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Medical Nutrition Therapy > Midterm > Flashcards

Midterm Flashcards

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USMLE® Step 1 flashcards
1
Q

MNT definition

A

in-depth, individualized nutrition assessment and a duration and frequency of care using NCP to manage disease

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2
Q

scope of practice

A
  • range of roles, activities, regulation in which RDNs perform
  • determined by professional licensure (states)
  • individual scope: your capabilities
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3
Q

purpose of NCP

A
  • systematic problem solving method used to critically think and make decisions to address nutrition-related problems and provide safe, effective, high-quality nutrition care
  • provides consistent structure and framework, systematic and consistent steps
  • EBP, scientific principles, protocals
  • outcome is improved quality of care and health status
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4
Q

4 steps of NCP

A

assessment, diagnosis, intervention, monitoring and evaluation

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5
Q

purpose of nutrition screening process

A
  • “on ramp” to the NCP
  • quickly identifies those who may benefit from NCP
  • identifies level of nutrition risk
  • high risk -> complete nutrition assessment by RD
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6
Q

feature of a good nutrition screening tool

A
  • quick, easy to use, valid, and reliable for patient population or setting
  • can be carried out by any trained personnel
  • no lab measurements
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7
Q

when must nutritional screening be completed on patients admitted to a hospital

A

JCAHO requires within 24 hours

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8
Q

EBP definition

A

rigorous systematic methods to:
- define clinical questions
- acquire relevant research literature and evidence
- apply findings as a graded/rated clinical guidelines or recommendation

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9
Q

EBP components

A
  • best available scientific research
  • clinical expertise of the practitioner
  • patient values and preferences
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10
Q

why EBP

A
  • clinical judgement can be lacking
  • research, best practices, and clinical guidelines can change
  • scientific evidence isn’t always definitive. critical thinking, clinical judgements, and patient values are needed to guide decisions
  • allows for patient focused care
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11
Q

research vs EBP

A

research: systematic investigation. designed to develop or contribute to generalizable knowledge. findings can contribute to EBP lit review
EBP: synthesize research with clinical expertise and patient preferences to inform a clinical decision. clinical problem can lead to a research question

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12
Q

nutrition assessment purpose

A

-systematic method for obtaining, verifying, and interpreting data needed to identify nutrition related problems, their cause, and significance
- review, cluster into domains, and compare to reliable standards

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13
Q

nutrition screening vs assessment

A

screening identifies those who require a complete assessment

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14
Q

5 domains of nutrition assessment

A
  • food/nutrition related history
  • anthropometric measurements
  • biochemical data, medical tests, and procedures
  • physical exam findings
  • client history
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15
Q

food and nutrition related history domain

A
  • food and nutrient intake
  • energy, protein, and fluid requirements
  • medication, supplements
  • knowledge, beliefs, behaviors, physical activity
  • access of foods/supplies
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16
Q

anthropometric measurements domain

A
  • body size, weight, height, circumferences
  • body shape, proportions, rations
  • BMI
  • body compositions
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17
Q

BMI equation

A

703 (lb/in^2) or kg/m^2

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18
Q

biochemical data, medical tests, and procedures domain

A
  • measurement of nutrition markers and indicators found in blood, urine, feces, and tissue samples
  • protein assessment
  • immunocompetence
  • hematological
  • vitamin and mineral asessment
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19
Q

physical exam domain

A
  • assess for signs and symptoms consistent with malnutrition or specific micronutrient deficiencies
  • techniques of inspection, palpation, percussion, and auscultation are used
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20
Q

client history domain

A
  • age, sex, gender, education, food security, socioeconomic data
  • previous medical history and testing
  • family medical history
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21
Q

sensitivity

A
  • test’s ability to correctly identify people with a disease
  • highly sensitive test has few false negatives
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22
Q

specificity

A
  • test’s ability to correctly identify people without a disease
  • highly specific test has few false positives
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23
Q

validity

A
  • how well an assessment measures what it’s supposed to measure
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24
Q

reliability

A

how reliable or consistent are the measures

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25
Q

methods to obtain height on a patient who cannot stand

A
  • half arm span x2
  • knee height with equation
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26
Q

calorie count

A
  • best for assessing actual food intake in an inpatient setting
  • food weighed before and after intake, or % consumed visually estimated
  • 3 day calorie count typically used
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27
Q

1 kg

A

2.2 lb

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28
Q

1 in

A

2.54 cm

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29
Q

ABW

A

actual body weight used in most situation/calculations

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30
Q

UBW

A

usual body weight used when a person has experienced significant weight fluctuations

