Topic A: Screening and Assessment Flashcards
The Nutrition Screen process happens before
ADIME
The use of preliminary nutrition assessment technique is used to identify
People who are malnourished, or who at risk for malnourishment
Who can participate in the nutrition screening process
All health care members (not part of the four step)
During the nutrition screening you want to review
client history, lab results, weight, physical signs
From these seven screening tools which focus on older adults
- SGA Subjective Global Assessment
- MNA Mini Nutritional Assessment
- NSI Nutrition Screening Innitiative
- GNRI Geriatric Nutritional Risk Index
- MST Malnutrition Screening Tool
- NRS Nutrition Risk Screening
- MUST Malnutrion Risk Screening
- MNA
- NSI
- GNRI
Which nutrtion assessement looks at history, intake, GI symptoms capacity, and physical appearance, edema, weight change & primary diagnosis
SGA
MNA evaluates independence, medications, number of full meals consumed each day, and ____
65 years or older
protein intake, fruits and vegetables, fluid, mode of feeding
Focus on older adults
GNRI looks at what 2 things
serum albumin, weight changes
under the age of 70
NRS includes three things:
% weight loss, BMI, and intake
used at medical-surgical hospitilized
Which screening tool looks at BMI, unintentional weight loss, effect of acute disease on intake for more than 5 days
MUST
Part A in ADIME
Dietary intake assessement, analysis includes
Nutritional status is dependent on info gathered on pt’s dietary habits
- diet history
- food record
- 24 hr recall
- food frequency lists
Diet history
Patterns of eating. Do not ask leading questions
Food Record is a food diary or
Kept by patient
record of everything eaten in a specific period of time
24 hr recall
Quick tool
Mental recall of everything eaten in 24 hours. Underreporting and overreporting are concerns
Clinical setting
Produces the best info when RD is involved
Food frequency lists
Quick way to determine intakes on large numbers of people
How often an item is consumed. Community setting.
Can be done without RD
A in ADIME
3 Assessment components
Review, cluster, and identify
If an outpatient would like to take Vit C supplements you should:
Ask her to keep a food diary to see where she is lacking
How can you increase Ca in a Hispanic woman
ex of food
pinto beans
Arm muscle area is useful in identifying
AMA
We want 80% or more
potential nutrition protein malnutrition
measures skeletal muscle mass (somatic protein)
How do calculate AMA
will be the same for somatic protien
use TSF and MAC (midarm circumference)
male 25.3cm; female 23.2 cm
Is AMA important to meausre in growing children
Yes
in child we use upper arm muscle area
A in ADIME
NFPE
Nutrition focused physical exam includes inspection, palpatation, and asulation
NFPE
Inspection includes visual assessment using ____
and hearing to observe_____
inspection= seeing
- sight, sense of smell
- textures, sizes, colors, shapes, and sounds
NFPE
The information from the Inspection tells you
obesity (fat stores), cachexia, fluid status, skin integrity, wound healing, feeding devices, jaundice, ascites
NFPE
Hair appears-thin, sparse, dull dry brittle
easily pluckable
what deficiency
vitamin C or protein deficiency
Eyes appear- pale, dry, poor vision
Consider vitamin A, zinc or riboflavin deficiencies
Lips appear- swollen, red, dry, cracked
Consider riboflavin, pyridoxine, niacin deficiencies
Tongue appears smooth, slick, purple, white coating
Consider vitamin or iron deficiencies
Gums appear sore, red, swollen, bleeding
Consider Vit C def
Teeth appears missing, loose, loss of enamel
Consider calcium deficiency, poor intake
Skin appears pale, dry, scaly
Consider iron, folic acid, zinc deficiency
Nails appear brittle, thin, spoon shaped
Consider iron or protien deficiency
A in ADIME
**serum albumin **
* normal range
* function is to maintain ___
* when low what is associated with
* when above normal associated with
* can its long half-life reflect current protein intake?
