Lecture 1

Question 1

What is the malnutrition skeleton?

Answer 1

The skeleton of the hospital revealed in 1974 by Charles Butterworth

• Cases of neglect in nutrition care were cited
• Changes in practice urgently needed to diagnose and treat undernourished patients

Question 2

What was Butterworth trying to prevent in hospitals?

Answer 2

Iatrogenic Malnutriton

-We are the cause of it

Question 3

What is Iatrogenic Malnutrition?

Answer 3

Malnutrition resulting form medical causes either by an effect of various meds, some complication to medical treatment to procedure or also by negligence among medical personnel

Question 4

What are key characteristics of Marasmus?

Answer 4

• Generalized muscle wasting
• Lack of subcutaneous fat
• Non-edematous PEM
• “skin and bones”

Question 5

What are key characteristics of Kwarshiorkor?

Answer 5

• Protein malnutrition
• Edema (feet, leg, peritoneum, upper extremities and face)
• See with skin lesions, diarrhea, infection, dry and brittle hair

Question 6

What is the difference between edema and non-pitting edema?

Answer 6

non-pitting Edema there are no pits but you can still see the swelling

Question 7

What is ascites?

Answer 7

Big distended/swollen stomach

Question 8

What is rickets?

Answer 8

When children are born with knock kneed or bowed legs

-due to vitamin D deficiency

Question 9

How do you ultimately know if someone is malnourished?

Answer 9

When an assessment is performed

Question 10

What is a nutrition assessment?

Answer 10

the evolution of nutritional status

Question 11

Why are nutrition assessments performed?

Answer 11

• Identify if an individual is at nutritional risk
• Justification of nutrition care plan (to healthcare team once intervention is needed)
• Basis of evaluation nutrition care plan

Question 12

What are the types or methods used in nutrition assessment?

Answer 12

• Screening
• Complrehensive, thorough or complete assessment
• Follow-up
• Research techniques

Question 13

What is nutrition screening?

Answer 13

Process of identifying individuals who have risk factors placing them at potential risk for nutritional problems

Question 14

Who should perform nutritional screening?

Answer 14

RD or HCP

-doesnt matter as long as they are trained because they would be getting better results

Question 15

What is the purpose of nutrition screening?

Answer 15

Quick initial identification of individuals:

• at risk for nutritional imbalances
• requiring more in depth nutrition assessment
• already malnourished and requiring nutrition intervention

Question 16

What is included in a complete nutrition assessment?

Answer 16

History of patient
ABCD findings
Medical
Social
Nutrition History

Question 17

In looking at patient history, what information should we obtain?

Answer 17

Medical
Social
Nutriton History

Question 18

In looking at medical history, what information should we obtain?

Answer 18

Chief complain (RFA.RFS)
Current health Status
Chronic Diseases states
Psych
Surgeries
Oral
Meds

Question 19

In looking at social history, what information should we obtain?

Answer 19

Socio economic status
Social support systems
Housing
Medical support
-access to healthcare 
-home care required
Stress management 
-recent crisis
-daily stress levels 
Lifestyle

Question 20

In looking at diet history, what information should we obtain?

Answer 20

Past/present diet perscribed
Past/present dietary habits
Past/present dietary restrictions
Appetite, satiety or taste changes
Food intolerance/allergy
Supplements
Weight history

Question 21

What are the ABCD findings?

Answer 21

Anthropometry and body comp
Biochemical lab data
Clinical/physical examination data
Dietary assessment data

Question 22

In the ABCD findings, what info do we use under A?

Answer 22

Evaluation of body size and proportions using

• height
• weight
• circumference
• Frame size
• Indexes

Question 23

in the ABCD findings, under A, how do we obtain measurements about body composition?

Answer 23

Evaluation of body content using

• circomferences and areas
• Skinfold thichness
• Bioelectrical impedance analysis (BIA)
• Dual energy X-ray. absorptiometry (DEXA)
• Air displacement plethysmography (Bod Pod)

Question 24

In the ABCD findings, what info do we use under B?

Answer 24

To detect substancial nutrient deficiencies

Can be altered by meds, nutrients and illness

Blood and urine used because they are easily affected by acute changes

Question 25

In the ABCD findings, what info do we use under C?

Answer 25

To look for clinical signs and symptoms reflecting malnutrition

Looking for signs and symptoms in later stages of malnutrition (often not specific)

Looking for reduced muscle mass via
-hallowing neat temple, protruding knee and reduced quads and calf

Looking for signs of reduced fat stores

• hallow eyes
• loose skin around eyes and cheeks

Question 26

What is PIP?

Answer 26

Problem, Interpretation, Plan

Question 27

What are some tools used in nutrition screening?

Answer 27

• Scored Patient Generated- Subjective global assessment (scored PG-SGA)
• Malnutrition screening tool (MST)
• Mini Nutritional Assessment (MNA)
• Canadian Nutrition Screening tool (CNST)

Question 28

How does the Canadian nutrition screening tool work?

Answer 28

2 questions are asked

• either yes or no
• 2 yes = positive score = need for intervention
• 1 yes= still a red flag

Question 29

What are the parameters used in the Canadian nutrition screening tool?

Answer 29

Unintentional weight loss

food intake

Question 30

What does it mean when you have low Hgb (>135)?

Answer 30

Anemic

Question 31

What does it mean when you have low MCV (>79)?

Answer 31

Microcytic anemia

Question 32

What does it mean when you have low Albumin (>35)?

Answer 32

Hypoalbuminemia (visceral protein)

Question 33

What does it mean when you have Prealbumin (>16)?

Answer 33

Low (visceral protein)

Question 34

What does it mean when you have low Serum creatinine (>55)?

Answer 34

Reflecting loss of lean muscle mass

Question 35

What does it mean when you have high Leukocytes (>4)?

Answer 35

High (stress response)

Question 36

What does it mean when you have low serum ferritin (>20)?

Answer 36

Reflecting low iron stores