Term
| A nutrition screening must be performed on all patients admitted to hospital within __ hours of admission. |
|
Definition
|
|
Term
| Is there a universally accepted approach to identify and diagnose malnutrition? |
|
Definition
|
|
Term
| How is screening defined in nutrition? |
|
Definition
A process to identify an individual who is malnourished or who is at risk for malnutrition to determine if a detailed nutrition assessment is needed.- ASPEN
Rapid and simple process conducted by admitting staff or community healthcare teams- ESPEN |
|
|
Term
what do you do with the following screening outcomes:
not at risk
at risk
at risk but metabolic or functional prevent a standard plan from being carried out |
|
Definition
-not at risk: rescreen at specified intervals
-at risk: plan carried out according to ordinary ward routines
-any of these cases referral should be made for an expert assessment |
|
|
Term
| All pts should be screened to identify _________ ________ _____. |
|
Definition
|
|
Term
| What is included in nutrition screening criteria? |
|
Definition
height
weight
change in weight
food allergies
diet
laboratory data
change in appetite
nausea or vomiting
bowel habits
chewing/ swallowing ability
Diagnosis |
|
|
Term
| Nutrition Risk Screening (NRS) received a grade of I, what is entailed in this screening tool? |
|
Definition
Weight loss, BMI, food intake
diagnosis and severity of dz
best predictor of postsurgical complications
predicted LOS, morbidity and mortality in acute care
In GI surgery, predicted morbidity, complications, LOS |
|
|
Term
| Mini Nutritional Assessment (MNA) received a grade of II, what is entailed in this screening tool? |
|
Definition
weight and height data
diet hx, appetites
hepatic proteins
self-perception of health status
predicted post-operative outcomes in elderly |
|
|
Term
| The malnutrition screening tool (MST) is used in most hospitals, why? |
|
Definition
it's very reliable in an outpatient setting
-tells you whether pt is at low, medium or high risk of malnutrition and how you should proceed. |
|
|
Term
| Malnutrition universal screening tool (MUST) received a grade of II, what is entailed in this screening tool? |
|
Definition
BMI, weight change, illness severity
predicted mortality in the elderly
identified oncology pts at risk for longer LOS |
|
|
Term
Where a screening is brief, an assessment is ________.
Where a screening is non-invasive, an assessment is _______.
Where a screening is inexpensive, an assessment is ________.
The goal for a screening is to determine the need for an assessment, what is the goal of an assessment? |
|
Definition
comprehensive
can include invasive testing
more expensive
goal is to identify need for intervention |
|
|
Term
| What is included in an assessment? |
|
Definition
food/nutrition history
client history
physical exam findings
anthropometric measurements
biochemical data, medical tests and procedures |
|
|
Term
| In what ways can a diet history be taken? |
|
Definition
24-hour recall
usual dietary intake or history
food frequency questionnaire
food diary or record |
|
|
Term
| What is pertinent in the pt hx of a nutritional assessment? |
|
Definition
medical
surgical
diet
social |
|
|
Term
| What is entailed in the social hx? |
|
Definition
degree of physical activity
extent of family support
housing situation
socioeconomic issues |
|
|
Term
| What is included in anthropometric data? |
|
Definition
height
weight
hair, skin, nails
BMI
eyes
waist:hip ratio |
|
|
Term
A BMI < _____ is underweight.
