Jean Inman Domain 2

Adjusted IBW for amputations =

(100-% amputation)/100 x IBW for original ht

IBW with amputations: *entire leg* (AKA)

*16%* (10-16%)of body wt

IBW with amputations: *forearm* with hand (below elbow)

*2.3%* of body wt

IBW with amputations: *entire arm*

*5%* of body wt

IBW with amputations: *lower leg* with foot (*BKA*)

*6%* of body wt

*Food frequency* lists are useful in what setting?

*Community*

*Food frequency* lists are a *quick* way to determine intakes on...

*LARGE NUMBERS of people*

Which 3 nutrition *screening tools* are specifically used for *elderly* patients?

*MNA* (Mini Nutritional Assessment) *NSI* (Nutrition Screening Initiative) & *GNRI* (Geriatric Nutritional Risk Index) NRS (Nutrition Risk Screening, also technically for pt's >70 yrs)

*MNA*, *NSI* & *GNRI*

*Mini Nutritional Assessment*, *Nutritional Screening Initiative* & *Geriatric Nutritional Risk Index* (screening tools used for ELDERLY pt's)

*SGA* (Subjective) looks at

*NO lab values*: talking, looking

What are *indicators compared against*?

*Nutrition care criteria*

*Food frequency lists* are what type of assessment?

*POPULATION assessment*

*BMI* is also known as

*Quetelet index*

*AMA* (arm muscle area, measure of skeletal muscle/somatic protein) is *measured using* ____ and ____

*TSF* (triceps skinfold thickness), *AC* (arm circumference) AMA= AC-TSF

*MST* (Malnutrition Screening Tools)

*acute, hospitalized adult* population- evaluates: recent weight loss recent poor dietary intake/appetite

*24-hr recall* is useful in what setting?

*clinical* setting

Assessment data is *clustered* for...

*comparison* with characteristics of a suspected dx- clustered into the 5 domains: -*food/nutrition related hx* -*anthropometrics* -*lab/medical tests* -*nutrition-focused physical findings* -*client hx*

*NRS* (Nutrition Risk Screening)

*medical-surgical hospitalized* patients, >70 yrs; evaluates *BMI* % weight loss intake

What are the 3 components of *assessment*?

*review*, *cluster*, *identify* -REVIEW data for factors that affect nutritional/health status -CLUSTER data for comparison with characteristics of suspected dx -compare indicators to IDENTIFIED standards

*GNRI* (Geriatric Nutritional Risk Index)

*serum albumin*, weight changes

What are *indicators* (in the NCP)?

*what we will measure during assessment*: i.e. intake, height, weight

What are the 7 screening tools?

-*SGA* (Subjective Global Assessment) -*MNA* (Mini Nutritional Assessment, *elderly*) -*NSI* (Nutrition Screening Initiative, *elderly*) -*GNRI* (Geriatric Nutritional Risk Index, *elderly*) -*MST* (Malnutrition Screening Tool-acute, hospitalized adult pt's) -*NRS* (Nutrition Risk Screening- medical & surgical hospitalized pt's) -*MUST* (Malnutrition Universal Screening Tool)

IBW with amputations: hand

.7% of BW

What are the 4 steps of the NCP?

1. Assess, diagnose, intervene, monitor, and evaluate (ADIME)

IBW with amputations: foot

1.5% BW

What is the healthy BMI for a healthy adult?

18.5-24.9

What is the healthy BMI range? AKA Quetelet index

18.5-24.9

Dietary intake assessment anaylsis includes which diet hx methodology?

24 hour recall method - ideal for pts with t2dm - so they can quickly determine timing of meals, snacks and insulin injections Usual intake - ideal for elderly in order to determine # of meals eaten, and infants, children and adolescents who diets are not very varied. Many pts are not consistent with their habits, and state that there is not usual a pattern Food frequency method - restrospective review

The Joint commission says that nutrition risk should be identified in hospitalized patients within ___ hours of admission, but does _____ mandate a method of ____

24, not, screening

What is the healthy BMI range for elderly?

24-29

What is the BMI range for overweight?

25-29.9

What is the obese 1 range for BMI?

30-34.9

What is the obese II range for BMI?

35-39.9

What is the obese III range for BMI?

>40 extreme obesity

What are risk factors?

A clinically important sign associated with an increased likelihood of acquiring a disease or other condition.

What is the Nutrition Care Process? (NCP)

A standardized, consistent structure and framework used to provide nutrition care

Who can participate in nutrition screening?

ALL HEALTH CARE TEAM MEMBERS - not a part of the four step process, but serves a supportive role

Men IBW - LARGE !! frame

Add 10%

Women IBW - LARGE !! frame

Add 10%

The physician-ordered diet would be included in the ______ section of the ADIME.

