Term
| In 1996, what did the joint commission mandate in regards to nutrition screening on newly admitted patients? is this universally accepted? |
|
Definition
| must be performed on them within 24 hours of admission. no, there is no universally accepted approach to identify and diagnose malnutrition |
|
|
Term
| how does the american society for parenteral and enteral nutrition define screening? |
|
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 |
|
|
Term
| When it comes to nutrition screening tools, is a smaller grade number or larger number characteristic of the highest sensitivity and specificity? which tools on the PPT had the best sensitivity and specificity for the patient populations studied? |
|
Definition
-the lower the grade number (I and II had the best)
-MNA-SF and MST |
|
|
Term
| of the two screening tools mentioned in the previous card, which one was tested in the elderly and may not be appropriate for younger pops? which one was the only tool to be shown to be both valid and reliable for identifying nutrition probs in the settings studied? |
|
Definition
|
|
Term
| which screening tool is the best predictor of post surgical complications? |
|
Definition
| nutrition risk screening (NRS) |
|
|
Term
| what is the screening tool used by most hospitals? |
|
Definition
| MST (malnutrition screening tool) |
|
|
Term
| which screening tool identified oncology patients at risk for longer LOS? |
|
Definition
| MUST (malnutrition universal screening tool) |
|
|
Term
| what is the goal of screening? what is the goal of assessment? |
|
Definition
-identify the need for assessment
-identify the need for intervention |
|
|
Term
| how does the ADA define nutrition assessment? |
|
Definition
| identifying and evaluating data needed to make decisions about a nutrition related problem or diagnosis |
|
|
Term
|
Definition
| Protein energy malnutrition |
|
|
Term
| What are the BMI classifications for normal and overweight? |
|
Definition
normal: 18.5-25
overweight: 25-29.9 |
|
|
Term
| what are the BMI classifications for the grades of PEM? |
|
Definition
I: 17-18.4
II: 16-16.9
III: <16 |
|
|
Term
| what are the BMI classifications for grades of obesity? |
|
Definition
I: 30-34.9
II: 35-39.9
III: >40 |
|
|
Term
| T or F: serum hepatic protein concentrations measure nutrition status. |
|
Definition
|
|
Term
| What are albumin and pre albumin good for when assessing nutrition? |
|
Definition
-albumin: good indicator of poor nutritional status in an ambulatory patient without any other significant medical problem, but in patients we now see admitted, it is not reliable indicator and not typically used in screens or assessment
-prealbumin: can be used to MONITOR the efficacy of the prescribed nutrition support, should be combined with acute phase reactant (like CRP) to determine inflammation and stress levels |
|
|
Term
| what is the half life of albumin? |
|
Definition
|
|
Term
| what are the two screening panels important in getting a complete picture of nutritional status? |
|
Definition
|
|
Term
| what type of pt is glucose monitored in? who gets insulin orders? |
|
Definition
ALL
everyone gets at least a sliding scale insulin orders if they demonstrate 1 BG above normal |
|
|
Term
| Who are lipid panels important for? |
|
Definition
most important in IV nutrition
but CHO levels can be used as indicator of nutritional status |
|
|
Term
| Who are lipid panels important for? |
|
Definition
most important in IV nutrition
but CHO levels can be used as indicator of nutritional status |
|
|
Term
| When are blood gases and acid base disorders considered daily? What aspect of these measurements can be negatively affected by overfeeding? |
|
Definition
when pt's are intubated-- if on PN adjustments are made to address acidosis or alkalosis
-on EN: overfeeding can affect the P-CO2 values negatively |
|
|
Term
| Which two acute phase proteins will rise when a pt is in a pro inflammatory state? what are the function of each? |
|
Definition
CRP: scavenger of cell membrane debris; complements DNA activation
ceruloplasmin: binds copper, antioxidant |
|
|
Term
| What are the 4 acute phase proteins that do not rise when a pt is in a pro-inflammatory state? what is the function of each? |
|
Definition
-albumin: binds Ca and other molecules; antioxidant, plasma oncotic pressure
-prealbumin: thyroxine transport; forms complex with RBP
-transferrin: iron absorption and transport
-IGF: promotes protein synthesis in liver & muscle; inhibits lipolysis |
|
|
Term
| negative acute phase proteins are excellent indicators of what? |
|
Definition
| the severity of illness, NOT nutritional status. may predict those at risk for malnutrition |
|
|
Term
| what is a positive pump sign? what does this mean? |
|
Definition
trauma patient with more than 5 pumps
means they are severely ill |
|
|
Term
| When it comes to inflammation, is nutrition support alone effective in prevention of muscle protein loss? what are indicators of inflammation? |
|
Definition
-no
-biomarkers (CRP, albumin), obesity, hyperglycemia, organ failure |
