Nutrition Assessment

Question 1

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

Answer 1

screening

Question 2

a positive screening result should result in

Answer 2

a nutrition consult

Question 3

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

Answer 3

Mini Nutrition Assessment

Question 4

what is the validated tool for the diagnosis of malnutrition

Answer 4

Subjective Global Assessment

Question 5

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

Answer 5

Subjective Global Assessment

Question 6

Social/Environmental malnutrition has ______ level of inflammation

Answer 6

no

Question 7

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

Answer 7

social/environmental

Question 8

a chronic condition is considered how long per CMS standards

Answer 8

1 month or greater

Question 9

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

Answer 9

mild/moderate; chronic disease

Question 10

acute malnutrition has a _____degree of inflammation

Answer 10

high

Question 11

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

Answer 11

acute malnutrition

Question 12

criteria for severe acute malnutrition

Answer 12

<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

Question 13

criteria for severe chronic malnutrition

Answer 13

=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

Question 14

criteria for severe social/environmental nutrition

Answer 14

<= 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

Question 15

Tools to assess dietary intake

Answer 15

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

Question 16

unintended weight loss is a ______ indicator of malnutrition

Answer 16

well validated

Question 17

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

Answer 17

NFPE

Question 18

a tool to evaluate decreased function in identification of malnutrition

Answer 18

hand grip strength (average of 3 tests)

Question 19

hand grip strength is a _____ predictor of nutrition status

Answer 19

independent

Question 20

is handgrip strength a validated tool

Answer 20

yes

Question 21

positive acute phase proteins

Answer 21

CRP, fibrinogen, antibodies

Question 22

positive acute phase proteins ____ during inflammation

Answer 22

INCREASE

Question 23

negative acute phase proteins

Answer 23

albumin, pre albumin, transferrin

Question 24

negative acute phase proteins _____ during inflammation

Answer 24

DECREASE

Question 25

albumin will be decreased during inflammation regardless of

Answer 25

nutrition status/malnutrition

Question 26

clinical indicators of inflammation

Answer 26

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

Question 27

chronic disease states have ______ level of inflammation

Answer 27

mild to moderate

Question 28

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

Answer 28

chronic (mild-moderate inflammation)

Question 29

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

Answer 29

severe / acute

Question 30

an approach to identify malnutrition globally with other global nutrition societies

Answer 30

Global Leadership Initiative on Malnutrition (GLIM)

Question 31

GLIM has 2 criteria ___ and ___

Answer 31

phenotypic and etiologic

Question 32

GLIM can be used in _____ settings/environments

Answer 32

all

Question 33

copper deficiency is associated with _____ anemia

Answer 33

microcytic hypochromic anemia

Question 34

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

Answer 34

anemia, leukopenia, neutropenia

Question 35

_____ deficiency also causes microcytic hypochromic anemia other than copper

Answer 35

iron

Question 36

B12 and Folate deficiencies cause ____ anemia

Answer 36

macrocytic

Question 37

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

Answer 37

increase fluid | increase sodium

Question 38

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

Answer 38

120mEq/L

Question 39

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

Answer 39

``` 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 ```

Question 40

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

Answer 40

cancer

Question 41

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

Answer 41

malnutrition

Question 42

Tricep skin fold thickness below the ____percentile indicates malnutrition

Answer 42

<5 percentile

Question 43

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

Answer 43

edema | obesity

Question 44

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

Answer 44

obese and non obese patients

Question 45

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

Answer 45

severe

Question 46

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

Answer 46

square with very prominent bones

Question 47

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

Answer 47

depressed between the thumb and fore finger

Question 48

in severe fat loss, the iliac crest will appear

Answer 48

prominent

Question 49

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

Answer 49

lipoysis

Question 50

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

Answer 50

both types of malnutrition

Question 51

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

Answer 51

Subjective Global Assessment (SGA)

Question 52

hypermetabolism/hyperglycemia are characteristic of ___ related malnutrition

Answer 52

stress

Question 53

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

Answer 53

well nourished moderately malnourished or severely malnourished

Question 54

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

Answer 54

NUTRIC/NRS 2002

Question 55

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

Answer 55

NRS

Question 56

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

Answer 56

The NUTRIC Tool

Question 57

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

Answer 57

The NRI (Nutritional Risk Index) Tool

Question 58

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

Answer 58

albumin

Question 59

______ is a negative acute phase protein

Answer 59

alubmin

Question 60

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

Answer 60

stress from disease, injury and inflammation

Question 61

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 ?

Answer 61

inflammatory response