24 Questions
What is the outcome of malnourished patients identified by nutrition assessment tools?
They have more infectious and noninfectious complications
What is the purpose of nutrition screening?
To identify patients at nutrition risk
What is the outcome of nutrition support intervention in malnourished patients?
Improved nutrition status and physical function
What is the recommendation for patients identified by screening and assessment as at risk for malnutrition or malnourished?
Nutrition support intervention is recommended
What is the outcome of patients with optimal nutrition status?
They have fewer complications and shorter hospitalizations
What is the grade of evidence for nutrition assessment in patients identified to be at nutrition risk?
Grade E
What determines the specific methods used to perform a clinical nutrition assessment?
Clinical skill, resource availability, and the setting
What is the primary purpose of reassessment and monitoring methods in nutrition care?
To extend the assessment process within overall nutrition care
According to experts, what is malnutrition?
An acute, subacute or chronic state of nutrition that has led to a change in body composition and diminished function
What is the primary cause of metabolic alterations associated with inflammation?
Cytokine-mediated mechanisms
What is the primary indicator of poor outcome in malnutrition?
Decreased synthesis of negative acute phase proteins
Why should albumin and prealbumin not be used in isolation to assess nutrition status?
They are markers of inflammatory metabolism
What is the primary purpose of nutrition screening in hospitalized patients?
To identify patients at risk for malnutrition
What is the consequence of not performing nutrition screening in hospitalized patients?
Longer length of hospital stay and complications
What is the recommended approach to diagnosing malnutrition in adults?
Based on etiology, integrating the present understanding of inflammatory responses to disease and trauma
What is the primary purpose of nutrition support interventions?
To provide nutrition support to patients at risk for malnutrition or malnourished
What is the primary goal of nutrition screening in patients with malnutrition?
To identify individuals who are malnourished or at risk for malnutrition
According to the Joint Commission, what is the timeframe for nutrition screening in acute care centers?
Within 24 hours of admission
What is the definition of nutrition assessment according to A.S.P.E.N.?
A comprehensive approach to diagnosing nutrition problems
What is the purpose of a nutrition assessment?
To diagnose nutrition problems and recommend interventions
What information is typically included in a nutrition assessment performed by a nutrition support clinician?
Diet and medical history, current clinical status, anthropometric data, laboratory data, physical assessment information, and often functional and economic information
What is the outcome of a nutrition assessment?
A recommendation for nutrition intervention
What is the relationship between nutrition screening and nutrition assessment?
Nutrition screening determines the need for a nutrition assessment
What is the purpose of nutrition intervention in patients with malnutrition?
To improve nutrition status
Study Notes
Nutrition Screening and Assessment
- Nutrition screening is the process of identifying individuals who are malnourished or at risk for malnutrition to determine if a detailed nutrition assessment is needed.
- The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) defines nutrition screening.
- The Joint Commission mandates nutrition screening within 24 hours of admission to an acute care center in the United States.
Nutrition Assessment
- Nutrition assessment is a comprehensive approach to diagnosing nutrition problems that uses a combination of medical, nutrition, and medication histories; physical examination; anthropometric measurements; and laboratory data.
- A.S.P.E.N. defines nutrition assessment.
- Nutrition assessment provides the basis for a nutrition intervention.
- A nutrition support clinician performs a nutrition assessment, which includes obtaining diet and medical history, current clinical status, anthropometric data, laboratory data, physical assessment information, and often functional and economic information.
Malnutrition
- Malnutrition is an acute, subacute, or chronic state of nutrition, in which varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function.
- Parameters used to diagnose malnutrition in screening and assessment processes reflect both nutrition intake and severity and duration of disease.
- An International Consensus Guideline Committee has proposed an approach to diagnosing malnutrition in adults based on etiology, integrating the present understanding of inflammatory responses to disease and trauma.
- The committee proposed three nutrition diagnoses: starvation-related malnutrition, chronic disease–related malnutrition, and acute disease or injury–related malnutrition.
Inflammation and Metabolic Alterations
- Inflammation and related compensatory mechanisms associated with disease or injury cause anorexia and alterations in body composition and stress metabolism.
- Metabolic alterations associated with inflammation are predominantly cytokine mediated and persist as long as the inflammatory stimulus is present.
- These metabolic alterations include elevated energy expenditure, lean tissue catabolism (proteolysis), fluid shift to the extracellular compartment, acute phase protein changes, and hyperglycemia.
Nutrition Support Guideline Recommendations
- Screening for nutrition risk is suggested for hospitalized patients.
- Nutrition assessment is suggested for all patients who are identified to be at nutrition risk by nutrition screening.
- Nutrition support intervention is recommended for patients identified by screening and assessment as at risk for malnutrition or malnourished.
This quiz covers the importance of nutrition screening, assessment, and intervention in patients with malnutrition, as defined by A.S.P.E.N. and mandated by the Joint Commission.
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