|
|
Term
| what is starvation related malnutrition? |
|
Definition
| chronic starvation without inflammation (anorexia) |
|
|
Term
| what is chronic dz related malnutrition? |
|
Definition
| inflammation is chronic and of a mild to moderate degree (RA, organ failure, pancreatic CA) |
|
|
Term
| what is acute disease or injury-related malnutrition? |
|
Definition
| inflammation is acute and of a severe degree (major infection, burns, trauma, closed head injury) |
|
|
Term
| define REE, BEE, BMR, RMR |
|
Definition
-REE: energy expended for normal body functions (the amount of energy required to maintain vital organ function in a resting state over 24 hours)
-BEE: minimal energy expended required for life
-BMR: measured in morning before eating and activity (the minimum caloric requirement at a neutral environmental temperature and fasting)
-RMR: may include energy for digestion and oxygen consumption of tissues |
|
|
Term
| what is considered the gold standard for estimating nutritional requirements? what does it measure |
|
Definition
| indirect calorimetry (measures REE and RQ) |
|
|
Term
| What is the respiratory quotient? what is the normal range? what is it a good marker of? |
|
Definition
-the ratio between CO2 produced and O2 consumed
-normal physiologic dance is 0.67-1.3 (she says .7-1)
-test validity, if outside that range, there is something wrong with the test |
|
|
Term
| should RQ be used to determine a specific nutrition regimen? |
|
Definition
|
|
Term
| What is a commonly used nutrition requirement prediction equation with a high error rate of obese patients? |
|
Definition
|
|
Term
| what nutrition prediction equation is tailored to patients that are ventilator dependent and to those are spontaneously breathing- and considers factors such as trauma, burns, and obesity? |
|
Definition
|
|
Term
| what nutrition prediction equation uses dynamic parameters associated with greater correlation to measured REE, but is less accurate in obese patents? |
|
Definition
|
|
Term
| Which nutrition prediction equation is an accurate estimate of actual resting metabolic rate in obese and non-obese pops with a low rate of overestimation, but not reliable in the critically ill patients? |
|
Definition
| Mifflin (she says "most accurate for people like us") |
|
|
Term
| what is the kcal/kg goal for critically patients? pt's with SIRS? |
|
Definition
|
|
Term
| in pt's with acute illness, stress of inury, or sepsis- do you do hypo- or hyper caloric feedings? |
|
Definition
|
|
Term
| in healthy individuals, how many grams of protein per kg per day is recommended? |
|
Definition
|
|
Term
| how many ml/kg of fluid is required for maintenance? |
|
Definition
|
|
Term
| how many ml/kg of fluid is required for maintenance? |
|
Definition
|
|
Term
| what is the RDA method for estimating fluid needs? |
|
Definition
| 1 cc fluid per 1 kcal of estimated needs |
|
|
Term
| what are two drug categories that can be used in weight management? |
|
Definition
-catecholaminergic drugs
-serotoninergic agents |
|
|
Term
| What are 3 advantages of the gastric band? |
|
Definition
-easy to place
-adjustable
-fewer nutritional deficiencies--> fewer needed supplements |
|
|
Term
| what are 4 disadvantages of the gastric band? |
|
Definition
-lower average weight loss (40-50% EBW)
-post-op adjustments
-erosion
-slippage |
|
|
Term
| what are 4 advantages of sleeve gastrectomy? |
|
Definition
-60-70% excess BW loss at one year
-fewer vitamin deficiencies
-better appetite control
-lower risk of ulcers and small bowel obstruction |
|
|
Term
| what are 3 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 three advantages of biliary pancreatic diversion? |
|
Definition
-long term weight loss (85%) in super obese patients (BMI > 50)
-lower ulceration risk
-excellent resolution of comorbid dz |
|
|
Term
| what are 4 disadvantages of biliary pancreatic diversion? |
|
Definition
-significant nutritional problems in non-compliant patients
-average 2 BM/day
-more extensive vitamin replacement regimen
-most complex WLS procedure |
|
|
Term
| what are 4 advantages of gastric bypass? |
|
Definition
-excellent resolution of co-morbid dzs
-excellent long term weight loss (75%)
-dumping to prevent sweets
-minimal nutritional problems |
|
|
Term
| what are 2 disadvantages to gastric bypass? |
|
Definition
-technically more complex than restrictive operations
-requires life long iron, Ca, B12, and thiamine supplements |
|
|
Term
| what are the BMI parameters for weight surgical intervention? |
|
Definition
| bmi >40 or >35 with comorbidities |
|
|
Term
| how long must a patient go on a medically supervised diet before surgical intervention? what are two other criteria? |
|
Definition
-3-6 months
-psychological eval
-metabolic do's have been ruled out or clinically treated with failure |
|
|
Term
| refined sugars will cause what in a patient having undergone bariatric surg? |
|
Definition
| may cause dumping syndrome |
|
|
Term
| excess fat will cause what in a pt with bariatric surg? |
|
Definition
|
|
