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Questions and Answers
According to the lecture, which of the following is NOT a primary focus of the session?
According to the lecture, which of the following is NOT a primary focus of the session?
Which of the following best describes the change in health trends in the U.S. between 1990 and 2016?
Which of the following best describes the change in health trends in the U.S. between 1990 and 2016?
What is the primary purpose of nutrition screening as outlined in the lecture?
What is the primary purpose of nutrition screening as outlined in the lecture?
Based on the session outline, which area would be discussed first?
Based on the session outline, which area would be discussed first?
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According to the data presented, which of the following has been associated with adverse health outcomes in some states?
According to the data presented, which of the following has been associated with adverse health outcomes in some states?
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Which of the following is the least likely to be categorized as a 'nutritional risk' factor based on the lecture?
Which of the following is the least likely to be categorized as a 'nutritional risk' factor based on the lecture?
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What is the most likely context in which the information from this lecture would be applied?
What is the most likely context in which the information from this lecture would be applied?
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Which of the following is NOT explicitly listed as a nutrition risk factor?
Which of the following is NOT explicitly listed as a nutrition risk factor?
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What percentage of usual body weight is identified as a potential nutrition risk factor?
What percentage of usual body weight is identified as a potential nutrition risk factor?
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According to the Nutrition Care Process, which step immediately follows the nutrition assessment?
According to the Nutrition Care Process, which step immediately follows the nutrition assessment?
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Which of these best describes the initial step in the Nutrition Care Process?
Which of these best describes the initial step in the Nutrition Care Process?
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In the Nutrition Care Process, what directly follows 'Describe the problem'
In the Nutrition Care Process, what directly follows 'Describe the problem'
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Which of the following is listed as an aspect of the 'Nutrition Assessment' stage of the Nutrition Care Process?
Which of the following is listed as an aspect of the 'Nutrition Assessment' stage of the Nutrition Care Process?
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What is the primary focus of the 'Monitoring and Evaluation' step in the Nutrition Care Process?
What is the primary focus of the 'Monitoring and Evaluation' step in the Nutrition Care Process?
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Which of the following is an example of an altered metabolic condition mentioned as a nutrition risk factor?
Which of the following is an example of an altered metabolic condition mentioned as a nutrition risk factor?
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According to the information provided, what is the definition of the Nutrition Care Process (NCP)?
According to the information provided, what is the definition of the Nutrition Care Process (NCP)?
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According to the consensus statement by the Academy of Nutrition and Dietetics and ASPEN, how many characteristics are needed to diagnose malnutrition?
According to the consensus statement by the Academy of Nutrition and Dietetics and ASPEN, how many characteristics are needed to diagnose malnutrition?
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A patient presents with hollows and depressions around their eyes. What does this physical finding indicate?
A patient presents with hollows and depressions around their eyes. What does this physical finding indicate?
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A clinician observes a depression or pit at the temples of a patient. This observation is most indicative of which condition?
A clinician observes a depression or pit at the temples of a patient. This observation is most indicative of which condition?
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During a nutrition-focused physical examination, which finding at the triceps suggests fat loss?
During a nutrition-focused physical examination, which finding at the triceps suggests fat loss?
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Which of the following physical examination findings might indicate dehydration or overhydration?
Which of the following physical examination findings might indicate dehydration or overhydration?
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Which of the following is NOT a component of a Chem-7 panel?
Which of the following is NOT a component of a Chem-7 panel?
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Which of the following accurately reflects the calculation of Total Lymphocyte Count (TLC)?
Which of the following accurately reflects the calculation of Total Lymphocyte Count (TLC)?
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Which measure is categorized as a hematological indicator?
Which measure is categorized as a hematological indicator?
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Which of the following is considered a visceral protein status marker?
Which of the following is considered a visceral protein status marker?
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What is the primary purpose of the Creatinine Height Index?
What is the primary purpose of the Creatinine Height Index?
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Which of the following is included in the Chem-20 panel but not in the Chem-7 panel?
Which of the following is included in the Chem-20 panel but not in the Chem-7 panel?
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What is the relationship between protein deficiency and the immune system?
What is the relationship between protein deficiency and the immune system?
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Which laboratory test is NOT used to assess micronutrient status?
Which laboratory test is NOT used to assess micronutrient status?
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For which condition would serum vitamin D be most routinely measured?
For which condition would serum vitamin D be most routinely measured?
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In long-term diuretic use or alcohol abuse, which vitamin level should be routinely measured?
In long-term diuretic use or alcohol abuse, which vitamin level should be routinely measured?