A BMI in the range of _____ to_____ is normal
A BMI > _____ is morbidly obese. |
|
Definition
|
|
Term
| What is included in the Subjective Global Assessment (SGA)? |
|
Definition
weight and diet hx
dx and level of stress
physical symptoms
fxnal capacity
predicted LOS in acute care
predicted GI dz
predicted morbidity and mortality in critically ill
predicted outcomes in elective surgery and stroke (elderly) |
|
|
Term
| T or F: serum hepatic protein concentrations measure nutrition status? |
|
Definition
false-only a good indicator if pt is of poor nutritional status without any other significant medical problem
-albumin takes 3 weeks to show up on a UA, so wont be able to see change for 3 weeks, prealbumin maybe helpful to predict if pt is being adequately nourished. |
|
|
Term
| Prealbumin can be used to monitor the efficacy of prescribed nutrition plan but should be combined with what? |
|
Definition
| acute phase reactant such as CRP to determine the level of inflammation and stress. |
|
|
Term
| Are a CBC and CMP important in getting a complete picture of nutritional status? |
|
Definition
|
|
Term
| What is monitored in all pts especially if admitted to the critical care units? |
|
Definition
glucose
-everyone gets at least sliding scale insulin orders if they demonstrate 1 BG that is above normal! |
|
|
Term
| Can cholesterol be used as a good indicator of nutritional status? |
|
Definition
| yes, the lower, the poorer the nutrition is. |
|
|
Term
| What panels are more important in IV nutrition than in determining nutrition? |
|
Definition
|
|
Term
| What are considered daily when pts are intubated? |
|
Definition
| blood gases and acid base disorders |
|
|
Term
| Micronutrient levels are not measured routinely, but when should they be monitored? |
|
Definition
| when clinical signs of deficiencies are evident |
|
|
Term
| What 3 things will be increased during an acute phase response (APR)? |
|
Definition
temperature
WHB count
C-reactive protein
Other nutrition related proteins will not return to mnormal until the APR resolves. |
|
|
Term
| What does c-reactive protein measure? |
|
Definition
| presence, intensity and recovery from an inflammatory process |
|
|
Term
| What is the fxn of ceruloplasmin, and will it rise during a pro-inflammatory state? |
|
Definition
Binds copper and is an antioxidant
yes |
|
|
Term
| What is the fxn of albumin, and will it rise during a pro-inflammatory state? |
|
Definition
binds calcium and other molecules
antioxidant
plasma oncotic pressure
NO |
|
|
Term
| What is the fxn of prealbumin, and will it rise during a pro-inflammatory state? |
|
Definition
thyroxine transport
forms complex with RBP
NO |
|
|
Term
| What is the fxn of transferrin, and will it rise during a pro-inflammatory state? |
|
Definition
iron absorption and transport
NO |
|
|
Term
| What is the fxn of c-reactive protein, and will it rise during a pro-inflammatory state? |
|
Definition
scavenger of cell membrane debris
complements DNA activation
YES |
|
|
Term
| What is the fxn of insulin like growth factor, and will it rise during a pro-inflammatory state? |
|
Definition
promotes protein synthesis in liver and muscle
inhibits lipolysis
NO |
|
|
Term
| During what times will hepatic synthesis of ceruloplasmin and c-reactive protein during acute stress change? |
|
Definition
trauma, infections, cancer and surgery
-low serum hepatic concentrations not necessarily caused by a nutrient deficiency
-low concentrations associated with illness will not normalize just with nutritional intervention |
|
|
Term
| If a pt's hepatic synthesis does not normalize with nutritional intervention alone, what might this indicate? |
|
Definition
| patient is not recovering from the primary problem |
|
|
Term
| The "negative acute phase proteins" (proteins that did not raise during an acute phase) are excellent indicators of what? |
|
Definition
severity of illness- correlate with morbidity and mortality
NOT nutritional status |
|
|
Term
| What might a decrease in negative acute phase proteins predict? |
|
Definition
malnutrition
-indicates need for a more comprehensive nutritional assessment |
|
|
Term
In malnutririon, the following are either increased or decreased:
morbidity and mortality
quality of life
function and mobility
frequency and length of hospital stays
health care costs |
|
Definition
increased
decreased
decreased
increased
increased |
|
|
Term
| What are the protein-calorie malnutrition criteria? (5) |
|
Definition
Albumin < 3.0 g/dL OR Prealbumin < 12 mg/dL
Wt loss > 10% usual body weight and history of poor intake
Current wt < 90% of ideal body weight OR BMI < 18 kg/m2
Pressure ulcer > Stage 2 OR a non-healing wound
RD clinical judgment of PCM |
|
|
Term
| How many of the protein calorie malnutrition criteria have to be present for malnutrition to be moderate? severe? |
|
Definition
|
|
Term
| What 3 groups of people already will have an extended LOS bc are already in pro-inflammatory states? |
|
Definition
|
|
Term
| What 3 groups of people already will have an extended LOS bc are already in pro-inflammatory states? |
|
Definition
|
|
Term
| Is any standardization currently available for documenting adult malnutrition? |
|
Definition
|
|
Term
| Nutrition imbalance has been accepted as a definition for malnutrition, what conditions does this encompass? |
|
Definition
overnutrition and obesity
lacking adequate calories and protein
inadequate intake of one or more nutrient (vitamins or minerals)
increased requirements due to disease
impaired absorption of nutrients or altered utilization of nutrients
inflammatory, hypermetabolic or hypercatabolic conditions/diseases |
|
|
Term
| Inflammation must be considered when conducting nutrition assessment, intervention and monitoring, is nutrition support alone effective in the prevention of muscle protein loss in the inflammatory state? |
|
Definition
|
|
Term
| What are 4 indicators of inflammation? |
|
Definition
biomarkers (albumin, c-reactive protein, cholesterol etc.)
