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CNSC Exam > Nutrition Assessment > Flashcards

Nutrition Assessment Flashcards

1
Q

the process to identify someone who may be malnourished or at risk for malnutrition, to determine if a comprehensive nutrition assessment is indicated

A

screening

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2
Q

a positive screening result should result in

A

a nutrition consult

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3
Q

This screening tool is used mostly in the elderly. Describes food intake, appetite, chewing/swallowing, weight loss in 3 months, mobility issues, recent psych distress, neuropsych and BMI. The higher the points, the higher the risk

A

Mini Nutrition Assessment

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4
Q

what is the validated tool for the diagnosis of malnutrition

A

Subjective Global Assessment

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5
Q

this tool assesses weight changes, dietary intake changes, GI symptoms, functional capacity, edema, and disease related nutrition requirements. Scoring is based on well nourished, moderately malnourished or severely malnourished

A

Subjective Global Assessment

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6
Q

Social/Environmental malnutrition has ______ level of inflammation

A

no

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7
Q

pure, chronic starvation, anorexia nervosa, ETOH abuse, homelessness and psychological issues are ____ types of malnutrition

A

social/environmental

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8
Q

a chronic condition is considered how long per CMS standards

A

1 month or greater

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9
Q

organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenia obesity, COPD, CHF, CA, and IBD are examples of ____ malnutrition

A

mild/moderate; chronic disease

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10
Q

acute malnutrition has a _____degree of inflammation

A

high

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11
Q

major infection, burns, trauma, closed head injuries are examples of _____ malnutrition

A

acute malnutrition

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12
Q

criteria for severe acute malnutrition

A 
<50% po > 5 days
>2% weight loss x 1 week
>5% weight loss x 1 month
>7.5% weight loss x 3 months
moderate fat loss
moderate muscle loss
moderate to severe edema
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13
Q

criteria for severe chronic malnutrition

A 
=75% po intake >/= 1 month
>5% weight loss x 1 month
>7.5% weight loss x 3 months
>10% weight loss x 6 months
>20% weight loss x 1 year
severe fat wasting
severe muscle wasting
severe edema 
below standards handgrip strength
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14
Q

criteria for severe social/environmental nutrition

A 
<= 50% po intake x >/= 1 month
>5% weight loss x 1 month
>7.5% weight loss x 3 months
> 10% weight loss x 6 months
>20% weight loss x 1 year
severe fat loss
severe muscle loss
below standards handgrip strength 
severe edema
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15
Q

Tools to assess dietary intake

A

direct from patient or family, from RN, 24 hour recall, 3 day recall, % meal eaten from EMR, indirect calorimetery

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16
Q

unintended weight loss is a ______ indicator of malnutrition

A

well validated

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17
Q

the most readily available tool inpatient to assess loss of subcutaneous fat/muscle

A

NFPE

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18
Q

a tool to evaluate decreased function in identification of malnutrition

A

hand grip strength (average of 3 tests)

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19
Q

hand grip strength is a _____ predictor of nutrition status

A

independent

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20
Q

is handgrip strength a validated tool

A

yes

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21
Q

positive acute phase proteins

A

CRP, fibrinogen, antibodies

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22
Q

positive acute phase proteins ____ during inflammation

A

INCREASE

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23
Q

negative acute phase proteins

A

albumin, pre albumin, transferrin

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24
Q

negative acute phase proteins _____ during inflammation

A

DECREASE

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25
Q

albumin will be decreased during inflammation regardless of

A

nutrition status/malnutrition

26
Q

clinical indicators of inflammation

A

fever, UTI, wound infection, hypothermia, PNA, BSI, abscess

27
Q

chronic disease states have ______ level of inflammation

A

mild to moderate

28
Q

hematological malignancy, IBD, CVD, celiac disease, COPD, CHF, obesity, pressure wounds, chronic pancreatitis CF, dementia, RA, organ transplants and solid tumors are examples of ____ malnutrition

A

chronic (mild-moderate inflammation)

29
Q

ARDS, closed head injury, critical illness, SIRS, acute severe malnutrition, major abdominal surgery, major infection/sepsis multi level trauma and severe burns are examples of ____ malnutrition

A

severe / acute

30
Q

an approach to identify malnutrition globally with other global nutrition societies

A

Global Leadership Initiative on Malnutrition (GLIM)

