Lecture 1 Flashcards
What is the malnutrition skeleton?
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
What was Butterworth trying to prevent in hospitals?
Iatrogenic Malnutriton
-We are the cause of it
What is Iatrogenic Malnutrition?
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
What are key characteristics of Marasmus?
- Generalized muscle wasting
- Lack of subcutaneous fat
- Non-edematous PEM
- “skin and bones”
What are key characteristics of Kwarshiorkor?
- Protein malnutrition
- Edema (feet, leg, peritoneum, upper extremities and face)
- See with skin lesions, diarrhea, infection, dry and brittle hair
What is the difference between edema and non-pitting edema?
non-pitting Edema there are no pits but you can still see the swelling
What is ascites?
Big distended/swollen stomach
What is rickets?
When children are born with knock kneed or bowed legs
-due to vitamin D deficiency
How do you ultimately know if someone is malnourished?
When an assessment is performed
What is a nutrition assessment?
the evolution of nutritional status
Why are nutrition assessments performed?
- 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
What are the types or methods used in nutrition assessment?
- Screening
- Complrehensive, thorough or complete assessment
- Follow-up
- Research techniques
What is nutrition screening?
Process of identifying individuals who have risk factors placing them at potential risk for nutritional problems
Who should perform nutritional screening?
RD or HCP
-doesnt matter as long as they are trained because they would be getting better results
What is the purpose of nutrition screening?
Quick initial identification of individuals:
- at risk for nutritional imbalances
- requiring more in depth nutrition assessment
- already malnourished and requiring nutrition intervention
What is included in a complete nutrition assessment?
History of patient ABCD findings Medical Social Nutrition History
In looking at patient history, what information should we obtain?
Medical
Social
Nutriton History
In looking at medical history, what information should we obtain?
Chief complain (RFA.RFS) Current health Status Chronic Diseases states Psych Surgeries Oral Meds
In looking at social history, what information should we obtain?
Socio economic status Social support systems Housing Medical support -access to healthcare -home care required Stress management -recent crisis -daily stress levels Lifestyle
In looking at diet history, what information should we obtain?
Past/present diet perscribed Past/present dietary habits Past/present dietary restrictions Appetite, satiety or taste changes Food intolerance/allergy Supplements Weight history
What are the ABCD findings?
Anthropometry and body comp
Biochemical lab data
Clinical/physical examination data
Dietary assessment data
In the ABCD findings, what info do we use under A?
Evaluation of body size and proportions using
- height
- weight
- circumference
- Frame size
- Indexes
in the ABCD findings, under A, how do we obtain measurements about body composition?
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)
In the ABCD findings, what info do we use under B?
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
In the ABCD findings, what info do we use under C?
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
What is PIP?
Problem, Interpretation, Plan
What are some tools used in nutrition screening?
- Scored Patient Generated- Subjective global assessment (scored PG-SGA)
- Malnutrition screening tool (MST)
- Mini Nutritional Assessment (MNA)
- Canadian Nutrition Screening tool (CNST)
How does the Canadian nutrition screening tool work?
2 questions are asked
- either yes or no
- 2 yes = positive score = need for intervention
- 1 yes= still a red flag
What are the parameters used in the Canadian nutrition screening tool?
Unintentional weight loss
food intake
What does it mean when you have low Hgb (>135)?
Anemic
What does it mean when you have low MCV (>79)?
Microcytic anemia
What does it mean when you have low Albumin (>35)?
Hypoalbuminemia (visceral protein)
What does it mean when you have Prealbumin (>16)?
Low (visceral protein)
What does it mean when you have low Serum creatinine (>55)?
Reflecting loss of lean muscle mass
What does it mean when you have high Leukocytes (>4)?
High (stress response)
What does it mean when you have low serum ferritin (>20)?
Reflecting low iron stores