obesity
hyperglycemia
organ failure syndromes |
|
|
Term
| Hyperglycemic patients are experience the __________________ effects of insulin which must be taken to account when evaluated one's malnutrition. |
|
Definition
|
|
Term
| Describe starvation related malnutrition. |
|
Definition
chronic starvation without inflammation (anorexia nervosa)
-mirasmus |
|
|
Term
| Define Chronic Disease Related Malnutrition. |
|
Definition
inflammation is chronic and of a mild to moderate degree (RA, organ failure, pancreatic cancer)
will see this a lot |
|
|
Term
| Describe acute disease or injury related malnutrition. |
|
Definition
| inflammation is acute and of a severe degree (major infection, burns, trauma or closed head injury) |
|
|
Term
| Resting Energy Expenditure (REE) |
|
Definition
| energy expended for normal body fxns |
|
|
Term
Basal Energy Expenditure (BEE)
- when is the basal metabolic rate (BMR) measured? |
|
Definition
minimal energy expended required for life
-in the morning
*know BEE and BMR |
|
|
Term
| Basal Metabolic Rate (BMR) |
|
Definition
| Measured in morning before eating and activity |
|
|
Term
| Resting Metabolic Rate (RMR) |
|
Definition
| may include energy for digestion and oxygen consumption of tissues |
|
|
Term
| What is considered the gold standard when measuring REE and RQ (respiratory quotient)? |
|
Definition
Indirect calorimetry.
-when used appropriate, <4% error rate
-limitations: expensive and requires trained personnel
-very sensitive to movements (so lot of restrictions) |
|
|
Term
| What is the physiological range of the Respiratory Quotient (RQ)? |
|
Definition
0.67-1.3
<0.7: prolonged fast > 1 hrs
>1.0: recent, excessive caloric intake
RQ is a good marker of test validity |
|
|
Term
|
Definition
ratio bw CO2 produced and O2 consumed
-will never go outside 0.7-1.0
-if does, then something went wrong with the test |
|
|
Term
Assuming the subject burns one substrate at a time, what is the RQ for:
carbohydrates
proteins
fats
mixed fuel? |
|
Definition
1.0
0.8
0.7
0.8-0.85
RQ should not be used to determine specific nutrition regimine |
|
|
Term
| What is the Harris Benedict used for? |
|
Definition
prediction equation to estimate nutrient requirements
-not as effective as it used to be due to increased presence of obesity
-commonly used |
|
|
Term
| What might be more accurate at predicting nutritional requirements than the harris-benedict? |
|
Definition
|
|
Term
| What type of patients is the Ireton-Jones equation tailored to? |
|
Definition
ventilator dependent patients that are spontaneously breathing (critically ill pts)
-considers factors such as trauma, burns, the presence of obesity |
|
|
Term
| Who is the Frankenfeld & Swinamer equation more accurate in predicting nutrient requirements for? |
|
Definition
young, non-obese
elderly, obese and non-obese |
|
|
Term
| Who is the Mifflin equationbest for? |
|
Definition
| healthy obese and non-pbese individuals |
|
|
Term
| What is the target calorie intake for a critically ill patient? for a SIRS (systemic inflammatory response syndrome) patient? |
|
Definition
|
|
Term
What is the calorie intake goal of someone with:
-hypocaloric feedings in pts with acute illness, stress of injury or sepsis?
