Lecture 1

Question 1

Disease –

Answer 1

process that interferes with or disrupts body’s normal function

Question 2

•Clinical Nutrition

Answer 2

• the branch of nutrition specifically related to providing nutritional care in disease.

Question 3

Etiology-

Answer 3

description and identification of the cause of disease

? (genetic(multiple genes) x environment(don’y know so can’t prevent it))

Question 4

Pathogenesis:

Answer 4

clinical course of the disease (how does the disease develop)

Question 5

Pathophysiology

Answer 5

– study of the disruption of the normal physiological processes

Question 6

Prognosis –

Answer 6

expected or usual course of outcome (is it long term or short)

Question 7

•Acute versus Chronic Disease?

Answer 7

Acute: short term, come on really quickly and have big symptoms
Characterized by a relatively short duration of symptoms that are usually severe (e.g. acute renal failure)
Chronic: long term, people may never notice

Question 8

•Enteral Feeding -

Answer 8

• administration of nutrients via the gastrointestinal tract.
  !Technically the term includes oral feeding as well as tube feeding.
  !Tube feeding involves the infusion of a formulated solution through feeding tubes positioned in the
  stomach or intestine. (when someone has tube feeding usually talking about tube feeding)

Question 9

Parental feeding and total parental feeding

Answer 9

• Is carried out through an intravenous route.

!Total parenteral feeding -when all daily requirements for all nutrients are provided via this route.

Question 10

Purpose of the The Nutritional Care Process

Answer 10

To restore a state of nutritional balance by influencing those factors that are contributing to
the altered nutritional status. Figuring out the problem and doing something about it

Question 11

What are the 4 steps of the NCP

Answer 11

1. Nutrition Assessment
2. Nutrition Diagnosis
3. Nutrition Intervention
4. Nutrition Monitoring and Evaluation

Question 12

1.Nutrition Assessment

Answer 12

Collect, organize, and analyze nutritional assessment information against reliable standards
•nutritional assessment as it relates to an ill or hospitalized person
•Focus is on nutritional assessment as it relates to an ill or hospitalized person
•Should be used on initial assessment and in an ongoing way during the course of the disease.

Question 13

what are the 5 categroies in the nutritional assessment

Answer 13

1. Anthropometric (weight height),
2. biochemical (transferrin saturation, blood glucose- tells you ability to regulat their glucose),
3. client history, (preexisiting disease, medication, occupation, social history)
4. food nutrition related history (ffq),
5. nutrition-focused physical finding (sunken eyes,)

Question 14

•What are we looking for when we undertake nutritional assessments on ill or hospitalized patients?

Answer 14

!primary nutrient deficiency -definition? Dietary origin- they are not eating enough of the nutrient.
!secondary nutrient deficiency -definition? Deficiency due to other causes- for example absorption, metabolism of the nutrient, excretion of the nutrient, something that increase the requirement
•e.g. celiac disease

Question 15

where is one of the largest pockets of malnutrition in north america

Answer 15

in hospitals
as high as 30-50% in hospitalized patients on general surgical
and medical wards (US)

Question 16

what has been done to avoid malnutrition in hospitals:

why is it still not working in some places

Answer 16

•1) Methods developed to detect malnutrition (nutritional assessment)
•2) Progress of patients more closely assessed
•3) Concept developed of a “nutrition support team” for very complex high risk patients, particularly for TPN
e.g team of clinical dietician, physician, nurse, pharmacist, social worker
•….But some hospital malnutrition still exists in modern hospitals that theoretically have all the
personnel and equipment to provide excellent nutritional care of patients. Why?
1. People are ill and have a poor appetite
2. People don’t like the food
3. Disconnect between the hospital and community (even if their condition did improve they went home and their diet went down again)
4. Nutrition education (not enough time to explain to the patients)
5. Lack of personalised treatment
6. Not enough dietician – overworked
7. Increase in again population- poor appetite, and need increase in nutrient density
8. Tube feedings/tpn- use when needed- the oral roote is always the first choice

Question 17

Who is the Canadian Malnutrition Taskforce (CMTF)

Answer 17

Their role: To undertake the Nutrition Care in Canadian Hospitals Study to:
! Investigate the prevalence of nutritional risk and malnutrition in Canadian
hospitals
! Describe the state of nutrition care in Canadian hospitals
! Uncover the increased negative outcomes, on health and the healthcare
system, associated with malnutrition, especially when it is not resolved
! Examine the reasons for malnutrition by interviewing dietitians,
physicians, nurses and patients, an collecting data from patients about their
medical history, living arrangements, cooking and shopping habits, and
anthropometric and biochemical measures.