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31
Q

IBW

A

ideal body weight used with certain protein recommendations validated using IBW

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32
Q

%UBW

A

CBW/UBW

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33
Q

% weight loss

A

(UBW - CBW)/UBW

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34
Q

adjusted body weight for amputations

A

subtract prosthetic weight
CBW/(1-%) x 100

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35
Q

somatic protein status indicators

A
  • (muscle stores)
  • creatinine height index (CHI)
  • nitrogen balance
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36
Q

visceral protein status indicators

A
  • (non skeletal muscle proteins)
  • albumin
  • transferrin
  • prealbumin
  • retinol binding protein (RBP)
  • C reactive protein (CRP)
  • not reliable indicators of nutritional protein status or malnutrition
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37
Q

acute phase protein

A
  • proteins produced by liver in response to inflammation, infection, or damaged tissue
  • inflammation markers
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38
Q

negative acute phase proteins

A
  • decrease in response to inflammation, not valid indicators of malnutrition
  • albumin
  • transferrin
  • prealbumin
  • RBP
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39
Q

positive acute phase proteins

A
  • C reactive protein
  • ferritin
  • hepcidin
40
Q

starvation related malnutrition

A

pure chronic starvation, anorexia

41
Q

acute disease or injury related malnutrition

A

major infection, burns, trauma, closed head injury

42
Q

chronic disease related malnutrition

A

organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity

43
Q

6 AAIM criteria

A
  • insufficient energy intake
  • weight loss
  • loss of muscle mass
  • loss of subcutaneous fat/body fat
  • fluid accumulation
  • hand grip strength
  • need 2/6
44
Q

muscle loss assessment

A
  • temple
  • quads, patellar
  • calves
  • clavicle, pectoral, deltoid
  • scapular
  • dorsal hand
45
Q

fat loss assessment

A
  • orbital
  • cheek
  • triceps, biceps
  • thoracic, lumbar, ribs
46
Q

how is fluid retention related to malnutrition

A
  • pitting edema may be a sign of hypoproteinemia (low protein)
  • edema can mask signs of fat and muscle loss
  • legs, arms, ascites
47
Q

how is metabolism affected by stress

A
  • everything ramps up
  • inflammation
  • increase in metabolic rate, energy needs, body temp, blood glucose
  • catabolism of lean mass
  • major fuel source: protein -> gluconeogenesis
48
Q

how is metabolism affected starvation

A
  • everything slows down
  • no inflammation
  • decrease in metabolic rate, energy needs, body temp, blood glucose (normal-low)
  • preservation of lean mass, protein stores are protected
  • major fuel source: fat -> ketones
49
Q

3 phases of the metabolic stress response

A

ebb, flow, recovery

50
Q

ebb phase

A
  • immediately after injury (2-48 hours)
  • shock hypovolemia
  • tissue hypoxia
  • decreased cardiac output, urinary output, oxygen consumption, body temperature
  • hemodynamically unstable
51
Q

flow phase

A
  • 36-48 hours after injury until 7-10 days
  • catabolism
  • increase positive acute phase proteins, decrease negative
  • hormonal and immune responses
  • increased cardiac output, oxygen consumption, body temperature, energy expenditure, protein catabolism
  • hemodynamically stable
  • hypermetabolic
  • provide enough energy and protein substrates to protect function and repair tissue damage
52
Q

recovery phase

A
  • 7-10 days after injury until months
  • lost tissue is restored
  • body restores to normal function
  • anabolism
53
Q

purpose of MNT during metabolic stress

A
  • important to consider the patient’s primary medical diagnosis along with accommodations for the metabolic changes that have occurred
  • establishing hemodynamic stability
    glycemic control
  • balance between prevention of malnutrition and prevention of the possible complications of providing nutrition support
54
Q

purpose of nutrition diagnosis

A
  • direct link between nutrition assessment and nutrition intervention
  • identifies a specific nutrition problem that can be resolved/improved by the RD with nutrition intervention
  • not a medical diagnosis
55
Q

three domains of nutrition diagnosis

A

intake (preferred), clinical, behavioral-environmental

56
Q

when would an intake domain diagnosis not be the preferred domain

A

when the primary nutrition problem is clearly related to a clinical condition or a behavioral factor

57
Q

three parts of PES statement

A

problem, etiology, signs and symptoms

58
Q

problem in PES

A
  • diagnositic eNCPT term that describes an alteration in the client’s nutritional status
  • “altered” “excessive” “inadequate”
  • RDN must be able to impact this problem
59
Q

etiology in PES

A
  • factors related to root cause or existence of problem
  • intervention is aimed at adressing/resolving or minimizing this underlying cause
  • causes the problem
60
Q

signs and symptoms in PES

A
  • defining characteristic obtained from subjective and objective nutrition assessment data
  • data used to determine a problem exists and provides evidence
  • intervention is directed at improving this
  • provides rationale for ideal goals and outcomes. measuring will indicate if the problem is improved
  • specific enough to be measured
61
Q