31
Q

GLIM has 2 criteria ___ and ___

A

phenotypic and etiologic

32
Q

GLIM can be used in _____ settings/environments

A

all

33
Q

copper deficiency is associated with _____ anemia

A

microcytic hypochromic anemia

34
Q

because of copper deficiency, patients on long term PN have developed

A

anemia, leukopenia, neutropenia

35
Q

_____ deficiency also causes microcytic hypochromic anemia other than copper

A

iron

36
Q

B12 and Folate deficiencies cause ____ anemia

A

macrocytic

37
Q

A patient getting PN has high ileostomy output, what changes to PN is recommended

A

increase fluid

increase sodium

38
Q

When ileostomy output is over 1,000mL a day, a patient can lose up to ____ mEq/L of sodium, and if not replaced can lead to significant hyponatremia

A

120mEq/L

39
Q

Clinical characteristics of acute disease or injury related severe malnutrition are _____ fat depletion, weight loss > _____% in _____ week(s), ______ weight loss in ____ month, > ___%weight loss in ____ months, decreased energy intake _____ days, _____ muscle depletion, ____ fluid accumulation

A 
moderate fat depletion
2% in 1 week
5% in 1 month
7.5% in 3 months
<50% > 5 days
moderate muscle depletion
moderate to severe fluid accumulation
40
Q

which condition(s) are most likely to result in malnutrition of mild to moderate inflammatory response

A

cancer

41
Q

involuntary weight loss of 10% of usual body weight over 6 months is suggestive of

A

malnutrition

42
Q

Tricep skin fold thickness below the ____percentile indicates malnutrition

A

<5 percentile

43
Q

Tricep skin fold thickness to assess for malnutrition may be falsely elevated with ____ and may not be reliable in _____

A

edema

obesity

44
Q

Recent, involuntary weight loss >10% in 6 months detect risk of malnutrition in both

A

obese and non obese patients

45
Q

When conducting an NFPE, hollowing/scooping depression of the temporalis muscle indicates ____ muscle loss

A

severe

46
Q

in severe muscle depletion, the clavicle and acromion process / deltoid muscle will appear

A

square with very prominent bones

47
Q

in severe muscle loss, the interosseous muscle on the dorsal hand will appear

A

depressed between the thumb and fore finger

48
Q

in severe fat loss, the iliac crest will appear

A

prominent

49
Q

Which is common in both acute illness or injury related malnutrition and social or environmental related malnutrition

A

lipoysis

50
Q

in acute illness/injury related and social/environmental malnutrition both how catabolism of endogenous substrate, including fat stored in adipose tissue, is common in

A

both types of malnutrition

51
Q

Which nutrition tool includes evaluating subsequent fat and muscle wasting at multiple body sites to determine nutrition status

A

Subjective Global Assessment (SGA)

52
Q

hypermetabolism/hyperglycemia are characteristic of ___ related malnutrition

A

stress

53
Q

The SGA is a nutrition assessment tool using 5 historical measures including weigh history, dietary intake, GI symptoms, functional status and metabolic demand plus 3 components of the physical exam (fat depletion, muscle wasting,, nutrition related edema). With this information patients are classified as

A

well nourished
moderately malnourished
or
severely malnourished

54
Q

ASPEN and the SCCM recommend to use these screening tools for malnutrition in the ICU

A

NUTRIC/NRS 2002

55
Q

This nutrition assessment tool monitors for unintentional weight loss, BMI, disease severity, impaired general condition and age over 70

A

NRS

56
Q

This nutrition assessment tool uses the APACHE III score, SOFA score, number of comorbidities and days from hospital to ICU admit to identify malnutrition risk

A

The NUTRIC Tool

57
Q

This nutrition assessment too uses serum albumin and the ratio of current weight to usual weight to asses malnutrition risk

A

The NRI (Nutritional Risk Index) Tool

58
Q

what has been reported to be a significant independent predictor of morbidity and mortality in critically ill patients

A

albumin

59
Q

______ is a negative acute phase protein

A

alubmin

60
Q

levels of albumin decrease during stress. Hypoalbuminemia is more of a reflection of the degree of_____ , ___ and ___ rather than malnutrition

A

stress from disease, injury and inflammation

61
Q

A previously well-nourished patient with persistent fever is admitted to the hospital. Lab tests reveal an albumin of 2.1 g/dL, C-RP of 30 mg/dL, and serum calcium of 7.2 mg/dL. What is the most likely cause of hypoalbuminemia ?

A

inflammatory response

CNSC Exam (32 decks)

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