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*RD Exam > Domain II > Flashcards

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
Q

NFPE - tongue

A

smooth, slick, purple, white coating

vitamin or iron

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26
Q

NFPE - gums

A

sore, red, swollen, bleeding

vitamin c

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27
Q

NFPE - teeth

A

missing, loose, loss of enamel

calcium deficiency, poor intake

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28
Q

NFPE - skin

A

pale, dry, scaly

iron, folic acid, zinc

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29
Q

NFPE - nails

A

brittle, thin, spoon-shaped

iron or protein

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30
Q

Serum albumin

A

3.5 - 5.0 g/dL

maintains colloidal osmotic pressure
hypoalbuminemia a/w edema (fluid travels into interstitial space)
high albumin = dehydration

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31
Q

serum transferrin

A

> 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
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32
Q

TTHY, PAB

transthyretin, prealbumin

A

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
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33
Q

RBP

retinol-binding protein

A

3-6 mg/dL

12 hour half life
circulates with prealbumin
binds and transports retinol

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34
Q

Hct

A

Men 42-52%
Women 37-47%
Pregnant women 33%
Newborn 44-64%

*volume of packed cells in whole blood

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35
Q

Hgb

A

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

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36
Q

Serum ferritin

A

10-150 ng/mL - female
12-300 ng/mL - male

indicates size of iron storage pool

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37
Q

Serum creatinine

A

0.6-1.4 mg/dL

related to muscle mass, measures somatic protein
may indicate renal disease and muscle wastage
Use with BUN

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38
Q

CHI

Creatinine height index

A

normal = 80%

ratio of creatinine excreted / 24 hours to height
estimates LBM - somatic protein
60-80% = mild muscle depletion

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39
Q

BUN

A

10-20 mg/dL

related to protein intake
indicator of renal dz

BUN:creatinine ratio
normal = 10-15:1

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40
Q

Urinary creatinine clearance

A

115 +/- 20 mL/minute

measures GFR
estimate includes BSA

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41
Q

TLC

total lymphocyte count

A

> 2700 cells/cu mm

measures immunocompetency
decreased in protein-energy malnutrition

moderate depletion = 900-1800
severe depletion = <900

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42
Q

CRP

c-reactive protein

A

marker of acute inflammatory stress

as it declines, indicates when nutritional therapy would benefit

when elevated CRP decreases, PAB increases

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43
Q

FEP

Free erythrocyte protoporphyrin

A

direct measure of toxic effects of lead on heme synthesis
increased in lead poisoning

lead depletes iron leading to anemia

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44
Q

PT

prothrombin time

A

11.0-12.5 seconds
85-100% of normal

anticoagulants prolong PT
change in vitamin K intake will alter rate

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45
Q

Activity Factors and BEE

A

BEE x 1.2 sedentary
BEE x 1.3 active
BEE x 1.5 stressed

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46
Q

megestrol acetate

A

appetite stimulant

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47
Q

orlistat

A

decrease fat absorption by binding lipase

vitamin / mineral supplement needed

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48
Q

marinol

A

appetite stimulant

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49
Q

Statins (HMG CoA reductase inhibitors)

A

decreased LDL, TG

Increase LDL

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50
Q

Chemotherapy

A

malabsorption

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51
Q

mineral oil, cholestyramine

A

decrease absorption of fat and fat-sol vitamins

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52
Q

glucocorticoids

A

protein deficits

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53
Q

oral contraceptives

A

decrease folate, B6, C

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54
Q

loop diuretics

A

deplete thiamin, K, Mg, Ca, NaCl

55
Q

thiazide diuretics

A

decrease K and Mg

ABSORB Ca

56
Q

antibiotics

A

decrease vitamin K

protein deficits

57
Q

steroids

A

decrease bone growth, CHO intolerance

58
Q

methotrexate

A

chemotherapy agent

decrease folate

59
Q

lithium carbonate (anti-depressant)

A

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
Q

anticoagulant (warfarin)

A

antagonizes vitamin K

avoid high dose vitamin A and E

61
Q

phenobarbital

A

decreased folic acid, vitamins B12, D, K, B6

62
Q

cyclosporine (immunosuppressant)

A

hyperlipidemia, hyerglycemia, hyperkalemia, HTN

63
Q

Isoniazid (treats TB)

INH

A

depletes pyridoxine, causing peripheral neuropathy

Don’t take with food, interferes with vitamin D, Ca, and P

64
Q

Elavil (anti-depressant)

A

sedative effect, weight gain, increased appetite

65
Q

Vitamin B6 and protein

A

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
Q

Cyramine

A

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
Q

Motivation and Attention Span

A

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
Q

Assessing Community Needs

A

whether nutritional resources are adequate
what groups are potentially at high nutritional risk
how well health needs are being met by existing programs

69
Q

HRA

A

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
Q

Incidence

A

( # of NEW cases of a disease in a period of time / total number of people at RISK ) x 100,000

71
Q

Prevalence

A

( total # of people with dz during a period of time / average number of people) x 100,000

