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Camelita- Medicine and Society II > Nutrition Assessment in Clinical Care > Flashcards

Nutrition Assessment in Clinical Care Flashcards

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1
Q

What is the purpose of nutrition assessment?

A
  • Accurately evaluate an individual’s dietary intake and nutritional status
  • Determine if medical nutrition therapy and/ or couseling is needed
  • Monitor changes in nutritional status
  • Evaluate the effectiveness of nutritional interventions
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2
Q

What is the purpose of obtaining dietary info?

A
  • To assess their nutritional status
  • Formulate a treatment plan

NOTE:

Infants, children, adolescents, pregnant women, older adults, and patients with a family history of or who have diabetes, hypertension, heart disease, hyperlipidemia, obesity, eating disorders, alcoholism, osteoporosis, gastrointestinal or renal disease, cancer, or weight loss or gain should always be asked about their eating habits, even during routine visits.

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3
Q

Key Diet History Questions for Brief Intervention

A
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4
Q

Questions for Patients with Hyperlipidemia

A
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5
Q

Questions for Patients with Hypertension

A
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6
Q

Questions for Patients with Diabetes

A
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7
Q

True or False. Review of Systems emphasizes current more than past information.

A

True

NOTE: One goal of this part of the history is to determine whether any dietary changes have occurred in the patient’s life, either voluntarily or as a consequence of illness, medication use, or psychological problems.

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8
Q

Nutrition questions vary according to the patient’s _____.

A

Age

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9
Q

What steps does a physical examination begin with?

A
  • Vital signs
  • Height
  • Wieght
  • Body mass index (BMI)
  • General appearance
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10
Q

Excess fat located in the abdominal area is reflected by _______ measurement.

A

Waist circumference

NOTE: Wais circumference is a predicator of morbidity, and is considered an independent risk factor for diabetes, dyslipidemia, hypertension, and cardiovascular disease even when BMI is not markedly increased.

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11
Q

Measuring waist circumference is recommended in patients with a BMI less than __________.

A

35 kg/m2

NOTE: In patients with a BMI greater than 35 kg/m2, there is little additional risk from elevated waist circumference, as severe risk is already present.

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12
Q

Percentage Weight Change

A
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13
Q

What components does the nutrition-oriented aspects of physical examinations focus on?

A

The skin, head, hair, eyes, mouth, nails, extremities, abdomen, skeletal muscle, and fat stores.

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14
Q

Areas to examine closely for muscle wasting include the _________ and __________ on the hands.

A

temporal muscles and the interosseous muscles

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15
Q

The skeletal muscles of the extremities also serve as an indicator of ____________.

A

undernutrition

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16
Q

Physical Examination Findings with Nutritional Implications (Vital Signs, General, Skin)

A
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17
Q

Physical Examination Findings with Nutritional Implications (Hair, Head, Eyes, and Mouth)

A
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18
Q

Physical Examination Findings with Nutritional Implications (Neck, Thorax, Cardiac, Genital/ Urinary)

A
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19
Q

Physical Examination Findings with Nutritional Implications (Extremities, Nails, and Neurological)

A
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20
Q

What test are used for alcoholism?

A
  • Aspartate aminotransferase (AST)
  • Alanine aminotransferase (ALT)
  • Gamma-glutamyl transferane (GGT)
  • Thiamine
  • Folate
  • Vitamin B12
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21
Q

What test are used for anemia?

A
  • Complete blood count (CBC)
  • Serum iron
  • Ferritin
  • Total iron binding capacity (TIBC)
  • Transferrin saturation
  • Mean corpuscular volume (MCV)
  • Reticulocyte count
  • Red blood cell folate
  • Serum vitamin B12
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22
Q

What test are used for diabetes?

A
  • Fasting serum glucose
  • Hemoglobin A1c
  • Insulin levels
  • C-reactive protein (CRP)
  • Serum and urinary ketone bodies.
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23
Q

What test are used for eating disorders?

A
  • Potassium
  • Albumin
  • Serum amylase
  • Thyroid studies
  • Beta carotene aspartate amino transferase (AST)
  • Alanine aminotransferase (ALT)
  • Anemia.
24
Q

What test are used for fluid, electrolyte, and renal function?

A
  • Sodium
  • Potassium
  • Chloride
  • Calcium
  • Phosphorus
  • Magnesium
  • Blood urea nitrogen (BUN)
  • Creatinine
  • Urine urea nitrogen
  • Urinary and serum, oxalic acid, and uric acid.
25
Q

What test are used for hyperlipidemia?

A
  • Cholesterol
  • Triglyceride
  • Low density lipoprotein – cholesterol (LDL-C)
  • High density lipoprotein – cholesterol (HCL-C)
  • Homocysteine
  • Thyroid stimulating hormone (TSH) (secondary cause).
26
Q

What tests are used for musculoskeletal pain and weakness?

A
  • 25(OH) vitamin D
  • Phosphate
  • PTH.
27
Q

What tests are used for malabsorption?