PES format

A

P related to E as evidenced by S

62
Q

factors that make a strong PES

A
  • clear and concise
  • select the most urgent problem
  • intake domain preferred
  • specific to the patient
63
Q

purpose of nutrition intervention

A
  • purposeful, planned action intended to improve or resolve a nutrition problem by addressing the underlying cause (etiology)
  • if the RDN cannot impact the etiology through nutrition intervention, then the intervention is directed toward improving the signs and symptoms
64
Q

two stages of the nutrition intervention

A

planning, implementation

65
Q

planning stage of nutrition intervention

A
  • prioritize nutrition diagnosis (PES)
  • write nutrition prescription
  • set goals
  • select nutrition intervention
66
Q

domains of nutrition intervention

A
  • food and/or nutrient delivery
  • nutrition education
  • nutrition counseling
  • coordination of nutrition care
67
Q

nutrition prescription

A
  • essential first component of the nutrition intervention
  • concisely communicates the RD’s diet recommendation based on a nutrition assessment
  • includes recommendations for energy, selected nutrients, and/or selected foods
68
Q

first thing you do in the planning stage of nutrition intervention

A

prioritize the nutrition diagnosis (PES)

69
Q

nutrition education

A
  • instruction or training intended to lead to nutrition related knowledge
  • group classes, individual instruction, written instruction, or via phone/electronic communication
  • outpatient setting is more conducive to education
  • in acute-care setting, more content focused
  • quickly useable content and straight forward instructions
70
Q

nutrition counseling

A
  • supportive process, characterized by a collaborative counselor-client relationship
  • establishes goal setting and individualized action plans
71
Q

purpose of monitoring and evaluation

A
  • determine the degree of progress being made and whether the client’s goals or desired outcomes of nutrition care are being achieved
  • is the nutrition intervention strategy working to resolve the nutrition diagnosis, its etiology, and/or its signs or symptoms
  • involves reassessment
72
Q

resolved

A

the nutrition problem no longer exists

73
Q

improvement shown

A

nutrition problem still exists but with positive progress toward goal

74
Q

unresolved

A

no improvement shown in the nutrition problem

75
Q

no longer appropriate

A

change in condition where the nutrition problem and intervention is no longer appropriate/relevant

76
Q

examples of therapeutic diets found in the hospital setting

A

texture modified diets, fluid restricted diets, clear liquid diet, full liquid diet, high fiber diet

77
Q

diet liberalization

A
  • modified therapeutic diet that relaxes restrictions to allow people to eat food they enjoy while still remaining healthy
  • potentially leads to improved nutritional intake
78
Q

some ways a hospital diet could be modified to include more energy

A
  • add butter, margarine, jam, jelly, honey, whole milk, cream, sour cream, yogurt, nut butters, cream cheese
79
Q

some ways a hospital diet could be modified to include more protein

A

add powdered milk, liquid egg substitutes, nuts, nut butters, chopped meats, cooked eggs, cheese, yogurt, tofu, soy crumbles

80
Q

purpose of texture modified diets in the hospital

A
  • for people with chewing and swallowing difficulties
  • reduce risk of choking and aspiration
81
Q

IDDSI framework

A
  • international set of descriptors describing texture modified foods and thickened liquids for people with eating, drinking, and swallowing problems (dysphagia) across the lifespan
82
Q

clear liquids

A
  • intended to supply fluid and energy in a form that requires minimal digestion and stimulation of the GI tract
  • not nutritionally adequate
  • should be limited to 24-48 hours unless supplements are added
  • research evidence does not support long term use
83
Q

purpose of fasting prior to surgical operations

A

minimize risk of aspirations

84
Q

current best evidence based guideline for feeding post operatively? rationale?

A
  • improved patient recovery with initiation of a general diet post operatively without transitional clear and full liquid diets
  • helps maintain gut function, reduce complications, and improve overall recovery by minimizing the stress response to surgery and promoting faster return to normal eating habits
85
Q

enteral nutrition

A
  • aka tube feeding
  • providing nutrition directly into the GI tract
86
Q

parental nutrition

A
  • intravenous (IV) nutrition
87
Q

when is EN needed

A
  • inability eat/eat enough
  • impaired digestion, absorption, metabolism
  • inadequate oral intake 7-14 days
  • gut works
88
Q

benefits of EN

A
  • cost effective
  • reduced length of hospital stay
  • reduced need for surgical interventions
  • reduced incidence of infectious complications in critically ill patients
  • improved wound healing
  • maintenance of GI function
89
Q

contraindications of EN

A
  • illeus: lack of movement of the intestines
  • complete obstruction of small or large bowel
  • severe diarrhea without response to medication
  • intractable vomiting
  • high output external fistula
  • hypovolemic or septic shock
  • very poor prognosis
  • patient’s wish
90
Q

why is EN preferred to PN

A
  • safer, more cost effective, easier on the body
  • if the gut works, use it
91
Q

short term vs long term for EN

A

4 weeks

92
Q

short term access routes

A

NG tube through nose, OGT through mouth

93
Q

long-term access routes

A

PEG through stomach, jejunostomy through small intestine

94
Q

prepyloric feeding

A
  • delivering nutrition into stomach
  • standard method
  • NG tube, PEG
95
Q

post-pyloric feeding

A
  • delivering nutrition past the pyloric valve, into the small intestine
  • used when gastric emptying is impaired, high risk of aspiration, severe gastric reflux, intestinal surgery history
  • ND tube, jejunostomy

Medical Nutrition Therapy (4 decks)

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