Nutrition Assessment Flashcards
the process to identify someone who may be malnourished or at risk for malnutrition, to determine if a comprehensive nutrition assessment is indicated
screening
a positive screening result should result in
a nutrition consult
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
Mini Nutrition Assessment
what is the validated tool for the diagnosis of malnutrition
Subjective Global Assessment
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
Subjective Global Assessment
Social/Environmental malnutrition has ______ level of inflammation
no
pure, chronic starvation, anorexia nervosa, ETOH abuse, homelessness and psychological issues are ____ types of malnutrition
social/environmental
a chronic condition is considered how long per CMS standards
1 month or greater
organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenia obesity, COPD, CHF, CA, and IBD are examples of ____ malnutrition
mild/moderate; chronic disease
acute malnutrition has a _____degree of inflammation
high
major infection, burns, trauma, closed head injuries are examples of _____ malnutrition
acute malnutrition
criteria for severe acute malnutrition
<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
criteria for severe chronic malnutrition
=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
criteria for severe social/environmental nutrition
<= 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
Tools to assess dietary intake
direct from patient or family, from RN, 24 hour recall, 3 day recall, % meal eaten from EMR, indirect calorimetery
unintended weight loss is a ______ indicator of malnutrition
well validated
the most readily available tool inpatient to assess loss of subcutaneous fat/muscle
NFPE
a tool to evaluate decreased function in identification of malnutrition
hand grip strength (average of 3 tests)
hand grip strength is a _____ predictor of nutrition status
independent
is handgrip strength a validated tool
yes
positive acute phase proteins
CRP, fibrinogen, antibodies
positive acute phase proteins ____ during inflammation
INCREASE
negative acute phase proteins
albumin, pre albumin, transferrin
negative acute phase proteins _____ during inflammation
DECREASE
albumin will be decreased during inflammation regardless of
nutrition status/malnutrition
clinical indicators of inflammation
fever, UTI, wound infection, hypothermia, PNA, BSI, abscess
chronic disease states have ______ level of inflammation
mild to moderate
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
chronic (mild-moderate inflammation)
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
severe / acute
an approach to identify malnutrition globally with other global nutrition societies
Global Leadership Initiative on Malnutrition (GLIM)
GLIM has 2 criteria ___ and ___
phenotypic and etiologic
GLIM can be used in _____ settings/environments
all
copper deficiency is associated with _____ anemia
microcytic hypochromic anemia
because of copper deficiency, patients on long term PN have developed
anemia, leukopenia, neutropenia
_____ deficiency also causes microcytic hypochromic anemia other than copper
iron
B12 and Folate deficiencies cause ____ anemia
macrocytic
A patient getting PN has high ileostomy output, what changes to PN is recommended
increase fluid
increase sodium
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
120mEq/L
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
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
which condition(s) are most likely to result in malnutrition of mild to moderate inflammatory response
cancer
involuntary weight loss of 10% of usual body weight over 6 months is suggestive of
malnutrition
Tricep skin fold thickness below the ____percentile indicates malnutrition
<5 percentile
Tricep skin fold thickness to assess for malnutrition may be falsely elevated with ____ and may not be reliable in _____
edema
obesity
Recent, involuntary weight loss >10% in 6 months detect risk of malnutrition in both
obese and non obese patients
When conducting an NFPE, hollowing/scooping depression of the temporalis muscle indicates ____ muscle loss
severe
in severe muscle depletion, the clavicle and acromion process / deltoid muscle will appear
square with very prominent bones
in severe muscle loss, the interosseous muscle on the dorsal hand will appear
depressed between the thumb and fore finger
in severe fat loss, the iliac crest will appear
prominent
Which is common in both acute illness or injury related malnutrition and social or environmental related malnutrition
lipoysis
in acute illness/injury related and social/environmental malnutrition both how catabolism of endogenous substrate, including fat stored in adipose tissue, is common in
both types of malnutrition
Which nutrition tool includes evaluating subsequent fat and muscle wasting at multiple body sites to determine nutrition status
Subjective Global Assessment (SGA)
hypermetabolism/hyperglycemia are characteristic of ___ related malnutrition
stress
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
well nourished
moderately malnourished
or
severely malnourished
ASPEN and the SCCM recommend to use these screening tools for malnutrition in the ICU
NUTRIC/NRS 2002
This nutrition assessment tool monitors for unintentional weight loss, BMI, disease severity, impaired general condition and age over 70
NRS
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
The NUTRIC Tool
This nutrition assessment too uses serum albumin and the ratio of current weight to usual weight to asses malnutrition risk
The NRI (Nutritional Risk Index) Tool
what has been reported to be a significant independent predictor of morbidity and mortality in critically ill patients
albumin
______ is a negative acute phase protein
alubmin
levels of albumin decrease during stress. Hypoalbuminemia is more of a reflection of the degree of_____ , ___ and ___ rather than malnutrition
stress from disease, injury and inflammation
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 ?
inflammatory response