Biochemical analysis, diagnostic tests
measures visceral protein (blood and organs)
a. 3.5-5.0 g/dl
b. colloidal osmotic pressure
c. hypoalbuminemia associated with edema, surgery
d. likely due to dehydration
e. no
high serum albumin= dehydration
When levels of albumin are low, water in the plasma moves into the ____
interstitial spaces
AKA edema
A patient can have high normal serum albumin (5.0 g/dl) when they have had
low calories and low fluids
Serum creatinine is related to____, measures ___, and may indicate ____ or ____
M: 0.6-1.2 mg/dl
F: 0.5-1.1
released by muscle cells and secreted by the kidney
- muscle mass
- measures somatic protein
- may indicate renal disease or muscle wastage
serum creatinine and creatinine clearance measure somatic protien
What serum creatinine level indicates immediate dialysis tx.
anything above 5
BUN Blood Urea Nitrogen
* range
* related to
* indicator of
Normal BUN:Cr ratio- 10-15:1
a. 10-20 mg/dl
b. protein intake
c. renal disease
A low BUN:Cr ratio indicates
inadequate protien intake
urinary creatinine clearance
* range
* mesures
* estimate includes
a. 115 (+ or -) 20ml/minute
b. GFR - glomerular filtration, renal function
c. body surface area (height and weight)
height and weight is used to determine urinary creatinine clearance
FEP
Free erythrocyte protoporphyrin is a direct measure of toxic effects of ____
* It is increased during ___
* Indicating ___ and ____ compete at plasma membrane for transport.
lead on heme synthesis (leading to anemia). Increased in lead poisoning.
Lead and calcium
Lead depletes iron leading to anemia
Medication Management
Tyramine causes HTN if taken with
Restrict aged, fermented, dired, pickled, smoked spoiled foods
MAOI (monoamine oxidase inhibitor)
tyramine
How do MAOI elevate blood pressure
by releasing norepinephrine
Tyramine
What should you avoid if taking MAOI
hard, aged cheese (cheddar, Swiss), sauerkraut, some sausages, luncheon meats, tofu, miso, Chianti wine, tomatoes
Limit sour cream, yogurt, buttermilk.
Tyramine
What is OK to eat when taking MAOI
cottage cheese, cream cheese, uncured cheese (cottage, ricotta)
Good advice: buy, cook, eat fresh foods
Medication Management
lithium carbonate causes
antidepressant
Maintain consistent sodium and caffeine to stablaize levels
increased appetite, weight gain
Decreasing sodium on lithium carbonate causes
Strict 2g Na diet
retention of lithium to toxic levels
lithium and sodium are reabsorbed at the same site at the kidneys
If sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity.
Drug
megestrol acetate is a
appetite stimulant
Vitamin B6 and protein decrease
Pyridoxine (protien)
L-dopa (levodopa) which controls symptoms of Parkinson’s disease
Take drug in morning with limited protein (less than 10g)
competes with drug for absorption sites
Parkisons Disease
Protein intake recommendation when on L-dopa (levodopa)
Minimize protein at breakfast and lunch; add to dinner
cyclosporine (immunosuppressant) can cause
hyperlipidemia, hyperglycemia, hyperkalemia, hypertension
Drug
Loop Diuretics decreases what 5 nutrients
thiamin, potassium, magnesium, calcium, sodium
Drug
Methylphenidate (Ritalin) causes
anorexia, weight loss, nausea
Nutrition assessment of populations and community needs assessment
population by age, ethnic groups, sex, birth rates, deaths, socioeconomic stratification census data, housing statistics are all included in the
demographics
included in community assessments
Prevalence of Food Insecurity
strategies that strengthen local food systems:
(1)** farmer’s markets** - increased access to fresh produce
(2) food recovery and gleaning programs - collect excess wholesome foods that would otherwise be thrown away (from farms, packing houses, caterers, cafeterias, restaurants) for delivery to hungry people
(3) PPFPs - Prepared and Perishable Food Programs
Which nonprofit program links sources of unused, cooked and fresh foods with social service agencies that serve the hungry
PPFP
NSI
Nutrition Screening Initiative includes
promotes nutrition and improve nutritional care for the elderly to identify nutritional problems early
a. DETERMINE checklist
b. LEVEL I screen
c. LEVEL II screen
NSI- elder years above age 80
which form identifies factors placing people at nutritional risk
-disease, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, needs assistance in self-care
Highlights warning signs of poor nutrition status
Would be filled out at congregate meal site
DETERMINE checklist
increases awareness of factors that influence nutritional health
NSI
which screening tool identifies those who need more comprehensive assessments
LEVEL I Screen
NSI
which screening provides more specific diagnostic info on nutritional status
RDNS most involved here
LEVEL II Screen
more serious nutrition problems
Nutrition Status and Nutrition-Related Health Measurements
PedNSS- Pediatric Nutrition Surveillance System
* includes low income, high risk children, birth - 17 years, emphasis on ____
* height, weight, birth-weight, ____
* monitors growth, nutritional status, and
USDHHS ages 0-17
a. birth-5 years
b. hematocrit, hemoglobin, cholesterol, breast-feeding
c. infant-feeding practices
sex and age needed to determine nutrition status
National Health and Nutrition Examination Survey
NHANES ongoing (repeated) survey to obtain info on
CDC
NHANES III for adults 65 and older
health of American people
Fresh Fruit and Vegetable Program
FFVP
* introduces children to ___
* help develop eating habits that improve ____
* free to children at
USDA
Focus is to provide fresh fruits and vegetables
a. fresh fruits and vegetables
b. health, prevent obesity and subsequent chronic disease
b. eligible elementary schools who operate the NSLP
NSLP- Nationa School Lunch Program
What We Eat in America
WWEIA
* includes ___with times of eating occasions and sources of foods
* who is in charge of conducting over-sampling of adults ≥60, African Americans, Hispanics?
