lab

Question 1

Nutrition Assessment Standardized Language: Domains and Examples

Answer 1

1. Food/Nutrition-Related History (FH)
2. 24 hour dietary recall, food frequency questionaires, food diaries
   _________________________________________________________________________
3. Anthropometric Measurements (AD)
4. Skin fold test, weight, height, circumference, body fat percentage
   _________________________________________________________________________
5. Biochemical Data, Medical Tests, and Procedures (BD)
6. Blood work; lipids, etc. Medical tests: blood glucose response, mri, ct scans, barium swallow.
   _________________________________________________________________________
7. Nutrition-Focused Physical Findings (PD)
8. Rickets, skin conditions, hair, physical signs of malnutrition- muscle wasting
   __________________________________________________________________________
9. Client History (CH)
10. Dentures, family histories, personal eating habits- vegetarian, medications, social history,who cooks, who shops, do they have kids,

Question 2

Interventions Resulting from Nutrition Assessment

4

Answer 2

• Food and/or Nutrient Delivery – individualized approach; meals, snacks, enteral and parenteral feeding, supplements
• Nutrition Education – instruct or train a patient/client
• Nutrition Counseling – set priorities, establish goals, create individualized action plans
• Coordination of Nutrition Care – consultation with, referral to, or coordination of nutrition care with other health care providers(occupational therapist , homecare dietician), institutions, or agencies that can assist in treating or managing nutrition-related problems

Question 3

Some points to consider:

Answer 3

• Is the respondent comfortable in revealing dietary intake? Eating disorder
• How specific are portion size estimates–how accurate do you feel they are? Over or under
• Are there cultural considerations for the respondent or interviewer? Muslims, pork restriction, language restrictions- may bring a family translator or interpreter at the facility, using pictures, some resources in different languages.
• Does gender influence the interviewing process? May be more comfortable with female or male dietitians. Stereotypes-males eat meat, do men cook. Some cultures may be not comfortable with the opposite sex.
• patients ability, dentures, hearing loss,
• Pregnancy,
• Health conditions
• Socio economic status – social assistance, access to food
• Did they ask to see you or did the doctor recommend them to you
• Mental illness

Question 4

nutrition diagnosis

Answer 4

The purpose of Nutrition Diagnosis is to identify and describe a specific nutrition problem that can be resolved or improved through treatment/nutrition intervention by a food and nutrition professional. There are three categories:

1. Intake
2. Clinical
3. Behavioural-Environmental

Question 5

Corrected Calcium

Answer 5

The normal or reference range for serum albumin is 35-50 g/L.
Forty per cent of serum calcium is bound to serum albumin.
If a patient’s albumin level is low, the blood calcium level may falsely appear low as well.
Use “corrected calcium” when serum albumin is low, i.e. < 35 g/L.

Question 6

Narrative Medicine:

Answer 6

Allowing a patient to tell his/her story. It is defined as “medicine practiced with the narrative competence to recognize, absorb, interpret and be moved by the stories if illness. It emphasizes listening to the patient before making a diagnosis. Initially described as “the principles and practices of including humanities and the arts into the care of the sick”. Three aspects of narrative medicine are: attention, representation, affiliation. The corresponding skills needed for this are: listening, close reading and picking up on nuances.

Question 7

Motivational Interviewing:

Answer 7

a patient-centered approach to counselling; one shows empathy as a genuine interest in the patient and achieves this by attentive listening skills. MI elicits narrative information from the patient in a respectful way. The four components are: asking open ended questions, providing affirmations, reflective listening, and the ability to periodically provide summary statements.

Question 8

Bioelectical Impedance Analysis (BIA)

Answer 8

“BIA is an increasingly common procedure used to estimate body composition. It is considered to be a rapid, safe, portable and noninvasive method of assessment. There are numerous types of equipment available to measure BIA, but they are all based on the same scientific principle. A small, low-frequency, alternating electrical current is administered at one extremity of the body. Measurement of impedance of the electrical current can then be used to estimate components of body composition, including body cell mass, fat-free mass, fat mass and total body water.”

“Tissues that contain little water such as fat and bone are poor conductors of electricity and therefore have a greater resistance or impedance to flow of current. Other tissues that have greater water content, such as blood, muscle and vital organs, are good conductors and therefore have lower impedance.”

Bioelectrical impedance analysis (BIA) can be used for estimating body composition.  The work in this area was pioneered during the 1940’s.  The science and technology for the equipment was developed in the late 1970’s.  RJL Systems currently provides a variety of BIA instruments and software.

Question 9

Bioelectrical Impedance Spectroscopy (BIS) - lay down one

Answer 9

Determine Resistance (“Res” or R) and Reactance (“Rea” or X) in ohms at 50 Khz for yourself or a subject.

Question 10

Omron Body Fat Analyzer

just hand held

Answer 10

The Omron Body Fat Analyzer is also relatively inexpensive and uses Bioelectrical Impedence technology. According to the instruction manual, “Normal or Athlete mode can be selected for a more accurate measurement.”

Do not operate this device in combination with a pacemaker, artificial heart or lung, an electrocardiograph or other portable electronic medical device.  Not recommended to be used by pregnant women.

Question 11

. Omron MONITOR – Body Composition Monitor with Scale

the one where you hold it and and step on scale

Answer 11

This monitor cannot be used with a cardiac pacemaker or other implanted medical devices. The Body Composition MONITOR with Scale passes an extremely weak electrical current through your body to determine the amount of fat tissue. The weak electrical current is not felt while using the monitor.

Do not use mobile phones, microwave & other devices that generate strong electrical or electromagnetic fields near the monitor; this may result in operational failure.

Do not step on measurement platform when your body or feet are wet.

Stand on the measurement platform with bare feet.  Additional instructions will be posted.

Question 12

3. Taylor Body Fat Analyzer & Scale with Cal-MaxTM Feature

Answer 12

Background
The Taylor® Body Analyzer & Scale was purchased at a local retail outlet. Individuals or groups may choose to use this type of electronic tool because of its relatively low cost.

Do not use this product if you have a pacemaker or other internal medical device.  When in doubt, contact your physician.

According to the instruction manual, “This instrument uses BIA (Bioelectrical Impedance Analysis).  BIA is one of the most accurate methods of measuring body fat.  It simply sends a harmless signal through the fat and muscle in your body.  This method calculates both your personal weight and body fat simultaneously, thus giving you a more accurate reading of your overall health and fitness.”

This analyser will give accurate body fat readings for a majority of people, but is not intended for use by the following groups:
	Children:  Anyone under the age of 18 years
	 Pregnant Women

Question 13

Subjective Global Assessment (SGA)

Answer 13

Background:

Subjective Global Assessment (SGA) was developed at the University of Toronto. It is the gold standard for diagnosing malnutrition. It is a simple bedside method of assessing the risk of malnutrition and identifying those who would benefit from nutrition care. The assessment includes taking a history of recent intake, weight change, gastrointestinal symptoms and a clinical evaluation. It has been validated in a variety of patient populations.

The SGA is sensitive and specific, it is easy to teach, and the inter-rater agreement is high. It can be used in both inpatient and outpatient settings; offices, clinics, home care, hospice, and extended care facilities. Using the same tool in all settings provides a consistent means of identifying patients with malnutrition and measuring outcomes of nutrition intervention as patients move through the health care system.