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Which method of dietary data collection is most susceptible to validity issues due to potential alterations or misrepresentation of intake?
Which method of dietary data collection is most susceptible to validity issues due to potential alterations or misrepresentation of intake?
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What is a key advantage of using a food record or food diary over a 24-hour recall?
What is a key advantage of using a food record or food diary over a 24-hour recall?
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Which of the following falls under the category of 'factors affecting access to food and food/nutrition-related supplies' in a patient's history?
Which of the following falls under the category of 'factors affecting access to food and food/nutrition-related supplies' in a patient's history?
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A patient's belief that changing their diet will not improve their blood glucose levels primarily represents an issue within which category of patient history?
A patient's belief that changing their diet will not improve their blood glucose levels primarily represents an issue within which category of patient history?
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Which of the following is a disadvantage of the 24-hour recall method?
Which of the following is a disadvantage of the 24-hour recall method?
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A patient states they will only eat at the kitchen table with family to reduce snacking. This aligns with which category of patient history?
A patient states they will only eat at the kitchen table with family to reduce snacking. This aligns with which category of patient history?
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Which of the following is considered as a source of patient history data, that is not directly patient reported?
Which of the following is considered as a source of patient history data, that is not directly patient reported?
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A food frequency questionnaire is mentioned in the content as:
A food frequency questionnaire is mentioned in the content as:
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Which of the items below is NOT typically considered a part of an initial patient history data collection?
Which of the items below is NOT typically considered a part of an initial patient history data collection?
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Which of the following represents a clinical finding that would contribute to patient history in regards to nutrition?
Which of the following represents a clinical finding that would contribute to patient history in regards to nutrition?
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Study Notes
COM 5005 Lecture 6: Nutrition Screening, Assessment, and Malnutrition
- Learning Objectives: Recall health trends in US nutritional status, list nutrition screening tools, define the Nutrition Care Process, identify nutritional assessment components, define malnutrition and its classifications.
Session Outline
- Nutrition Screening: Identifying nutritional risk, nutrition risk factors, screening tools and resources for practice.
- Nutrition Assessment: Components of nutritional assessment, physical exam and hallmark findings, assessment tools and resources for practice.
- Nutrition Diagnosis: Forms of malnutrition, classification and communication about malnutrition, applications in patient care.
Why Does Nutrition Matter?
- Case Studies: Show cases of individuals (56-yo labor worker, 16-yo soccer player, 70-yo accountant) with different nutritional risks. Their activities, medical history (if any), and BMI are provided.
- Discussion about the factors that contribute to a person's nutritional status.
- Research Findings: Systematic analysis of 333 causes and 84 risk factors, improved US health from 1990-2016, changes in mortality and morbidity drivers, increased probability of death between 20 and 55 years of age in 5 states.
Health Trends
- Health Care Spending (2021): $4,255.1 billion. Breakdown of spending by category.
- Global Nutrition Targets: Discusses progress toward global targets related to malnutrition.
Terminology in Nutritional Care
- Nutrition Status: State of the body related to consumption and utilization of nutrients, nutrient stores, intake, individual needs, and demand.
- Nutrition Screening: Steps towards identifying nutrition risk in patients/clients, assessment followed by benefitting from diagnosis and intervention.
- Nutrition Assessment: Systematic process to obtain, verify, and interpret data concerning nutrition-related problems.
Nutrition Risk Factors
- Age: Elderly and children have altered nutritional needs.
- Altered Nutrition Needs: Pregnancy, lactation, and adolescence.
- Socioeconomic Factors: Financial situations and social factors.
- Unintended Weight Loss: >10% in 6 months.
- Usual Body Weight: 85% or less.
- Impaired Nutrient Digestion/Absorption/Utilization: Problems with these processes affect nutrient intake and status.
- Altered Metabolic Conditions: Critical illness, cancer, and diabetes.
Nutrition Care Process
- The process of evaluating, assessing, diagnosing, and intervening in nutrition-related complications. This involves screening, detailed assessment, diagnosis, and implementing interventions.
Nutrition Care Algorithm
- A flowchart illustrating the process of nutrition care, from initial screening to patient readmission, reassessment, plan update, or plan termination.
Nutrition Screening Tools
- MUST: Malnutrition Universal Screening Tool (identifies nutritional risks, mortality prediction) for adults and community settings.
- NRS-2000: Nutrition Risk Screening (acute adult, retrospective factors).
- DETERMINE Checklist: Non-institutionalized older adults, used by Older Americans Act programs.
- MNA: Mini Nutrition Assessment (validated for older adults).
