Domain II Flashcards
SGA
Subjective Global Assessment
- history
- intake
- GI symptoms
- functional capacity
- physical appearance
- edema
- weight change
MNA
Mini Nutritional Assessment
- evaluates independence, medications, number of full meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding
- 65+
NSI
Nutrition Screening Initiative
- elderly
GNRI
Geriatric Nutritional Risk Index
- serum albumin
- Weight changes
MST
Malnutrition Screening Tool
- acute hospitalized adult population
- recent weight loss, recent poor dietary intake
NRS
Nutrition Risk Screening
- medical-surgical hospitalized
- % wt. loss, BMI, intake
- > 70 yeras old
MUST
Malnutrition Universal Screening Tool
- BMI, unintentional weight loss, effect of acute disease on intake for more than 5 days
Nutrition Indicators
clearly defined markers that can be observed and measured
also used to monitor and evaluate progress toward nutrition outcomes
Nutrition Care Criteria
what indicators are compared against
24 hour recall
best tool for a clinical setting when the dietitian is involved because the RD can clarify amounts and other factors
Critical Thinking - Nutrition Care Process
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
Joint Commission
Nutrition risk in hospitalized patients should be identified within 24 hour of admission, but no mandate of a method for screening
Critical thinking skills needed for nutrition assessment
- observe verbal/nonverbal cues that can guide effective interviewing methods
- determine appropriate data to collect
- select tools and procedure sand apply in valid, reliable ways
- distinguish relevant from irrelevant and important from unimportant data
- validate, organize and categorize data
amputation percentages for IBW adjustment
entire leg = 16%
lower leg = 6%
entire arm = 5%
forearm = 2.3%
spinal cord injury IBW adjustment
quadriplegic: reduce by 10-15%
paraplegic: reduce by 5-10%
TSF
tricep skinfold thickness
measures body fat and calorie reserves
Male: 12.5mm
Female: 16.5mm
AMA
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
Waist circumference
M: >40
F: >35
independent risk factor for disease when out of proportion to total body fat (with BMI 25-34.9)
WHR
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
BIA
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
Bod Pod
air displaced
accuracy = underwater weighting
NFPE - hair
thin, sparse, dull dry brittle, easily pluckable
vitamin C, protein deficiency
NFPE - eyes
pale, dry, poor vision
Vitamin A, zinc or riboflavin
NFPE - lips
swollen, red, dry, cracked
riboflavin, pyridoxine, niacin
NFPE - tongue
smooth, slick, purple, white coating
vitamin or iron
NFPE - gums
sore, red, swollen, bleeding
vitamin c
NFPE - teeth
missing, loose, loss of enamel
calcium deficiency, poor intake
NFPE - skin
pale, dry, scaly
iron, folic acid, zinc
NFPE - nails
brittle, thin, spoon-shaped
iron or protein
Serum albumin
3.5 - 5.0 g/dL
maintains colloidal osmotic pressure
hypoalbuminemia a/w edema (fluid travels into interstitial space)
high albumin = dehydration
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
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
RBP
retinol-binding protein
3-6 mg/dL
12 hour half life
circulates with prealbumin
binds and transports retinol
Hct
Men 42-52%
Women 37-47%
Pregnant women 33%
Newborn 44-64%
*volume of packed cells in whole blood
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
Serum ferritin
10-150 ng/mL - female
12-300 ng/mL - male
indicates size of iron storage pool
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
CHI
Creatinine height index
normal = 80%
ratio of creatinine excreted / 24 hours to height
estimates LBM - somatic protein
60-80% = mild muscle depletion
BUN
10-20 mg/dL
related to protein intake
indicator of renal dz
BUN:creatinine ratio
normal = 10-15:1
Urinary creatinine clearance
115 +/- 20 mL/minute
measures GFR
estimate includes BSA
TLC
total lymphocyte count
> 2700 cells/cu mm
measures immunocompetency
decreased in protein-energy malnutrition
moderate depletion = 900-1800
severe depletion = <900
CRP
c-reactive protein
marker of acute inflammatory stress
as it declines, indicates when nutritional therapy would benefit
when elevated CRP decreases, PAB increases
FEP
Free erythrocyte protoporphyrin
direct measure of toxic effects of lead on heme synthesis
increased in lead poisoning
lead depletes iron leading to anemia
PT
prothrombin time
11.0-12.5 seconds
85-100% of normal
anticoagulants prolong PT
change in vitamin K intake will alter rate
Activity Factors and BEE
BEE x 1.2 sedentary
BEE x 1.3 active
BEE x 1.5 stressed
megestrol acetate
appetite stimulant
orlistat
decrease fat absorption by binding lipase
vitamin / mineral supplement needed
marinol
appetite stimulant
Statins (HMG CoA reductase inhibitors)
decreased LDL, TG
Increase LDL
Chemotherapy
malabsorption
mineral oil, cholestyramine
decrease absorption of fat and fat-sol vitamins
glucocorticoids
protein deficits
oral contraceptives
decrease folate, B6, C
loop diuretics
deplete thiamin, K, Mg, Ca, NaCl
thiazide diuretics
decrease K and Mg
ABSORB Ca
antibiotics
decrease vitamin K
protein deficits
steroids
decrease bone growth, CHO intolerance
methotrexate
chemotherapy agent
decrease folate
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
anticoagulant (warfarin)
antagonizes vitamin K
avoid high dose vitamin A and E
phenobarbital
decreased folic acid, vitamins B12, D, K, B6
cyclosporine (immunosuppressant)
hyperlipidemia, hyerglycemia, hyperkalemia, HTN
Isoniazid (treats TB)
INH
depletes pyridoxine, causing peripheral neuropathy
Don’t take with food, interferes with vitamin D, Ca, and P
Elavil (anti-depressant)
sedative effect, weight gain, increased appetite
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)
Cyramine
HTN if taken with MAOI
- eliminate dopamine and restrict tyramine. MAOI interact, releasing norepinephrine, which elevates BP
- restrict aged, fermented, dried, pickled, smoked and spoiled foods
- avoid hard, aged cheese (cheddar, swiss), sauerkraut, some sausages, luncheon meats, tofu, miso, chianti wine. Limit sour cream, yogurt, buttermilk.
