Module Assessment 1

Question 1

What is nutritional status/importance

Answer 1

the extent to which an individual is meeting physiological nutrition needs
Nutrition plays a part in overall health and alterations affect body functions

Question 2

What are the factors affecting under nutrition (5)

Answer 2

poor po intake
impaired digestion/absorption
alteration in metabolic process
increased excretion of nutrients

Question 3

Results of undernutrition (7)

Answer 3

FTT
slow development
osteoporosis
Anemia
Poor immune function
poor wound healing
poor clinical outcome with increased risk of M&M (morbidity and mortality)

Question 4

Results of overnutrition (6)

Answer 4

obesity, diabetes, metabolic syndrome, CVD, HTN, poor clinical outcome with increased risk of M&M

Question 5

What is the nutrition Care Process (4 steps)

Answer 5

ADIME
Assessment and re-assesnent—> diagnosis(documentation, PES..problem, etiology, and signs and symptoms )/—->intervention——> monitoring and evaluation
A
- D—>PES = Problems/Etiology/Signs and Symptoms; Documentation for MR
(Medical Record)
- I—> Interventions (eg. Provide boost twice daily)
- M/E (weight is not monitored only intake/tolerance)

Question 6

How is nutrition risk determined

Answer 6

There’s a screening and an assessment. Everyone is screened within 24 hours of admission in variety of ways
Identifies patients who are at nutritional risk
- Anyone can do a nutritional screening
- Every patient is screened within 24 hours of admission
- Has to be many points taken into context to determine a condition - Every facility has their own screening criteria
anyone can screen only the RD can do a full assessment

Question 7

Questions asked during nutrition screening

Answer 7

Questions likely asked? gastric bypass, more than 10% unintentional weightloss, nausea and vomiting more than 2 weeks and chewing and swallowing problems
yes to any questions then they get a consult

Question 8

What is PG-SGA vs SGA

Answer 8

SGA is subjective global assessment while PG-SGA is the same but filled out by patients

Question 9

Information obtained from screening

Answer 9

filters out patients who might be at nutritional risk
information obtained includes; Ht & Wt, changes in weight and appetite, diagnosis, difficulty chewing swallowing, food allergies, labs, meds, GI symptoms, diet order, nutrition support/supplements

Question 10

What should be reviewed for past and medical problems?
Nutritional status can be affected by

Answer 10

MR(medical record)
acute or chronic illness w/ nutrition implications
Tx that induces an increase in nutr needs or malabsorption
Sx or Dz of GI tract, liver, pancreas
ETOH, drug addiction
Meds affecting appetite, absorption, digestion

Question 11

What information is obtained from nutritional assessment

Answer 11

All points covered in Nutr screen
in depth nutritional hx
social hx
physical exam
anthropometric measurments
medical / laboratory data
and INTERPRETATION of ALL points

Question 12

Step one of the NCP involves

Answer 12

Anthropometrics
Biochemical
Clinical
Dietary hx
estimating energy/protein needs
TOOLS IN YOUR TOOL BOX FOR ASSESMENT

Question 13

What is anthropometry

Answer 13

assessment of measures and proportions of the human body
they should be compared to standards or against patients previous hx

Question 14

1 in =cm
1 kg=lb

Answer 14

2.54cm
2.2lbs

Question 15

How to calculate IBW

Answer 15

Females: 100# for first 5’
5# per inch
Males: 106# for first 5’
6# per inch

+/- 10% for frame size

Question 16

When is ABW used and what is the equation

Answer 16

Used for obese patients (120% of IBW)
(Actual- IBW) x .25+ IBW

Question 17

Body composition tools for fat vs protein

Answer 17

fat: skin fold (measures subcutaneous fat over time) and BMI
Somatic protein: AMA (arm muscle area) measures somatic (skeletal) muscle. MAC (MID-ARM circumference)

Question 18

BMI Equation
and interpretation

Answer 18

Weight (lb)/height (in) X 703

<18.5 underweight
18.25-24.9 Healthy
25-29.9 Overweight
30<35 Obese class 1
35<40 Moderately obese class 2
>40 Extreme Obesity, class 3

Question 19

%IBW
what is it and how to calculate/interpret?
IMPORTANT

Answer 19

used to determine whether a pt is obese, underweight, or WNL (within normal limits)

ABW/IDW x100
>/=200 morbidly obese
>/=150 obese
>/=120 overweight
80-90% mild
70-79% moderate
</=69 severe underweight

Question 20

%UBW
what is it and how to calculate/interpret?
IMPORTANT

Answer 20

Compares what the pt usually weighs with what their weight is now

ABW/UBW x100
85-90%= mild
75-80%= moderate
</= 74% =severe

Question 21

%Weight Change
what is it and how to calculate/interpret?
IMPORTANT

Answer 21

Determines whether a significant weight loss has occurred within a specific time frame
used to diagnose malnutrition (anything above 10% is red flag)
%wt= UBW-ABW/UBW x100

						  	Significant              Severe -1 WEEK              1-2%                >2% -1 MONTH             5%                 >5% -3 MONTH            7.5%              >7.5% -6 MONTH             10%               >10%

Question 22

What are the terms for Nutrition support

Answer 22

TPN (vein)
and TF

Question 23

What are Acute phase proteins? Which are positive and negative?

Answer 23

Acute phase proteins are proteins that change in concentration in response to inflammation
Positive ACUTE PHASE- (Liver is making)
C reactive protein
Fibrinogen
Serum Amyloid A
Negative ACUTE PHASE- (Liver is not making)
Albumin
Pre-Albumin

Question 24

What is NFPE? What is it for and why is it important?

Answer 24

Nutrition Focused Physical Exam
useful in diagnosing malnutrition
(hollow eyes and temporal shrinkage)
Hair, skin, eyes, lips, teeth
includes visual (most common), palpation, percussion(not always used), auscultation (e.g.bowel sounds)

Question 25

What are the methods of Dietary data? Which are retrospective vs prospective?

Answer 25

24 HOUR RECALL (usually used for assessing tolerances)
Usual intake pattern (used for everyone else)
Food frequency questionnaire
Calorie Count (Only method that is prospective)
tray ticket has all cals of food and amount of food that was actually eaten)

Question 26

Order of interviewing patient? Limitations of interviewing patients?

Answer 26

Intake —->appetite or dislikes food
Nausea
Vomiting
Diarrhea
Constipation
Weight loss???
Limitations-Memory, someone’s food beliefs, altered mental status, and Patient may not divulge all the information about their status

Question 27

How to estimate kcal needs? Gold standard and limitations?

Answer 27

-Formulas (used for close estimation
-Energy expenditure
-Direct calorimetry
-GOLD STANDARD~Indirect calorimetry (the patient is breathing into a machine where it calculates) -
However you need to have access to medical carts which you typically don’t have
Therefore you need to calculate calorie needs using 4 formulas (kcal/kg) tight ranges are best ex. 20-22 kcal/kg

Question 28

Factors affecting REE

Answer 28

Resting energy expenditure
Body composition
Age
Gender
Disease
Hormonal status
Infection