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Nutritional Assessment Flashcards

1
Q

Nutritional Screening

A
  • Food and Nutrient Intake Patterns
    • Calorie, macros, vits, minerals
    • Swallowing issues, GI issues,
    • Food habits, misuse of supplements
    • Restricted, therapeutic diet
  • Psych and Social factors
    • Low literacy, language
    • Depression, mental health
    • Resources, income, substance abuse
  • Physical Conditions
    • Age extremes, pregnancy, fat/muscle wasting, organ dysfunction, AIDS, cancer
  • Abnormal Lab Values: visceral proteins, lipids, BG - Medications
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2
Q

Characteristics of a Good Screen

A

Simple and quick process Uses data routinely gathered

Facilitates completion of early intervention goals

Includes data on risk factors

Cost effective

**Main goal: Determines need for nutrition assessment

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3
Q

Individual Assessment

A

Evaluate, Analyze, Plan, Implement, Evaluate and Record

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4
Q

Community Assessment

A

Focus on high risk groups

  • Phases:
    • Screening and assessment
    • Data collection of population
    • Analysis of information to identify health needs and problems
  • Objectives:
    • General goals determined
    • Involving staff and agency decisions
    • Establish time line
  • Program Plan: Plan of action, staff, documentation, sources of funding, budget planning, equipment
  • Evaluation: Assessment should be ongoing, evaluate results, revisions for study purposes or for conversion to regular, ongoing program status
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5
Q

Anthropometric - Weight

A

Ideal weight for height (% ideal)

Usual weight (% usual)

Actual weight

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6
Q

“Ideal Weight”

A

Met Life Insurance Tables ‘59 and ‘83

Some people think we should aim to achieve ‘59 values because we were thinner back then

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7
Q

Miller Method

A

Women: 119 lbs for 5ft + 3 lbs/in

Men: 135 lbs for 5 ft + 3lbs/in

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8
Q

Frame Size by Wrist Circumference

A

r = Height (cm) / Wrist Circumference (cm)

  • Males
    • r > 10.4 small
    • r = 9.6-10.4 medium
    • r < 9.6 large
  • Females
    • r > 11 small
    • r = 10.1-11 medium
    • r < 10.1 large
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9
Q

Body Compartments

A

Lean Body Mass = Fat Free Mass

Body fat = # and size of fat cells

Body water - LBM contains more water

Mineral Mass - smallest component

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10
Q

BMI

A

BMI = wt (kg) / ht (m)

  • 2 2.54 cm/in

Not a good measure if:

  • Very high in muscle mass
  • Low muscle mass
  • Dense/large bones
  • Dehydration, overhydration
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11
Q

Mid-Upper-Arm Circumference (MAC)

A

Non-dominant arm

Midpoint between scapula and elbow

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12
Q

Triceps Skinfold Thickness (TSF)

A

Requires calipers good estimate of subcutaneous fat

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13
Q

Mid-Upper-Arm MUSCLE Circumference (MAMC)

A

Calculated using MAC and TSF to estimate body’s skeletal muscle mass

MAC(cm) - [(.314 x TSF(mm)]

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14
Q

Waist to Hip Ratio

A

Indicative of android obesity, which correlates with obesity related diseases

Healthy:

  • Women < 0.8
  • Men < 1.0
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15
Q

Bioelectrical Impedance Analysis (BIA)

A
  • Body fat/body composition analysis
  • LBM has higher electrical conductivity and low impedance, relative to water, based on electrolyte content
  • Electrodes attached to extremities
  • Electrical and resistance data obtained
  • Highly sensitive to hydration status
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16
Q

Biochemical Analysis

A

Most objective and most sensitive data

Quality control can be maintained

Nutrition specific lab data tests on body fluids

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17
Q

Albumin

A

Normal: 3.5-5

  • Most abundant and most often measured protein
  • Long Half life - 21 days - can’t evaluate short term changes
  • Made in liver
  • Functions to maintain oncotic pressure, keeping fluids in the right places in the body
  • Nonspecific carrier protein
  • Inexpensive nutritional marker in a non-stressed person
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18
Q

Preablumin / Transthyretin

A

Normal: 19 - 43

  • Transport protein with many physiological roles
  • Correlates with short term changes in nutritional status in non-stressed person
  • Short half life - 2 days
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19
Q

Hematocrit

A

Men: 41-53%

Women: 36-46%

  • Percentage of RBC’s in the blood by vol
  • Indicates ratio of RBC vol to total blood vol
  • Low level can be indicative of anemia or blood loss
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20
Q

Hemoglobin

A

Men >14

Women >12

  • Oxygen carrying pigment in RBC
  • Formed by developing RBC in bone marrow
  • Low level indicative of anemia
21
Q

Blood Level Evaluation

A

Used for:

  • Absorptive capacity
  • Organ function
  • Disease management
  • Nutritional status
  • Risk for chronic dx
    • Lipid profile
    • CRP
    • Glycosylated Hgb
22
Q

Lymphocyte Count

A

Normal >2700

Decreased in PCM (protein calorie malnutrition)

Affected by many medical conditions, infections, medications (chemo, XRT, steroids)

23
Q

Skin Testing

A

PPD: Purified protein derivative of tuberculin

Mumps

Anergy (no response) can be sign of PCM

24
Q

Nitrogen Balance

A
  • Term used to describe relative balance of daily intake and output of nitrogen
  • Measure of how well tissue proteins are being maintained

[Protein intake (g) / 6.25] - [UUN*(g) + 4g**]