- OKAY: cottage cheese, cream cheese
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
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
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
Incidence
( # of NEW cases of a disease in a period of time / total number of people at RISK ) x 100,000
Prevalence
( total # of people with dz during a period of time / average number of people) x 100,000
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
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
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
Nutrition Survey
examination of a population group at a particular point of time
cross-sectional, pin-points problems
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
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
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
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
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
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
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
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
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
YRBSS
Youth Risk Behavior Surveillance Systems
HHS
Grades 9-12
smoking, alcohol use, wt control, exercise, eating habits
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)
TANF
Temporary Assistance to Needy Families
STATES determine eligibility & benefits
Commodity Food Donation and Distribution Program
USDA
food - to meet nutritional needs - children and adults
helps American farmers
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
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
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
NSBP
Breakfast
USDA
Entitlement
1/4 rec. protein, calcium, iron, vitamin A, vitamin C
ASP
After School Snack
USDA
cash subsidies for each snack
SMP
Special Milk Program
USDA
subsidy for milk
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
CACFP
Child and Adult Care Food Program
USDA
food service
nutrition education
FFVP
Fresh F&V Program
USDA
eating habits that improve health
WIC
USDA
health exam req.
not an entitlement
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
Maternal and Child Health Block Grant
HHS
Title V of SSA
Healthy Start
HHS
reduces infant mortality and improve health of low income women, infants, children, and families
NSIP
Nutrition Services Incentive Program
AoA
OAA
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
SNAP
USDA
entitlement, largest food assistance program
CMS
Medicare and Medicaid
HHS
Part A - hospital insurance
Part B - optional insurance for supplementary benefits
AWV
Annual Wellness Visit
ACA Medicare
RD’s are eligible medical professionals
Medicaid
HHS
federal administered by states
CHIP
Children’s Health Insurance Program
SSA
Fed and State
covers families between Medicaid and private coverage
Headstart
HHS
low income, ages 3-5
new foods, good habits
children’s participation in activities is key
NETP
Nutrition Ed Training Program
USDA 1977
Amendment to school lunch act
SFMNP
Senior Farmers’ Market Nutrition Program
USDA
coupons for eligible food at farmers markets
FAO
Food and Agricultural Organization
international agency most directly concerned with food
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
Clinical Diagnostic Domain (NC)
nutritional findings/problems that relate to medical / physical condition
functional balance
biochemical balance
weight balance
Functional Balance NC
physical or mechanical change that interferes / prevents desired nutritional results
swallowing / chewing or altered GI function
Biochemical balance NC
change in capacity to METABOLIZE nutrients due to medications, surgery, or indicated by lab values
Weight Balance NC
chronic or changed weight states when compared with UBW
involuntary weight loss
Intake Diagnostic Domain (NI)
actual problems related to intake
- caloric energy balance: hypermetabolism, hypometabolism, increased energy expenditure
- oral or nutrition support intake: compared to goal
- fluid intake balance
- bioactive substances: supp., alcohol, functional foods
- nutrient balance: intake compared to desired levels
Behavioral-environmental Diagnostic Domain (NB)
related to knowledge, access to food, and food safety
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
Evaluating PES Statements
- Can you resolve or improve the nutrition diagnosis for this person/group? INTAKE diagnoses are more specific to RDs
- Is the etiology you selected the “root cause” that can be addressed with nutrition intervention? Or can you at least lessen the s/s?
- 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?
- Does assessment data support a particular diagnosis with a typical etiology and s/s?
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
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
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
Critical Thinking Skills - Diagnosis
- Finding patterns and relationships among the data and possible causes
- Making inferences (if ___ continues, then ____ will likely happen)
- State problem clearly and be objective
- Rule in or out specific diagnoses; prioritize relative importance of problems
Nutrition Intervention
Four categories:
Food delivery
Education
Counseling
Coordination of care with other providers
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
Critical Thinking Skills - Intervention
Setting goals and prioritizing Defining nutrition prescription or plan Making interdisciplinary connections Initiating interventions Specifying time and frequency of care
Primary Prevention Programs
Reduced exposure to a promoter of disease (ex: early screening for risk factors)
Health promotion
Secondary Prevention
Recruiting those with elevated risk factors into treatment
Risk reduction
Tertiary Prevention
As disease progresses, intervention to reduce severity, manage complications
Rehabilitation efforts
FTC
Federal Trade Commission
Internet, TV, radio
bogus weight loss claims
NCAHF
National Council Against Health Fraud
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