-obesity (>120% ideal body weight for height)
-morbid obesity
-stable pts with marasmus |
|
Definition
20-25 kcal/kg body weight
20 kcal/kg body weight
8-14 kcal/kg body weight
37 kcal/kg body weight |
|
|
Term
| What are the protein requirements for adult maintenance? |
|
Definition
|
|
Term
| What are the protein requirements for a pt with critical illness? |
|
Definition
|
|
Term
| What are the protein requirements for a pt with renal dz? |
|
Definition
|
|
Term
| What are the protein requirements for a pt with liver dz? |
|
Definition
|
|
Term
| What are the protein requirements for a pt with cancer? |
|
Definition
|
|
Term
| What are the protein requirements for a pt with GI dz? |
|
Definition
|
|
Term
| What are the protein requirements for a pt with obesity, stressed? |
|
Definition
| 1.5-2.0 g/kg of ideal body weight |
|
|
Term
| What are the protein requirements for healthy individuals? |
|
Definition
|
|
Term
| What are the protein requirements for a pt who is stressed and <120 % ideal weight for height? |
|
Definition
| 1.5 g/kg/day of actual weight |
|
|
Term
| What are the protein requirements for a pt who is stressed and > 120 % ideal weight for height? |
|
Definition
| 1.5 g/kg/day of ideal weight |
|
|
Term
| What are the protein requirements for a pt with head injury/ CVA/ bleeds |
|
Definition
| 1.8 g/kg/day of actual weight |
|
|
Term
| What are the protein requirements for a pt with renal failure? |
|
Definition
| 1.0-1.5 g/kg/day of dry weight with dialysis |
|
|
Term
The body needs 30-35 mL/kg fluids for maintenance.
_______ for the first 10 kg of body weight.
_______ for the second 10 kg of body weight.
Add______ for any weight above 20 kg (under 50 yrs)
Add______ for any weight above 20 kg (over 50 yrs) |
|
Definition
100 cc
50 cc
20 cc/kg/day
15 cc/kg/day |
|
|
Term
| When should liquid provisions be monitored? |
|
Definition
| When IVF and medications reduced or D/C'd |
|
|
Term
| What is the RDA method of estimating fluid needs? |
|
Definition
| 1cc fluid per 1 kcal of estimated needs |
|
|
Term
| What is the Holliday-Segar method for estimating fluid needs? |
|
Definition
<10 kg: 100 ml/kg
11-20 kg: 1000 ml+10ml/kg for each kg >10
>20 kg: 1500 ml + 20 ml/kg for each kg>20 |
|
|
Term
| What are various ways in which weight is being managed today? |
|
Definition
fasting
body wraps
drugs (catecholaminergic drugs, serotinergic agents)
surgery |
|
|
Term
| What four factors contribute to determining types of obesity? |
|
Definition
genetic factors
psychological factors
social factors
physiological factors |
|
|
Term
| What physiological factors must be considered when determining types of obesity? |
|
Definition
set point theory
RMR resets itself
Gut peptides
thyroid hormones
hypoglycemia
leptin |
|
|
Term
| What are some various methods of weight control? |
|
Definition
calorie restrictions
high CHO, low fat
High protein, low fat
exchange system
meal replacements
commercial programs |
|
|
Term
| What are 5 causes of being underweight? |
|
Definition
low intake
exercise
absorption
wasting diseases
stress |
|
|
Term
| What are 2 ways to deal with the underweight pt? |
|
Definition
deal with the underlying dz
high-energy diets |
|
|
Term
| What are some characteristics of anorexia? |
|
Definition
fears
body image distortion
amenorrhea
depression due to starvation
obsessive/ compulsive
medical complications |
|
|
Term
| What are some characteristics of bulemia? |
|
Definition
binge eating
induced vomiting
laxatives
medical complications |
|
|
Term
| What are the advantages to the gastric band? |
|
Definition
easy to place
adjustable
few nutritional deficiencies
fewer vitamin supplements needed |
|
|
Term
| What are the disadvantages of the gastric band? |
|
Definition
-lower avg weight loss (40-50% EBW)
-post-op adjustments
-erosions
-slippage |
|
|
Term
| WHat are the advantages to a sleeve gastrectomy? |
|
Definition
-60-70% excess body weight loss at one year
-Fewer vitamin Deficiencies
-Better appetite control
-Lower risk of ulcers and small bowel obstruction |
|
|
Term
| What are the disadvantages of sleeve gastrectomy? |
|
Definition
-Long term studies lacking for use as a weight loss surgical procedure alone.