72
Q

Food Security

A

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
Q

Community Food Security Initiative

A

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
Q

Food Insecurity

A

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
Q

Nutrition Survey

A

examination of a population group at a particular point of time

cross-sectional, pin-points problems

76
Q

Nutrition Surveillance

A

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
Q

NSI

A

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
Q

NNMRRP

A

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
Q

PedNSS

A

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
Q

PNSS

A

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
Q

NHANES

A

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
Q

WWEIA

A

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
Q

NFCS

A

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
Q

BRFSS

A

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
Q

YRBSS

A

Youth Risk Behavior Surveillance Systems
HHS

Grades 9-12

smoking, alcohol use, wt control, exercise, eating habits

86
Q

Health and Diet Survey

A

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
Q

TANF

A

Temporary Assistance to Needy Families

STATES determine eligibility & benefits

88
Q

Commodity Food Donation and Distribution Program

A

USDA

food - to meet nutritional needs - children and adults
helps American farmers

89
Q

CSFP

A

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
Q

TEFAP

A

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
Q

NSLP

A

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
Q

NSBP

A

Breakfast
USDA
Entitlement

1/4 rec. protein, calcium, iron, vitamin A, vitamin C

93
Q

ASP

A

After School Snack
USDA

cash subsidies for each snack

94
Q

SMP

A

Special Milk Program
USDA

subsidy for milk

95
Q

SFSP

A

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
Q

CACFP

A

Child and Adult Care Food Program
USDA

food service
nutrition education

97
Q

FFVP

A

Fresh F&V Program
USDA

eating habits that improve health

98
Q

WIC

A

USDA

health exam req.
not an entitlement

99
Q

EFNEP

A

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
Q

Maternal and Child Health Block Grant

A

HHS

Title V of SSA

101
Q

Healthy Start

A

HHS

reduces infant mortality and improve health of low income women, infants, children, and families

102
Q

NSIP

A

Nutrition Services Incentive Program
AoA

OAA

103
Q

OAA

A

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
Q

SNAP

A

USDA

entitlement, largest food assistance program

105
Q

CMS

A

Medicare and Medicaid
HHS

Part A - hospital insurance
Part B - optional insurance for supplementary benefits

106
Q

AWV

A

Annual Wellness Visit
ACA Medicare
RD’s are eligible medical professionals

107
Q

Medicaid

A

HHS

federal administered by states

108
Q

CHIP

A

Children’s Health Insurance Program
SSA
Fed and State
covers families between Medicaid and private coverage

109
Q

Headstart

A

HHS

low income, ages 3-5
new foods, good habits
children’s participation in activities is key

110
Q

NETP

A

Nutrition Ed Training Program
USDA 1977
Amendment to school lunch act

111
Q

SFMNP

A

Senior Farmers’ Market Nutrition Program
USDA
coupons for eligible food at farmers markets

112
Q

FAO

A

Food and Agricultural Organization

international agency most directly concerned with food

113
Q

Nutrition Diagnosis

A

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
Q

Clinical Diagnostic Domain (NC)

A

nutritional findings/problems that relate to medical / physical condition

functional balance
biochemical balance
weight balance

115
Q

Functional Balance NC

A

physical or mechanical change that interferes / prevents desired nutritional results

swallowing / chewing or altered GI function

116
Q

Biochemical balance NC

A

change in capacity to METABOLIZE nutrients due to medications, surgery, or indicated by lab values

117
Q

Weight Balance NC

A

chronic or changed weight states when compared with UBW

involuntary weight loss

118
Q

Intake Diagnostic Domain (NI)

A

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
Q

Behavioral-environmental Diagnostic Domain (NB)

A

related to knowledge, access to food, and food safety

120
Q

PES

A

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
Q

Evaluating PES Statements

A
  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
Q

NC 1.4 Altered GI function

A

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
Q

NC 2.1 Impaired Nutrient Utilization

A

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
Q

Etiology

A

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
Q

Critical Thinking Skills - Diagnosis

A
  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
Q

Nutrition Intervention

A

Four categories:

Food delivery
Education
Counseling
Coordination of care with other providers

127
Q

Nutrition Care Planning

A

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
Q

Critical Thinking Skills - Intervention

A 
Setting goals and prioritizing
Defining nutrition prescription or plan
Making interdisciplinary connections
Initiating interventions
Specifying time and frequency of care
129
Q

Primary Prevention Programs

A

Reduced exposure to a promoter of disease (ex: early screening for risk factors)

Health promotion

130
Q

Secondary Prevention

A

Recruiting those with elevated risk factors into treatment

Risk reduction

131
Q

Tertiary Prevention

A

As disease progresses, intervention to reduce severity, manage complications

Rehabilitation efforts

132
Q

FTC

Federal Trade Commission

A

Internet, TV, radio

bogus weight loss claims

133
Q

NCAHF

A

National Council Against Health Fraud

134
Q

CARS Checklist

A

Credibility: credentials of author

Accuracy: info is current, factual, comprehensive

Reasonableness: is info fair, balanced, consistent

Support: is supporting documentation cited for scientific statements

*RD Exam (3 decks)

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