A
  • 24-hour fecal fat
  • Barium studies
  • Electrolytes
  • Albumin
  • Serum triglyceride
  • Hydrogen breath test.
28
Q

What tests are used for metabolic syndrome?

A
  • Fasting serum glucose
  • Lipid panel
  • Uric acid.
29
Q

What tests are used for refeeding syndrome?

A
  • Albumin
  • Calcium
  • Phosphorous
  • Magnesium
  • Potassium.
30
Q

Compare and contrast serum albumin, transferrin, and prealbumin.

A

Albumin

  • Half-life: 18 to 20 days
  • Reflects nutritional status over the previous 1 to 2 months
  • Decrease in cases of: acute stress, overhydration, trauma, surgery, liver disease, and renal disease
  • <3.5 mg/dL associated with increased morbidity and mortality

Transferrin

  • Half-life: 8 to 9 days
  • Changes levels are influenced by iron status, as well as protein and calorie intake

Prealbumin

  • Half-life: 2 to 3 days
  • Reflects nutritional status as well as protein and calorie intake
  • Levels may be falsely elevated with renal disease
  • Levels are reduced with severe liver disease
31
Q

Active problems are listed in order of _______.

A

Their importance

32
Q

A primary nutrition problem is usaully the result of _______,__________, or __________.

A

Imbalnces, inadequecies, excess in patient’s nutrient intake

NOTE: Evidence of a nutrition disorder should be considered primary if it occurs in an individual with no other etiology that explains signs and symptoms of undernutrition

33
Q

What are some common causes of secondary nutritional disorders?

A

Anorexia Nervosa

Malabsorption

Diabetes

Trauma

Acute medical illness

Surgery

NOTE: After assessing each problem, medical nutrition therapy should be recommended that includes both a diagnostic component and a treatment plan.

34
Q

Key Dietary Issues by Age and Disease

A
35
Q

Key Dietary Issues by Age and Disease

A
36
Q

Key Dietary issues by Age and Disease

A
37
Q

Key Dietary issues by Age and Disease

A
38
Q

Key Dietary issues by Age and Disease

A
39
Q

What are some possible causes of decreased oral intake?

A

Poverty, poor dentition, gastrointestinal obstruction, abdominal pain, anorexia, dysphagia, depression, social isolation, and chronic pain

40
Q

What are some possible causes of increased nutrient loss?

A

Glycosuria, gastrointestinal bleeding, diarrhea, malabsorption, nephrosis, a draining fistula, or protein-losing enteropathy

41
Q

What are some possible causes of undernutrition?

A

Hypermetabolic state or excessive catabolic processes, like: surgery, trauma, fever, burns, hyperthyroidism, severe infection, malabsorption syndromes, cancer COPD, cardiac cachexia, critical illness, and HIV/AIDS.

NOTE: Pregnant women and children are also at risk due to increased nutritional requirements during growth and development.

42
Q

According to WHO,________ percent of deaths among children less than five years of age in developing countries are associated with undernutrition.

A

50

43
Q

Why is rise of obesity of particular concern for health professionals?

A

Obese individuals have 50 to 100 percent increased risk of remature death from all causes

44
Q

What is the first priciple of behavior change?

A
  • To understand the long-term nature of lifestyle changes
  • To encourage a person who has not met goals or has relapsed
  • For health care providers who also can become discouraged with apparent lack of immediate success
45
Q

Prochaska Stage of Change Model

A
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse

NOTE: This model is often used to clarify for people and their providers their readiness for change.

46
Q

Important questions that could be asked of al patients seen for follow-up to assess their level of change

A
  • žHow have you changed your diet or exercise since the last visit?
  • žWhat problems did you encounter in making these changes?
  • žDo you feel confident that you can maintain the changes you have made?
  • žWhat changes would you still like to make in your diet or exercise pattern to improve your health?
  • žHow can I help you with these changes?
  • žWhat one behavior could you change that would result in the most significant change in your health?
  • žWhat one or two behaviors would you like to change now?
47
Q

It’s recommended to measure BMI in cases of waist circumference less than _________.

A

35 kg/m2

48
Q

BMI less than ___= Malnutrition

A

20

49
Q

Metabolic Syndrome

A
  • Increased blood pressure
  • High blood sugar
  • Excess body fat around the waist
  • Abnormal cholesterol or triglyceride levels
    • High LDL
    • Low HDL
50
Q

Best way to measure malnutrition

A

ALBUMIN

NOTE: Albumin levels are increased in cases of dehydration

51
Q
  • Alcoholics are deficient in ______, _______, and ______.
A

thiamine, B12, and folic acid

52
Q

_________, ______, and ________ are required for cell synthesis

A

Folic acid, iron, and B12

53
Q

Olive oil is a _________ fat.

A

monosaturated

54
Q
  • Causes of Undernutrition
A
  • Decreased oral intake
  • Increased nutrient loss
  • Increased nutrient requirements
55
Q
  • Prochaska Stage of Change Model
A
  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Relapse

Camelita- Medicine and Society II (7 decks)

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