dietary intake component of NHANES
also known as National Food and Nutrition Survey NFNS
(1) two days of 24 hour dietary recall
(2) USDA
all about food consumption
Special Supplemental Nutrition Program for Women, Infants, and Children
WIC is for ____and provides provides food for low income mothers at ____
USDA
Priorities: pregnant, breastfeeding, infants up to 1 yr
a. for pregnant, postpartum, breast-feeding women; infants and children up to 5
b. nutritional risk (abnormal weight gain, history of high risk, LBW, underweight, overweight, anemia)
provides food, education, and referrals for other agencies
Nutrition risks WIC looks for
Health exam is required
must meet income standards, be at nutritional risk, and in need of foods offered
weight, height, head circumference in infants, hemoglobin, hematocrit
expected outcome: less anemia, increased HgB and Hct in women
Will tell you about prenatal problems in the community
Not an entitlement program
Foods offered by WIC
provides food with certain nutrients and teaches good nut. practices
No cooking classes
-iron-fortified formula, cereal, milk, cheese, fruit juice
EBT electronic benefits transfer card
WIC FMNP Farmers’ Market Nutrition Program: coupons to purchase fresh,
locally grown foods at farmers’ markets
USDA
EFNER- Expanded Food and Nutrition Education Program
* provides grants to ____
* trains nutrition aides to____
* works with small groups; teaches ____
does not provide food * only education, focus is teaching
(how to budget, meal planning, shop, cook)
a. universities that assist in community development
b. educate the public
c. skills needed to obtain a healthy diet
NSIP
Nutrition Services Incentive Program includes the
AoA Administration on Aging
USDHHS Title Ill
OAA Older Americans Act Nutrition Program
formerly ENP Elderly Nutrition Program)
*affluent = well off
USDHHS Title Ill
OAA Older Americans Act Nutrition Program provides
* how many hot meals a day, 5 days/week, which meets ___ recommended intake?
* ____ - ambulatory; transportation essential for rural elderly
* Home delivered meals - Meals on Wheels - must be ____
* counseling, nutrition education, referrals, and ____
eligibility: all aged 60 and older plus spouse, regardless of income
(1) one hot meal each day and 1/3 recommended intake
(2) Congregate Meals
(3) homebound
(5) social interaction
USDA
Which program supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless shelters, nonresidential adult daycare centers
b. Which organization reimburses operators for meal costs, provides commodity foods and nutrition education materials
provides food and education at centers
meals must meet guidelines; must offer free or reduced-price to eligible
CACFP- Child and Adult Care Food Program
USDA
eligibility standards same as NSLP (1/3)
USDHHS - county
Which program
a. introduces new foods, teaches good food habits
b. child’s participation in food activities is important
helps low income children; ages 3 through 5
Headstart
SFMNP
Which program provides
a. cash grants from ____to states to provide low-income seniors (≥ 60 years) with coupons to be exchanged for eligible foods at farmers’ markets, roadside stands, community supported agriculture programs (CSA)
b. may be limited to specific and locally grown foods
c. nutrition education and information are provided (how to select, store, prepare)
Focus is to provide fresh fruits and vegetables
USDA
Senior Farmers’ Market Nutrition Program
USDA
If qualifies for SFMNP = qualifies for Meals on Wheals
fresh, nutritious, unprepared fruits, vegetables, herbs and honey
Community resources and nutrition-related programs
Feeding America is the
Non-goverenmental Agency
the largest domestic hunger relief organization in the US (food banks, shelters, soup kitchens)
provides food
