Lecture 4 - Nutrition Assessment and Screening Flashcards
Why do we use screening?
To see if you need to conduct a compete assessment
What are the characteristics on an ideal nutrition assessment method?
Validity Reproducibility Accuracy Sensitivity Specificity Ethical
What tis validity?
Adequacy to reflect what is intended to measure
What is reproducibility?
Degree to which repeated measurements of a variable give the same value
What is accuracy?
Extent to which a measurement is close to the correct value
What is sensitivity?
Extend to which an index or indicator correctly reflects a current status of predicts changes
What is important to note about accuracy?
A test can be reproducible but inaccurate
How do we determine if a test has good reproducibility?
If the coefficient is less than 15 than it is a good reproducible test
How is sensitivity expressed?
In terms of proportion or % of individuals
What does 100% sensitivity identifies?
Correctly identifies all those who are genuinely malnourished
- No malnournide persons are classified as well
- NO FALSE POSITIVES
What is a true positive/true negative and false positive.false negative?
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
What is analytical sensitivity?
Minimum detection limit of ability of an analytical method to detect the smallest amount of the substance of interest
What is specificity?
Ability of an index or indicator to correctly identify or classify individuals as having a characteristic
How is specificity expressed?
IN terms of proportions of % of individuals
What does 100% specificity mean?
All genuinely well nourished individuals will be correctly identified
- No well nourished individuals will be classified as ill
- NO FALSE POSITIVES
What does it mean when we have a specificity of 75-80% or higher?
Is considered a good specificity
-hard to 100%
How are ethical in screening and assessments?
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
Why I nutrition screening a good thing?
Good for identifying those at risk
Prevention is better than treatment
Why is nutrition screening necessary?
- 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
What is Iatrogenic Malnutrition?
Malnutrition resulting from medical causes: effect of meds or complications from medical. treatment
What causes iatrogenic malnutrition?
Negligenc amount medical personnel
- NPO
- Feeding tube
- Calorie count
When we see a patient with NPO on their chart what does this mean for us?
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
What are the ethology based definitions?
Based on starvation related, chronic disease related or acute disease related and whether their inflammation is sever and the top of inflammation they have
Why is nutrition screening necessary?
- 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
What are some of the effective nutrition screening tools?
Quick and simple Based on data routinely gathered Performed by any HCP Efficient Inexpensive/cost effective Reproducible or reliable Valid Accurate& sensitive Specific Ethical
What are some of the criteria often used in nutrition screening?
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
Why do a variety of screening tools exist?
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”)
What is the SGA test?
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)
What are the parameters used for SGA?
Med history Physical exam Weight loss Reduced physical function Appetite
What re the advantages of a PG SGA?
Validated tool Standardized Reproducible Little $ Quick Easy to teach to HCP Sensitivity and specificity superior Direct patient participation
In the PG SAG what is it sensitivity and specificity superior too?
Serum (albumin) and transferrin
Delayed hypersensitivity skin test
Anthropometry
Creatinine heigh index
What can the PG SAG be used to rate?
- Overall nutrition status into:
- well nourished or anabolic A
- Moderate or suspected malnutrition B
- Severely malnourished C - Outcomes of nation care plan
In PG SAG/SAG which category is hardest to determine?
B
-usually these ones that need to investigate thoroughly
What are the limitations of PG SAG?
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
What is the MST?
Malnutrition Screening Tool
- simple
- quick to administer
- 2 question tool
What are the parameters of the MST?
Unintentional weight loss
Appetite
How do you catacgorize a MST score?
0 or 1 they are not at risk
2 or more at risk
What is the NRS?
Nutrition Risk Screening
- developed by ESPEN
- Preferred tool to screen for malnutrition in European hospital settings
What are the parameters of NRS?
Unintentional weight los BMI Appetite/food Intake Disease severity Age Impaired general condition
What is SNAQ?
Short nutritional assessment Questionnaire
- simple
- easy administration
- 3 question tool
- developed in the Netherlands for hospital screening
What are the parameters used in SNAQ?
Unintentional weigh loss
Appetite
Use of oral supplement or tube feeding
What is MUST?
Malnutrition Universal Screening Tool
- simple
- easy administraiton
- few questions
- developed for hospital in and out patient screening
What re the parameters of MUST?
Unintentional weight loss
BMI
Appetite/Food intake
Acutely ill
What is CNST?
Canadian nutrition screening tool
- simple
- easy administration
- developed in Canada for hospital screening
What are the parameters for CNST?
Unintentional weight loss
Appetite/food intake
What is the CNST used for?
The initial step int he pathway of nutrition assessment and intervention
How many people go and leave from hospitals malnourished?
45% admitted are malnourished (SGA)
48% leave malnourished
Is albumin a marker of malnutrition? Why?
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.
What is the process as to why albumin is not used as a marker of malnutrition?
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
Why do we need to be nutrition champions/
Need to identify malnutrition, screening tools and intervention strategies as RD
-Need to advocate for your patient
What is the origin of DETERMINE?
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
What does determine stand for?
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
What is MNA?
Mini Nutritional Assessment
-used for grading the nutritional state of elderly?
What is the origin of MNA?
Developed in Switzerland in 1994 especially to screen elderly patients for risk of malnutrition
What do we use in Canada for screening elderly?
Screen 3
-looking for the elderly population
What are the biases of MNA?
History data
Anthropometry and dietary findings
Malnutrition index score calculated based on evaluation of 18 components in 2 steps
Is nutrition screening a complete nutrition assessment?
NO
-need to screen, intervene and monitor to figure out if its working and if you need to make adjustments
What is the key difference between screening and assessment?
Screening identifies risk factors
Assessment provides diagnosis
What is INPAC?
Integrated nutrition pathway for acute care
-evidence and consensus based algotirht for identification, prevention, treatment and monitoring of malnutrition in hospitals
