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PT: Nutrition Exam 1 > Nutritional Assessment: Adults > Flashcards

Nutritional Assessment: Adults Flashcards

1
Q

Nutritional assessment definition

A

Systemic process of obtaining, verifying, & interpreting data to make a decision about the nature & cause of nutrition-related problems

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2
Q

Value of nutritional assessment

A
  • diagnose malnutrition

- association between malnutrition & poor outcome

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3
Q

Why be concerned about malnutrition?

A
  • increased complications
  • increased risk of infection
  • increased length of stay
  • increased human suffering
  • increased reimbursement with malnutrition as a comorbidity
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4
Q

ABCD’s of nutritional assessment (A-F)

A 
A = anthropometrics
B = biochemical data
C = clinical findings
D = dietary data
E = edema (fluid status)
F = functional status
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5
Q

Anthropometrics definition

A
  • physical measurements of body size & composition (fat, muscle)
  • provides information on muscle mass & fat reserves
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6
Q

Anthropometrics measurements

A
  • height
  • weight
  • BMI
  • tricep skin fold (fat mass)
  • Midarm muscle circumference (muscle mass)
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7
Q

Height use

A

Body SA

BMI

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8
Q

How do you measure weight

A
  • primary parameter
  • standard tables (Hamwi method)
  • look at trends
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9
Q

What is the Hamwi Method?

A
  • ideal weight
  • Male 5’ = 106lbs, 6lbs for every inch after 5’
  • Female 5’ = 100lbs, 5lbs for every inch after 5’
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10
Q

Problems with height

A
  • men over state
  • women under state
  • as you age start to lose height
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11
Q

Alternative methods for measuring height

A
  • arm span

- knee height

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12
Q

Guidelines for weight trends

A
  • > 10% involuntary weight loss over 6 months or ~10lbs in 6 months
  • trigger for action
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13
Q

BMI measurement

A

Weight/height^2

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14
Q

Underweight BMI

A

<18.5 kg/m^2

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15
Q

Desirable BMI

A

18.5 - 24.9 kg/m^2

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16
Q

Overweight BMI

A

25 - 29.0 kg/m^2

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17
Q

Obesity BMI

A

> 30 kg/m^2

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18
Q

Normal albumin level

A

3.6-5gm/dL

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19
Q

Biochemical data measurements

A

Albumin

Prealbumin

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20
Q

Non-nutritional causes of hypoalbuminemia

A
  • infection/inflammation (APR)
  • post surgical state (APR)
  • fluid state (dehydrated = more)
  • liver or renal dysfunction
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21
Q

Nutritional causes of hypoalbuminemia

A

Inadequate protein intake

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22
Q

Albumin

A
  • commonly used indicator (historically)
  • misinterpreted as nutritional marker
  • predictor of mortality/morbidity
  • half live 2-3 days
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23
Q

What are you looking for in clinical findings?

A

Physical evidence of malnutrition

- hair, skin, nails, tongue, gums, eyes, muscle wasting

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24
Q

Muscle wasting

A
  • temporal wasting
  • prominent clavicle
  • deltoid muscle
  • thorax
  • biceps
  • hand-interosseous wasting
  • quads
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25
Q

Hair in malnutrition

A
  • dry, thin, pluckable
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26
Q

Skin in malnutrition

A
  • texture, turgor, pigment
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27
Q

Nails in malnutrition

A
  • brittle, spoon shaped
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28
Q

Tongue in malnutrition

A

Swollen, magenta

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29
Q

Gums in malnutrition

A

Bleeding, soft

30
Q

Eyes in malnutrition

A

Pale conjunctiva

31
Q

What do you look at for dietary data?

A
  • appetite
  • dietary intake data
  • food record, calorie count (3-7 days)
  • evaluation
32
Q

Dietary intake data

A
  • % meals/snacks eaten
33
Q

Evaluation of dietary data

A
  • compare intake to standard or estimated needs
  • DRIs, RDAs
  • food guide pyramid, My plate
34
Q

What does edema tell you?

A

Physical evidence of generalized or localized fluid accumulation

35
Q

Edema as nutritional assessment

A
  • extremities
  • vulvar/scrotal edema
  • ascites
  • unexplained weight gain; weight loss often masked by edema
36
Q

Inpatient measures of functional status

A

Hand grip strength

37
Q

Outpatient measures of functional status

A
  • ADLs
  • distance walked
  • rising out of seated position
38
Q

T/F there is a single parameter that is sufficient in all patients in nutritional assessment

A

FALSE

  • there is no single parameter
  • conclusions should be confirmed using multiple parameters
39
Q

Subjective Global Assessment

A

SGA

  • method based on a focused history & physical examination
  • practical, reliable tool
40
Q

SGA ratings

A
  • well-nourished
  • mildly-moderately malnourished
  • severely malnourished
41
Q

Components of SGA

A
  • history of weight & dietary change
  • GI symptoms
  • functional impairment
  • physical exam
42
Q

What are you looking for in physical examination in SGA?

