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FN 3344 > Lecture 4 - Nutrition Assessment and Screening > Flashcards

Lecture 4 - Nutrition Assessment and Screening Flashcards

1
Q

Why do we use screening?

A

To see if you need to conduct a compete assessment

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2
Q

What are the characteristics on an ideal nutrition assessment method?

A 
Validity
Reproducibility
Accuracy
Sensitivity
Specificity
Ethical
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3
Q

What tis validity?

A

Adequacy to reflect what is intended to measure

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4
Q

What is reproducibility?

A

Degree to which repeated measurements of a variable give the same value

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5
Q

What is accuracy?

A

Extent to which a measurement is close to the correct value

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6
Q

What is sensitivity?

A

Extend to which an index or indicator correctly reflects a current status of predicts changes

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7
Q

What is important to note about accuracy?

A

A test can be reproducible but inaccurate

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8
Q

How do we determine if a test has good reproducibility?

A

If the coefficient is less than 15 than it is a good reproducible test

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9
Q

How is sensitivity expressed?

A

In terms of proportion or % of individuals

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10
Q

What does 100% sensitivity identifies?

A

Correctly identifies all those who are genuinely malnourished

  • No malnournide persons are classified as well
  • NO FALSE POSITIVES
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11
Q

What is a true positive/true negative and false positive.false negative?

A

TP: Is malnourished and identified as malnourished

TN: Not malnourished and not identified as malnourished

FP: Not malnourished but identified as malnourished

FN: malnourished but not identified as malnourished

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12
Q

What is analytical sensitivity?

A

Minimum detection limit of ability of an analytical method to detect the smallest amount of the substance of interest

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13
Q

What is specificity?

A

Ability of an index or indicator to correctly identify or classify individuals as having a characteristic

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14
Q

How is specificity expressed?

A

IN terms of proportions of % of individuals

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15
Q

What does 100% specificity mean?

A

All genuinely well nourished individuals will be correctly identified

  • No well nourished individuals will be classified as ill
  • NO FALSE POSITIVES
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16
Q

What does it mean when we have a specificity of 75-80% or higher?

A

Is considered a good specificity

-hard to 100%

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17
Q

How are ethical in screening and assessments?

A

Making sure you have informed consent

  • explain measurement & procedure
  • give risk and benefit
  • Respecitna nd documenting choice of individual
  • Allow to change their mind freely (can quit whenever)
  • answer questions

Ensuring protection of confidentiality and safety

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18
Q

Why I nutrition screening a good thing?

A

Good for identifying those at risk

Prevention is better than treatment

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19
Q

Why is nutrition screening necessary?

A
  • Many patients in healthcare setting are eat risk for malnutrition
  • Complication of malnutrition (increased morbidity, mortality, health care costs)
  • Timely screening can frequent improve outcomes
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20
Q

What is Iatrogenic Malnutrition?

A

Malnutrition resulting from medical causes: effect of meds or complications from medical. treatment

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21
Q

What causes iatrogenic malnutrition?

A

Negligenc amount medical personnel

  • NPO
  • Feeding tube
  • Calorie count
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22
Q

When we see a patient with NPO on their chart what does this mean for us?

A

Nothing by mouth
-we need to figure out why they are like this -
how long they have been like this
-if there is a plan for getting them out of NPO

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23
Q

What are the ethology based definitions?

A

Based on starvation related, chronic disease related or acute disease related and whether their inflammation is sever and the top of inflammation they have

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24
Q

Why is nutrition screening necessary?

A
  • Allows to identify nutritional tis and the need for nutritional intervention
  • Required by law in healthcare institutions (patients must be see 24-48hr after admission) (SIM, screen, intervene, monitor)
  • Document they value of nutritional care and its outcomes
25
Q

What are some of the effective nutrition screening tools?

A 
Quick and simple
Based on data routinely gathered
Performed by any HCP
Efficient
Inexpensive/cost effective
Reproducible or reliable
Valid
Accurate& sensitive
Specific
Ethical
26
Q

What are some of the criteria often used in nutrition screening?

A

History data
-diagnosis, bowel habits

Anthropometric finding’s
-Ht, Wt, Wt change, BMI

Biochemical findings
-Serum (albumin), Hb

Clinical findings

  • Nausea/vomiting
  • chewing/swallowing ability

Dietary findings

  • Change in appetite
  • Dietary habity
  • dietary supplants
27
Q

Why do a variety of screening tools exist?

A

For different stages of the life cycle

For general population or various disease states

Some have scoring/point system
-Identify degree of nutrition risk. The greater the severity of nutritional risk the earlier that intervention should take place “triage”)

28
Q

What is the SGA test?

A

Subjective global assessment

  • Developed in torotnto initialy for cancer patients
  • can be used for adult hospitalized patients
  • needs trained health professionals to perform
  • Needs more times
  • Scoring system to allow for triaging (newest one is nutritional triaging)
29
Q

What are the parameters used for SGA?