- SGA: Subjective Global Assessment (comprehensive physical and functional history).
Assessment: Key Components
- Patient History: Dietary history, medical records, family history, socioeconomic factors, and clinical findings.
- Anthropometrics: Height/weight, BMI, waist circumference, and skinfold measurements.
- Biochemical Data: Blood, urine, feces, and tissue samples; hematological measures (e.g., Hgb, Hct, MCV), protein assessment, immunocompetence, presence of inflammation, vitamin & mineral assessment.
- Clinical/Nutrition-Focused Physical Exam: Includes identifying signs of malnutrition.
- Functional Assessment: Hand grip strength, timed up and go test, ADLs.
Anthropometrics: Body Composition, Skinfold, BIA, InBody Scanner
- Describing how body composition is evaluated through different measurements.
- Focuses on body mass index, weight, and skinfold measurements, including the use of bioelectrical impedance analysis (BIA) and InBody scanners.
Biochemical Medical Tests and Procedures
- Biochemical markers and indicators in blood, urine, and tissues.
- Routine laboratory measures, hematological assessments, protein assessment, immunocompetence indicators and presence of inflammation, and vitamin and mineral assessment.
Biochemical Indicators
- Chem-7 and Chem-20 Panels, nutritional markers in blood; details on specific elements within these panels.
- Immunocompetence and protein deficiency correlation.
- Total Lymphocyte Counts for immunocompetence markers.
Biochemical Data: Hematological, Visceral Protein, Somatic Protein, and Micronutrient Status
- Hematological indicators: Hemoglobin, hematocrit, MCV, MCH, and other associated components in blood tests.
- Visceral protein assessment: Albumin, transferrin, prealbumin/transthyretin, retinol-binding protein (RBP), and C-reactive protein (CRP) for inflammation detection.
- Somatic protein assessment: Creatinine height index for somatic protein measurements and evaluating daily ration of creatine output to height.
- Micronutrient status: High-performance liquid chromatography, immunological tests, and other assays for measuring levels of various vitamins and minerals.
4. Clinical/Nutrition-Focused Physical Examination (NFPE)
- Head-to-toe examination in determining nutritional status.
- Malnutrition is determined based on the presence of two or more characteristics from the list provided.
Facial Features, Nutrition-Focused Physical Examination
- Photo examples of different levels of malnutrition and normal, mild-moderate, and severe physical manifestations related to nutrition status, through visual assessment of facial features and body conditions.
5. Functional Assessment
- Methods assessing muscle strength, endurance, and other indicators of function related to nutritional health and status.
- Methods: hand grip, 30-second chair stand, timed up and go test, and Activities of Daily Living (ADL) scale/Karnofsky Performance Index correlating with role of sarcopenia.
Causes of Malnutrition
- Primary Factors: Inadequate nutrient intake (e.g., self-restrictive eating, socioeconomic, global issues).
- Secondary Factors: Malabsorption, impaired utilization/storage of nutrients, excessive nutrient losses, and increased nutrient needs (e.g., chronic illness, inflammation, infections).
Secondary Causes of Malnutrition, Contributing Factors
- A description of the different factors that contribute to the secondary causes of malnutrition and examples.
Compare Perspectives: Medical vs. Nutritional Dx
- Comparing medical diagnoses (e.g., diabetes, trauma, obesity, mechanical ventilation dependence, anorexia nervosa) with corresponding nutritional diagnoses, outlining how they relate to the etiology, signs/symptoms, and the need to comprehensively address individual needs and status.
Etiology-Based Malnutrition Definitions
- Defining malnutrition based on underlying causes and severity of the condition.
- Differentiation between starvation, inflammation, and chronic disease-related and acute-disease-related malnutrition.
Two Factors for Malnutrition Diagnosis
- Table listing criteria for nutritional diagnosis based on acute illness/injury, chronic illness, and social/environmental factors.
Classic Malnutrition Syndromes
- Kwashiorkor: Severe protein deficiency characterized by dramatic loss of protein intake, risk for infections, and specific physical ailments (edema; fatty liver).
- Marasmus: Protein-calorie malnutrition typified by somatic muscle wasting, skin changes, body weight loss, and absence of edema
Summary Points
- Discussion of the various factors influencing malnutrition and its consequences.
- Highlights that nutrition assessment and screening are important for identifying risks and improving patient care.
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Description
Test your knowledge on the Nutrition Care Process and key trends in U.S. health from 1990 to 2016. This quiz covers various topics such as nutrition screening, risk factors, and the steps involved in nutrition assessment. Assess your understanding of how nutrition information can be applied in real-world contexts.
