II A: Assessment & screening Flashcards
steps of the NCP?***
assess, diagnose, intervene, monitor, evaluate (ADIME)
what is the nutrition care process?
STANDARDIZED, CONSISTENT structure and framework to provide nutrition care (solely standardized care = not individualized)
what is nutrition screening?**
use of PRELIMINARY NUTRITION ASSESSMENT TECHNIQUES to identify people who are malnourished or at risk
who can participate in nutrition screening? how long does it take?***
- all health care team members
- brief 5-10 minutes
specificity vs sensitivity
specific - can you find the patients without a condition?
sensitive - can you ID those who have a condition?
if no emerging nutrition problem exists after nutrition screening, what should be done?
document that discharge from nutrition care is appropriate
the Joint Commission & screening***
identify risk within 24 HOURS OF ADM, but DO NOT MANDATE A METHOD of screening
types of screening tools***
SGA, MNA, NSI, GNRI
SGA - what is it? what does it stand for?***
SCREENING tool - Subjective Global Assessment
hx, intake, wt change, functional capacity, physical appearance, edema, ETC., but NO LABS!!
MNA - what is it? what does it stand for?***
SCREENING tool - Mini Nutritional Assessment
ELDERLY
NSI - what is it? what does it stand for?***
SCREENING tool - Nutrition Screening Initiative
ELDERLY
GNRI - what is it? what does it stand for?***
SCREENING tool - Geriatric Nutritional Risk Index
ELDERLY (serum albumin & weight changes)
_____ provides the basis for the nutrition diagnosis
assessment
assessment is initiated by?
referral/screening for nutritional risk factors
types of assessment data
food/nutrition related hx, anthropometrics, labs/medical tests, nutrition-focused physical findings, client hx
the 3 components of assessment are?
RCI review, cluster, identify - look at the pt data, cluster everything together (food hx, anthropometrics, labs, etc.), and then identify them against a standard
components of nutrition assessment**
- food/nutrition-related history
- anthropometrics
- biomedical
- nutrition-focused physical findings
- client history
what are nutrition indicators?
clearly defined markers that can be observed and measured
ways to assess dietary intake?
diet hx, food record, 24 hr recall, FFQ
diet history
PRESENT pattern of eating, no leading Qs
food record
exact record of everything eaten in a specific period of time
24 hour recall
mental recall of everything eaten in past 24 hours; quick tool used in clinical setting
food frequency lists***
how often an item is consumed; large group of people (quick method)
FFQ can be done in what kind of setting? how?**
COMMUNITY- done by THEMSELVES
desirable body weight for women***
HAMWI - 100 lbs + 5 (for each inch past 5’) [subtract 5 for each inch under 5’]
desirable body weight for men***
HAMWI - 106 lbs + 6 (for each inch past 5’) [subtract 6 for each inch under 5’]
desirable/ideal body weight for a small frame? large frame?***
subtract (small) or add (large) 10%
amputations & desirable body weight***
(100- % amputation)/100 x IBW
amputation for entire leg***
16%
amputation for lower leg with foot (BKA)***
6%
amputation for entire arm***
5%
amputation for forearm with hand***
2.3%
% weight change formula***
(usual weight - actual weight) / usual weight x 100
what is the % weight change formula used to assess?***
potential NUTRITION RISK!
what does the triceps skinfold thickness (TSF) measure?
body fat and calorie reserves
arm muscle area (AMA) is important to measure in whom?***
growing children
arm muscle area measures what?
skeletal muscle mass (somatic protein)
how is AMA (arm muscle area) determined?
