, N/V/D, steatorrhea, constipation, malabsorption, IBS, diverticulitis
123
NC 2.1 Impaired Nutrient Utilization
problems with METABOLISM of nutrients once they have entered the circulatory system. Includes endocrine functions of pancreas, liver, pituitary and parathyroid Some indicators: - thin, wasted appearance - abnormal liver fx tests, pituitary hormones, hypoglycemia, hyperglycemia - renal failure, liver failure, inborn errors of metabolism
124
Etiology
Identifying the etiology leads to the selection of a nutrition intervention First, aim to resolve the underlying CAUSE of the nutrition problem. If not possible, nutrition intervention should aim to MINIMIZE S/S
125
Critical Thinking Skills - Diagnosis
1. Finding patterns and relationships among the data and possible causes 2. Making inferences (if ___ continues, then ____ will likely happen) 3. State problem clearly and be objective 4. Rule in or out specific diagnoses; prioritize relative importance of problems
126
Nutrition Intervention
Four categories: Food delivery Education Counseling Coordination of care with other providers
127
Nutrition Care Planning
Prioritize nutrition diagnoses Consult EAL and other practice guidelines Determine patient-focused outcomes for each diagnosis Confer with caregivers Define time and frequency of care Identify resources needed
128
Critical Thinking Skills - Intervention
``` Setting goals and prioritizing Defining nutrition prescription or plan Making interdisciplinary connections Initiating interventions Specifying time and frequency of care ```
129
Primary Prevention Programs
Reduced exposure to a promoter of disease (ex: early screening for risk factors) Health promotion
130
Secondary Prevention
Recruiting those with elevated risk factors into treatment Risk reduction
131
Tertiary Prevention
As disease progresses, intervention to reduce severity, manage complications Rehabilitation efforts
132
FTC | Federal Trade Commission
Internet, TV, radio bogus weight loss claims
133
NCAHF
National Council Against Health Fraud
134
CARS Checklist
Credibility: credentials of author Accuracy: info is current, factual, comprehensive Reasonableness: is info fair, balanced, consistent Support: is supporting documentation cited for scientific statements