Question 18

In response to the increasing amount of malnutrition in hospital, what has Dietitians of Canada doen

Answer 18

To control hospital costs, many hospitals use a nutrition risk screening tool:
! Purpose: Identify malnourished patients or patients at risk for
malnutrition——–they need a detailed nutritional assessment, diagnosis,
treatment plan.
! Intended to be simple, fast, and predictive, but the tools vary in content.
• e.g. CMTF Nutrition Risk Screening Tool
- All patietns are asked 2 questions to determine nutrional risk

Question 19

Step 2 of the NCP:

Nutrition Diagnosis

Answer 19

Describes a problem for which nutrition-related activities provide the primary
intervention
o Nutrition diagnosis vs. medical diagnosis
nutrition diagnosis:
describes a nutrition problem for which nutrition-related activities
•Sets the stage for steps 3 and 4
Examples:
•“Inadequate energy intake related to changes in taste and appetite secondary to
chemotherapy as evidenced by average daily kcal intake 50% less than estimated needs.”

Question 20

step 3 of NCP: Nutrition Intervention

Answer 20

!Planning and implementation to elicit a change
!Client-driven approach
1.Prioritize nutrition diagnoses with the client- for example focuse on just one thing, for example decreases sugar intake for diabetic patient
2.Write the nutrition prescription
3.Set goals (patient-focused) – measurable outcome terms- short and long term
4.Select the nutrition intervention.
-nutrient delivery, nutrition education/counseling, coordinate nutrition care(for example when they go home).
5. Implement the nutrition intervention.
Use critical thinking

EXAMPLES - Nutrition Intervention:
•Consume < 7% of kcal from saturated fat (treating hyperlipidemia).
•Maintain nutritional status as measured by (whatever assessment tools are chosen).
•Achieve weight loss of 1-2 pounds/week (treating obesity).

!May require a therapeutic diet: based on normal nutritional needs, and then
modified as needed for the disease and nutritional status.
!Guidelines for a therapeutic diet:
•Should vary from the individual’s normal diet as little as possible, unless
the normal diet is inadequate.
•Should aim to meet the best estimate of nutrient requirements for the
disease condition.
•Should account for patient’s food intake habits and preferences,
socioeconomic status, religious practices, and other environmental factors
b) Any vitamin/mineral or other supplements necessary
c) Plans for nutritional counselling and education.
d) Plans for discharge counselling and outpatient followup if needed.

Question 21

Step4. Nutrition Monitoring & Evaluation

Answer 21

Measuring and recording changes in client’s condition
•Monitor progress
–Monitor, measure and evaluate on a planned schedule

•Measure and evaluate outcomes
 –Nutrition, clinical and health status, patient/client centered, and health care utilization 
 • Use effective indicators - Examples:
1.	 Nutrition outcomes: 
-	 knowledge gained
-	behavior chage
-	food or nutrient intake changes

2. Health outcomes:
   - Laboratory values
   - Blood pressure
   - Risk factors
3. Patient-centered outcomes:
   - Quality of life
   - Satisfaction
   - Self-management
4. Health care utilization and cost outcomes:
   Eg. Unplanned health care visits
5. Is the intervention being implemented as planned?
   - Is the patient understanding the goals?
   - Was the planned intervention correct?
   • e.g. were the estimates correct? Eg. Target caloric intake
   - Is a change in route of feeding indicated?
   - Is the patient meeting target caloric intake?
   - Are changes in the patient’s condition occurring?
   - •e.g. patient needed very high intake following trauma, not now have recovered to the point where energy/protein needs are decreasing.