  • * Measured Urinary Urea Nitrogen
  • ** 4g accounting for average N lost in stool and skin
  • 6.25 g Protein = 1g N
25
Catabolism
* Negative Nitrogen balance * ongoing process of the breakdown of tissue proteins * Active during stress/illness - body uses its own muscle mass to meet nitrogen requirements
26
Anabolism
Positive Nitrogen Balance Process of re-synthesizing tissue proteins Active during growth, recoery and weight training
27
Clinical - General Appearance
* Confusion*: thiamin, Niacin, dehydration * Weakness*: PCM, B12, Niacin, anemia * Neuropathy*: thiamin, chromium, pyridoxine * Psychmotor changes*: **Kwashiorkor** (protein malnutrition - no albumin, no oncotic pressure, fluid goes into abdomen) * Sensory losses*: Niacin * Dementia*: B12, thiamin
28
Clinical - Hair
Luster, color, alopecia, scalp PCM, protein, EFA's, zinc, copper
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Clinical - Skin
* Scaling around nostrils*: Riboflavin * Scaly dermatitis:* niacin, Vit A, zinc, EFA's * Swollen, moon face:* protein * Pale:* anemia * Dry, poor turgor:* dehydration
30
Clinical - Nails
Cup-like depressions: IRON
31
Clinical - Eyes
* Pale conjunctiva*: Anemia * Dry, dull conjunctiva*: Vit A * Night Blindness*: Vit A * Redness, fissuring at corners*: Riboflavin, pyridoxine
32
Clinical - Mouth
* Angular Cheilosis*: Riboflavin - Swollen lips, buccal mucosa extends to lips * Magenta Tongue*: Riboflavin * Mucosal Atrophy*: Niacin * Bleeding Gums:* Vit C and Vit K * Flourosis* - White areas in the enamel of teeth: too much flouride * Dental Caries*: decreased flouride, excess sugar
33
Clinical - Muscles, Skeleton
**Cachexia**: general malnutrition, protein wasting * Bruising*: Vit C, K * Tremor*: electrolytes * Edema*: protein * Rickets, osteoporosis, bone pain*: calcium, Vit D, Phosphorus
34
Clinical - Abdomen, GI Function
**Ascites**: PCM, protein, other disorders * Diarrhea*: PCM, thiamine, malabsorption, IBD, infection, meds, antibiotics * Bloating, distention*: lactose, intolerances, disorders, meds * Appetite*: PCM, thiamine, niacin, meds, other problems * Taste changes*: zinc, meds
35
Diet History
* Usual food and beverage habits * Meal patterns, changes on weekend * likes, dislikes * Food allergies and intolerances * ETOH and drugs * Vitamins and supplements * Physical and Sedentary activities
36
24 Hour Recall
Guided by clinician Type and amount of each food and beverage in the previous 24 hours Downfalls: * may not reflect typical intake * Not ideal for individuals with memory problems * Misreported portion sizes
37
Nutrient Intake Analysis
"Calorie Count" Collected by direct observations - may yield inconsistent and subjective estimates of food consumption Portion sizes vary Labor intensive For studies, use pre meal and post meal weights
38
Food Records
3-7 Days of analysis Need to teach client how to describe, measure and record foods Best method to obtain accurate info Downfalls * Data is only as good as the record * Intake may be influenced by recording process * Not good for people who can't read
39
Food Frequency Questionnaire
Assessment of nutrient intake over an extended period of time Retrospective Clinician guided or client centered Not ideal for individuals with memory problems Useful for group studies of disease risk and incidence
40
Caution with Dietary Assessment Tools
10-45% underreport food intake Underreporting: * increases as children age * women \> men * obese \> non-obese
41
Harris-Benedict Equation
* Intended for adults, not kids * Estimated Basal (BEE) Women: BEE = 655 + 9.56W + 1.85H - 4.68A Men: BEE = 66.5 + 13.75W + 5H - 6.75A Downfalls * Overestimates by 7-24% * 45-81% accuracy * Does not factor in body composition * Activity level is difficult to assign * Taller and heavier than 1919 * young/old and underweight/overweight not represented
42
Activity Levels - Harris Benedict
* Sedentary 1-1.39 * Bed Bound 1.2 * Low Activity 1.4-1.59 * Active 1.6-1.89 * High 1.9-2.5
43
Mifflin St. Jeor Equation
* Healthy Population * 82% accuracy in non-obese Women: REE = 10W + 6.25H - 5A - 161 Men: REE = 10W + 6.25H - 5A + 5 Activity Levels * Sedentary: 1.2 * Obese: 1.3 * Light Activity: 1.4-1.6 * Moderate: 1.55 * Very High: 1.725
44
Ballpark Method
* 15 kcal/lb (maintenance) * 13 kcal/lb (weight loss) * 17 kcal/lb (weight gain) Ranges * 14-20 kcal/kg * Obese * inactive * Chronic dieters * 30 kcal/kg * Very active women * Active men * 25-29 kcal/kg * Adults \>55 * Active women * Sedentary men * Hospitalized, non-stressed patients * 35-45 kcal/kg * Underweight * Very active men * Malnourished * Catabolic
45
Adjusted BW
[(Actual BW - Ideal BW) x 0.25] + IBW * Debated * Equation to try to account for excess actual body weight * Assumes 25% of excess BW is metabolically active
46
Protein Requirements
* Healthy adults: 0.8g / kg IBW * Minimum to maintain N balance in healthy adult = 0.5 g/kg BW
47
Malnutrition
Prevalent in low income families Prevalent in hospitalized, chronically ill and especially in elderly Can occur at any weight May result in poor growth, osteoporosis, lowered resistance to infections, poor healing, increased morbidity and mortality
48

Life Cycles (11 decks)

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