A 
Med history
Physical exam
Weight loss
Reduced physical function
Appetite
30
Q

What re the advantages of a PG SGA?

A 
Validated tool
Standardized
Reproducible 
Little $
Quick
Easy to teach to HCP
Sensitivity and specificity superior
Direct patient participation
31
Q

In the PG SAG what is it sensitivity and specificity superior too?

A

Serum (albumin) and transferrin
Delayed hypersensitivity skin test
Anthropometry
Creatinine heigh index

32
Q

What can the PG SAG be used to rate?

A
  1. Overall nutrition status into:
    - well nourished or anabolic A
    - Moderate or suspected malnutrition B
    - Severely malnourished C
  2. Outcomes of nation care plan
33
Q

In PG SAG/SAG which category is hardest to determine?

A

B

-usually these ones that need to investigate thoroughly

34
Q

What are the limitations of PG SAG?

A

Not be the only nutrition assessment tool used

Patient participation not always possible

Not validated for all age groups

Large subjective component in assessment

Training of health care professionals required

35
Q

What is the MST?

A

Malnutrition Screening Tool

  • simple
  • quick to administer
  • 2 question tool
36
Q

What are the parameters of the MST?

A

Unintentional weight loss

Appetite

37
Q

How do you catacgorize a MST score?

A

0 or 1 they are not at risk

2 or more at risk

38
Q

What is the NRS?

A

Nutrition Risk Screening

  • developed by ESPEN
  • Preferred tool to screen for malnutrition in European hospital settings
39
Q

What are the parameters of NRS?

A 
Unintentional weight los
BMI
Appetite/food Intake
Disease severity 
Age
Impaired general condition
40
Q

What is SNAQ?

A

Short nutritional assessment Questionnaire

  • simple
  • easy administration
  • 3 question tool
  • developed in the Netherlands for hospital screening
41
Q

What are the parameters used in SNAQ?

A

Unintentional weigh loss
Appetite
Use of oral supplement or tube feeding

42
Q

What is MUST?

A

Malnutrition Universal Screening Tool

  • simple
  • easy administraiton
  • few questions
  • developed for hospital in and out patient screening
43
Q

What re the parameters of MUST?

A

Unintentional weight loss
BMI
Appetite/Food intake
Acutely ill

44
Q

What is CNST?

A

Canadian nutrition screening tool

  • simple
  • easy administration
  • developed in Canada for hospital screening
45
Q

What are the parameters for CNST?

A

Unintentional weight loss

Appetite/food intake

46
Q

What is the CNST used for?

A

The initial step int he pathway of nutrition assessment and intervention

47
Q

How many people go and leave from hospitals malnourished?

A

45% admitted are malnourished (SGA)

48% leave malnourished

48
Q

Is albumin a marker of malnutrition? Why?

A

No

  • poor specificity to nutrition status
  • low levels very prevalent in critically illpatient
  • negative acute phase reactant
  • pre albumin shorter half life but same limitation.
49
Q

What is the process as to why albumin is not used as a marker of malnutrition?

A

Sythesis, breakdown and leakage out of vascular compartment with edema are influenced by cytokine-mediated inflammatory response
-in critically ill patient liver shuts down albumin production
MArker for severity of underlying disease (inflammation) not malnutrition

50
Q

Why do we need to be nutrition champions/

A

Need to identify malnutrition, screening tools and intervention strategies as RD
-Need to advocate for your patient

51
Q

What is the origin of DETERMINE?

A

Used as a public awareness tool, developed in 1991 in Washington, especially for elderly individuals

-project of the AAFP
ADA, national council on the Aging

52
Q

What does determine stand for?

A 
Disease
Eating poorly
Tooth loss/mouth pain
Economic hardship
Reduced social contact
Multiple medicines
Involuntary weigh loss/gain
Needs assistance in self care
Elder years above age 80
53
Q

What is MNA?

A

Mini Nutritional Assessment

-used for grading the nutritional state of elderly?

54
Q

What is the origin of MNA?

A

Developed in Switzerland in 1994 especially to screen elderly patients for risk of malnutrition

55
Q

What do we use in Canada for screening elderly?

A

Screen 3

-looking for the elderly population

56
Q

What are the biases of MNA?

A

History data
Anthropometry and dietary findings
Malnutrition index score calculated based on evaluation of 18 components in 2 steps

57
Q

Is nutrition screening a complete nutrition assessment?

A

NO

-need to screen, intervene and monitor to figure out if its working and if you need to make adjustments

58
Q

What is the key difference between screening and assessment?

A

Screening identifies risk factors

Assessment provides diagnosis

59
Q

What is INPAC?

A

Integrated nutrition pathway for acute care
-evidence and consensus based algotirht for identification, prevention, treatment and monitoring of malnutrition in hospitals

FN 3344 (13 decks)

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