A
  • loss of subcu fat
  • muscle wasting
  • edema
43
Q

Malnutrition in adults definition

A
  • inadequate intake of protein and/or energy (calories) over prolonged periods of time resulting in loss of fat stores and/or muscle wasting
44
Q

3 types of adult malnutrition

A
  • starvation related
  • chronic disease or injury related (>3 months)
  • acute disease or injury related (<3 months)
45
Q

ABC’s of malnutrition (6)

A 
A = weight loss (%/time), loss of muscle mass
C = loss of subcu fat
D = insufficient energy intake
E = edema- fluid status
F = diminished functional status (hand grip)
46
Q

Starvation related malnutrition

A
  • no inflammation present

- pure chronic starvation (anorexia)

47
Q

Chronic disease related malnutrition

A
  • mild -moderate inflammation

- organ failure, pancreatic cancer, RA)

48
Q

Acute disease or injury related malnutrition

A
  • marked inflammatory response

- major infection, burns, trauma, closed head injury

49
Q

Adult diagnosis of malnurtition

A
  • minimum of 2 characteristics

- intervene early

50
Q

T/F when inflammation is present, parameters may stabilize but no significantly improve with nutrition support

A

TRUE!

51
Q

What needs do you look at once adult diagnosed with malnutrition?

A
  • calorie needs
  • protein needs
  • fluid needs
  • mode of treatment
52
Q

Nutritional needs rule of thumb in malnourished adults

A

Calories: 25 - 35 Kcal/kg
Protein: 1-2 gm/kg
Fluid: 30-40 ml/kg (1ml/Kcal)

53
Q

Progression of nutrition treatment

A
  • balance oral diet
  • oral diet + oral supplements
  • tube feeding
  • parenteral nutrition
  • combinations
54
Q

Ways to measure nutrition progress

A
  • indirect calorimetry (measure energy expenditure)

- nitrogen balance (measures protein needs)

55
Q

Pharmacist role in malnutrition

A
  • BE ALERT (be aware of hospital practices that can contribute to malnutrition
  • diagnose, intervene early monitor treatment
  • consult dietitian
56
Q

Levels of CRP and albumin/prealbumin in inflammation

A

Increased CRP

Decreased prealbumin/albumin

57
Q

Levels of CRP and albumin/prealbumin in malnutrition

A

Decreased CRP

Increased albumin/prealbumin

58
Q

+ acute phase protein

A

CRP protein

Increase with stress

59
Q

(-) acute phase protein

A

Albumin/prealbumin

Decrease with stress

60
Q

Acute phase response

A
  • systemic response to inflammation
  • associated with infection, trauma, surgery, cancer
  • releases cytokines
  • liver reprioritizes protein synthesis to maximize host defense
61
Q

What does acute phase response indicate?

A

Level of stress OR response to illness

62
Q

T/F inflammation is present in starvation related malnutrition

A

False!

Only in chronic and acute disease related malnutrition

63
Q

Importance of anthropometric measurements in adults

A

Provide information of patient’s muscle mass and fat reserve

64
Q

What is the primary parameter for anthropometric measurements in adults?

A

Weight

65
Q

Dysfunction of which 2 organs cause low levels of albumin & prealbumin?

A

Livers & kidneys

66
Q

Normal CRP level

A

<0.7 mg/dL

67
Q

Why are albumin and prealbumin unreliable indicators of malnutrition?

A

Both levels decrease in presence of stress due to acute illness as well as malnutrition

Must look at whole picture rather than rely on these 2 values alone

68
Q

What does hand interosseous wasting look like?

A

Decreased padding in fat pad between thumb and pointer finger on hands

69
Q

Edema is often caused by low intake of which macronutrient?

A

Proteins

70
Q

What test is used to determine protein needs?

A

N balance via urine collection or equation

Do NOT confuse this method with BUN (blood urea nitrogen lab)

71
Q

What are the 3 modes of nutritional treatment in adults?

A

Oral
Enteral
Parenteral

72
Q

What is the first step in treatment of malnutrition in adults?

A

Diagnosis

PT: Nutrition Exam 1 (12 decks)

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