NCP specifications Flashcards
?: reinforcement of basic/essential nutrition related knowledge
Nutrition Education
?: nutritional diagnostic, therapy, and counseling services for purpose of disease management aided by RDN
MNT (Medical Nutrition Therapy)
?: done at entry point into the NCP and can be done by RDNs or other professionals (nurses)
Screening/referrals
Common Nutrition screening tools:
- Malnutrition universal screening tool (MUST)
- Mini nutritional assessment (MNA)
- Geriatric nutritional risk index (GNRI)
?: developed in 2004 used across healthcare to assess malnutrition quickly (wt, ht, BMI, unintentional wt loss, change in nutrition intake >5 days)
MUST
?: used in older adults and assesses oral intake, wt loss, mobility, neurological/psychological status, current stress levels, BMI
MNA
?: older adults relies on changes in current body wt, previous body wt, and serum albumin
GNRI
The Joint commission:
- Mandates hospital have system set in place to specify who should conduct nutrition screenings, on which patients, and which timeframe
- specify hospital should decide what patient needs/conditions warrant nutrition screening
- mandate nutrition screening performed within 24 hrs of inpatient admission
Referrals in nutrition education:
RDN advertise nutrition classes where pt can sign up
Referrals in MNT:
written referral from physician specifically for MNT-billable condition
Nutrition assessment includes:
- food and nutrition-related history
- biochemical data, medical tests and procedures
- anthropometric measures
- NFPE (nutrition focused physical findings)
- relevant client history
During assessment, RDN:
collects data and information to compare against standards
During diagnoses, RDN:
identify and label actual problem of the pt/client
Screening determines:
Assessment determines:
- risk of a problem
- presence of a problem
?: clearly defined and measurable markers to be used as signs and symptoms in Nutrition Diagnoses and markers of progression during Nutrition M&E
Nutrition Care indicators
Nutrition care indicators are compared to:
Nutrition care criteria
Nutrition assessment in nutrition education:
ask client about nutrition concerns/fill out questionnaire/pre-test
Nutrition assessment in MNT:
use of MNT Evidence-Based guide for practice to collect relevant data
Food and Nutrition Related history:
Intake, medications, CAM (complementary and alternative medicine), knowledge/beliefs, availability of foods, physical activity, nutrition related quality of life.
Intake via:
24 hour recalls, food frequency questionnaires, food records
Medications Interactions can:
- decrease appetite
- decrease intake due to N/V, mouth sores
- decrease nutrient absorption (laxatives, anticonvulsants)
- decrease nutrient production
- interfere nutrient metabolism
CDC recommends WHO charts used for children between the ages:
0-2 years
CDC recommends CDC charts used for children aged:
over age of 2 yrs
WHO 0-2 years (0-24 months) includes:
length-for-age
wt-for-age
head circumference-for-age
wt-for-lenght
WHO 0-3 years (0-36 months) includes:
length-for-age
wt-for-age
head cicumference-for-age
wt-for-length
CDC 2-5 yrs includes:
wt-for-stature
CDC 2-20 yrs includes:
wt-for-age
stature-for-age
BMI-for-age
which growth charts are used for nutritional risk screening:
wt-for-length
wt-for-stature
BMI-for-age
Z scores Mild malnutrition
-1 to -1.9
Z scores moderate malnutrition
-2 to -2.9
Z scores severe malnutrition
> /= -3
Short stature
WHO (0-2 yrs):
length-for-age <2nd percentile
CDC (+2yrs):
ht-for-age <3rd or <5th percentile
Underwt
WHO (0-2yrs):
wt-for-length <2nd percentile
CDC (+2yrs):
BMI-for-age <3rd or <5th percentile
Overwt
WHO (0-2 yrs)
wt-for-length >98th percentile
CDC (+2yrs):
overwt= BMI-for-age 85th-95th percentile
obese= BMI-for-age >95th percentile
Ht measured:
directly: stadiometer
indirectly: knee-ht measurements, arm spans, recumbent length
Wt measured:
IBW using Hamwi
Usual body wt (pt reported)
Current body wt (measured)
Adjusted body wt
ABW
ABW (kg)= [(CBW-IBW) x 0.25] + IBW
IBW (Hamwi men and women)
Men:
106 lbs + (6lbs per inch over 5 feet)
Women:
100 lbs + (5lbs per inch over 5 feet)
Amputations
- Arm= 5%
- Forearm + Hand= 2.3%
- Hand= 0.7%
- Leg= 16%
- Lower leg + Foot= 5.9%
- Foot= 1.5%
BMI
= wt(kg)/ ht (m)^2
Kilograms to pounds=
Pounds to Kilograms=
x 2.2
/ 2.2
Convert Inches to meters=
divide inches by 39.37
Category and BMI
underwt= <18.5
normal wt= 18.5-24.9
overwt= 25-29.5
obese= >/= 30
class 1= 30-34.9
class 2= 35-39.9
class 3= >/= 40
Percent wt change=
(previous wt-current wt)/previous wt X100
OR
wt loss/previous wt x 100
Degree of wt loss and time frame
(SIGNIFICANT)
1 week= 1-2%
1 month= 5%
3 months= 7.5%
6 months= 10%
Degree of wt loss and time frame
(SEVERE)
1 week= >1.2%
1 months= >5%
3 months= >7.5%
6 months= >10%
Body composition measures:
fat mass to fat-free mass
Direct methods for body compositions include:
- BOD-POD: air displacements rather than body water content
- Bioelectrical impedance analysis: lean body tissue has higher electrical conductivity and lower impedance than fatty tissue (dependent on water, so must hydrate no caffeine or diuretics)
- DEXA: measures bone, fat, muscle compartments using xrays
- Underwater weighing: uses water displacement to estimate body volume
Indirect methods for body composition:
skin folds, midarm muscle circumference, midarm circumference
Nitrogen Balance=
1) 24hr urinary urea nitrogen= (protein g 24 hrs/6.25 g) - (urinary urea nitrogen + 4)
2) 24hr total urinary nitrogen=
(protein g 24hrs/6.25g) - (total urea nitrogen + 2)
NFPE
overall appearance, hair, face, eyes, mouth, nails, legs/feet, neurological, skin
Hair thin, sparse, dull, dry brittle OR easily pluckable
vit C and protein deficiency
OR: protein deficiency
eyes pale, dry, poor vision
vit A, zinc, riboflavin deficiency
Lips swollen, red, dry, cracked
riboflavin, pyridoxine, niacin def
Gums sore, red, swollen, bleeding
Vit C def
Teeth missing, loose, loss of enamel
Calcium def, poor intake
Skin pale, dry, scaly
iron, folic acid, zinc def
Nails brittle, thin, spoon-shaped
iron or protein def
Auscultation
listening to bowel using stethoscope on RLG (ileocecal valve)
- NORM: gurgling high pitched every 5-15 sec
- HYPOACTIVE: sounds every 15-20 sec (could indicate paralytic ileus or peritonitis)
- HYPERACTIVE: continuous high pitched, diarrhea/intestinal obstructoin
Food security:
Access by all people at all times, no food access problems or limitations
Marginal food security:
some anxiety over food sufficiency or shortage in household, little or no indication of diet change or reduced food intake
Low food security:
food quality, variety, diet desirability of household members reduced because household lacks money, little to no indication of reduced intake
Very low food security:
food intake of household reduced and normal eating patterns are disrupted multiple times