TSF & AC (arm circumference)
healthy BMI**
18.5-24.9 (BMI is AKA Quetlet’s index)
when do BMI for age charts begin to be used?
age 2 (once you can obtain an appropriate height/stature)
BMI equation
weight (kg) / height (m) SQUARED
OR
weight (lbs) / height (in) SQUARED x 703
healthy BMI for most elderly
24-29
waist circumference - risk for disease #***
> 40 M, >35 F
waist-hip-ratio (WHR)- risk for disease #***
> 1.0 M; >0.8 W
type of obesity that correlates with an increased risk for co-morbidities of obesity
android- apple shaped/men (abdominal obesity)
if hair is thin, sparse, dull/dry/brittle, or easily pluckable, what should be considered in the nutritional focused physical exam?***
vitamin C or protein deficiency
eyes: pale, dry, poor vision- what could be the cause?
vitamin A, zinc, or riboflavin deficiencies
lips: swollen, red, dry, cracked- what could be the cause?
riboflavin, pyridoxine, niacin deficiencies
tongue: smooth, slick, purple, white coating- what could be the cause?
vitamin or iron deficiencies
gums: sore, red, swollen, bleeding- what could be the cause?
vitamin C deficiency
teeth: missing, loose, loss of enamel- what could be the cause?
calcium deficiency, poor intake
skin: pale, dry, scaly- what could be the cause?
iron, folic acid, zinc deficiency
nails: brittle, thin, spoon-shaped- what could be the cause?
iron or protein deficiency
serum albumin- appropriate lab value?***
3.5-5.0 g/dL
what is serum albumin?***
VISCERAL protein - blood and organs
hypoalbuminemia is associated with?***
edema or surgery
hyperalbuminemia is associated with?***
dehydration
half life of serum albumin?** what does this indicate?**
long half life…does NOT reflect current protein intake
what is transferrin?
protein that transports iron in the blood stream; serum level controlled by iron storage pool
what happens to the lab value tranferrin with iron deficiency?
RISES
transferrin can be determined from what lab value?
TIBC- total iron binding capacity, or the amount of iron capable of being bound to serum proteins
prealbumin is AKA**
transthyretin (TTHY)
half life of PAB? what does this indicate?***
SHORT- picks up changes in PRO status quickly
what is retinol-binding protein?
- shortest half-life, circulates with PAB
- binds & transports retinol
appropriate levels of Hct (hematocrit) for men and women***
M 42-52%
W 35-47%
Hct level for pregnant women***
33%
what is Hct? what is Hgb?***
- Hct= volume of packed cells in the blood
- Hgb= iron-containing pigment of RBCs
where are RBCs produced?
bone marrow
Hgb levels for men and women***
M 14-17 g/dL; W 12-15 g/dL
Hgb level for pregnant women***
<= 11
what is ferritin?
storage form of iron
appropriate level of serum creatinine?***
0.6-1.4 mg/dL
what is serum CRT related to?** what may it indicate?**
r/t MUSCLE MASS
what does serum CRT measure?***
SOMATIC PROTEIN
what may abnormal serum creatinine indicate?**
may indicate RENAL DISEASE or muscle wastage
what is the creatinine height index?***
ratio of creatinine excreted / 24 hours ro height
what does the creatinine height index (CHI) estimate?***
SOMATIC protein
appropriate BUN levels?***
10-20 mg/dL
appropriate BUN:creatinine ratio***
10-15:1
BUN is related to what nutrient’s intake?
protein
BUN is an indicator of what disease?
renal
what does urinary creatinine clearance measure?
GFR- glomerular filtration & renal function
what is TLC? what does it measure?
total lymphocyte count: measures immunocompetency (immune system)
normal levels of TLC***
(total lymphocyte count) = >2700 cells/cu mm
how is lab value of TLC affected with protein-energy malnutrition?
DECREASES
what is CRP?***
C-reactive protein = MARKER OF INFLAMMATORY STRESS (NOT nutritional status)
relationship between CRP and PAB
inverse: when elevated CRP decreases (aka progressing towards a less inflamed state), PAB increased
what is FEP?
free erythrocyte protoporphyrin
what does FEP measure?***
toxic effects of lead on heme synthesis; INCREASED IN LEAD POISONING
relationship between lead and iron
lead depletes iron –> anemia
normal lab value for prothrombin time***
11.0-12.5 seconds
what can prolong prothrombin time?
anticoagulants
what is prothrombin time?
evaluates clotting adequacy
changes in ____ intake will alter rate of prothrombin time
vitamin K
hair analysis is useful for?
measuring intake of toxic metals (NOT for nutritional assessment)
activity factors
BEE x AF
1.2 = sedentary, 1.3 = active, 1.5 = stressed
what is PAL?
physical activity levels