-Irreversible
-Less effective for BMI greater than 50 |
|
|
Term
| What are the advantages of biliary pancreatic diversion? |
|
Definition
Long term weight loss (85%) in super-obese patients (BMI > 50)
Lower ulceration risk
Excellent resolution of comorbid diseases |
|
|
Term
| What are the disadvantages of biliary pancreatic diversion? |
|
Definition
-Significant nutritional problems in noncompliant patients
-Average 2 BM/Day
-More extensive Vitamin replacement regimen
-Most complex WLS procedure |
|
|
Term
| What are the advantages of gastric bypass? |
|
Definition
-Excellent resolution of Co-Morbid diseases,
-Excellent long term weight loss (75%)
-Dumping to prevent sweets
-Minimal nutritional problems |
|
|
Term
| What are the disadvantages of gastric bypass? |
|
Definition
-Technically more complex than the restrictive operations
-Requires life long Iron, Calcium, B12, and thiamine supplements |
|
|
Term
| How are pts chosen for weight loss procedures? |
|
Definition
BMI >40 or >35 with comorbidities
(comorbidities such as HTN, DM, dyslipidemia, depresion OSA etc..)
3-6 month medically supervised diet
psychological evaluation
metabolic disorders have been ruled out or clinically treated with failure |
|
|
Term
| What are the nutritional guidelines for pts who have undergone bariatric procedures? |
|
Definition
| No standardized diet diet progression varies from program to program, but generally: 1- liquids 2- puree 3- soft foods (adding fruits and veggies) 4- full bariatric (adding starches and beef) |
|
|
Term
| What are the generalized standards for post bariatric pts? |
|
Definition
3 meals/day, no snacking
avoid high sugar and high fat food
chew food thoroughly
no liquids with meals or 30-60 mins after
64 oz fluid daily |
|
|
Term
| What are some nutritional considerations with bariatric procedures? |
|
Definition
difficulty swallowing
gastritis and esophagitis
dumping syndrome
hypoglycemia
anorexia
altered bowel habits
hair loss |
|
|
Term
| What are the usual protein requirements for post bariatric procedure pts? |
|
Definition
60-100 g/day
-supplements recommended
-lactose free supplements preferred
-taste, texture, and quality to be considered |
|
|
Term
| What are the usual carbohydrate requirements for post bariatric procedure pts? |
|
Definition
less than 100 g/day
-carbs=energy
-refined sugars will cause dumping syndrome
easiest to get in through juices, milk, G2 |
|
|
Term
| What are the usual fat requirements for post bariatric procedure pts? |
|
Definition
< 45 g/day
-excess fat will cause diarrhea
-fried foods and added fat are discouraged |
|
|
Term
| During gastric bypass, the gastric fundus, body and antrum, the duodenum and a variable length of the proximal jejunum are bypassed, what vitamin deficiencies are pts at risk for developing? |
|
Definition
iron
B-1
B-12
folate
calcium
possibly others |
|
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