Assessment

What is involved in the assessments of functional status, ADLs, and body system assessments?

Assessment of functional status evaluates instrumental activities of daily living (such as chores, cleaning, cooking, driving or using public transportation, grocery shopping, home repair, paying bills or other financial tasks, taking prescribed medications, and using a phone), activities of daily living (such as dressing, eating meals/snacks, bathing, using the toilet, walking) and body systems assessment (such as ambulation status; cognitive status; functional independence like exercise, housework, work outside of the home; and sensory status like hearing, vision, and speech).

*MUST* (Malnutrition Universal Screening Tool)

BMI, unintentional weight loss, *effect of ACUTE disease* on *intake* for *>5 days*

What other items are included in food & nutrient related hx?

Behavior (self-management) Access to food & water PA & function Mx Pt's perceptions of nutrition

How long does nutrition screening take?

Brief (5-10 mins)

% IBW formula

CBW / IBW x 100

% UBW formula

CBW / UBW x 100

What is reviewed during nutrition screening?

Client's history, lab results, weight, physical signs

What should you document during the nutrition assessment?

Date & time Comparison with standards patient's perceptions values & motivation related to problem changes in pt's level of understanding behaviors, outcomes, and reasons for discharge

What does the Hamwi equation estimate?

Desirable body weight AKA IBW

What items are included in the anthropometric section?

Ht CBW UBW IBW BMI %IBW % Weight Change

What are the six characteristics recommended for identifying malnutrition in older adults: When diagnosing malnutrition in older adults, what is the measurement for determining diminished functional status?

Insufficient energy intake Weight loss Loss of muscle mass Loss of subcutaneous fat Localized or generalized fluid accumulation Diminished functional status as measured by handgrip strength Because there is no single, definitive parameter for diagnosing adult malnutrition, it is recommended that diagnosis be contingent on presence of at least two of these parameters. Diminished functional status as measured by handgrip strength

*TSF* (triceps skinfold thickness, fat) *standards* for M & F

M *12.5*mm F *16.5*mm

normal/standard *AMA* for M & F

M *25.3*cm F *23.2*cm

normal *TSF & AMA* for males vs females

M: TSF 12.5mm, AMA 25.3cm F: TSF 16.5mm, AMA 23.3cm

What is needed to dx malnutrition?

Minimum of 2 characteristics to dx either severe or non-severe malnutrition Energy intake for non-severe is <75% of energy x >7 days Severe - <50% of energy x >5 days Weight loss Sub body fat, muscle mass, fluid for non severe: mild Severe - moderate Reduced grip strength for non severe - N/A Severe - measurably reduced

% wt change ASSESSES...

NUTRITIONAL RISK !!

What are Nutrition Care indicators?

Nutrition Care Indicators: markers that can be measured and evaluated to determine effectiveness of nutrition care Ex - lab values Indictator is "adequate protein intake" - what do you want to monitor

Critical skills needed during the nutrition assessment include

Observe verbal/nonverbal cues Determine the appropriate data to collect Select tools and procedures and apply in valid relaibale ways Distinguish relevant from irrelevant Validate, organize, and categorize data

Women IBW - MEDIUM !! frame

Over 5': 100# for first 5 feet + 5# for each additional inch > 60" (5') Under 5': 100# for first 5 feet - 5# for each inch < 60" (5')

Men IBW - MEDIUM !! frame

Over 60": 106# for first 5 feet + 6# for each additional inch > 60" (5') Under 60": 106# for first 5 feet - 6# for each inch < 60" (5')

IBW for spinal cord injury: *QUADRIPLEGIC* (all 4 limbs paralyzed, neck-down)

Reduce by *10-15%*

IBW for spinal cord injury: *paraplegic* (2 limbs paralyzed)

Reduce by *5-10%*

The following indicators (alone or in conjunction) have been associated with increased risk for wound healing problems in the lower extremity amputation population: Serum albumin - ____ Total lymphocyte count (TLC) - ____ Hyperglycemia - ____ Patients who are having problems with prosthesis fit Any weight gain or loss - ____

Serum albumin <3.5 g/dL Total lymphocyte count (TLC) <1,500 cells/mL Hyperglycemia (fasting glucose >126 mg/dL) Patients who are having problems with prosthesis fit Any weight gain or loss >5 lbs

% wt change stresses what?

Severe wt loss: >2% in 1 week >5% in 1 month >7.5% in 3 months >10% in 6 months >20% in 1 year

% weight change showing significant wt loss

Significant wt loss: 1-2% in 1 week 5% in 1 month 7.5% in 3 months 10% in 6 months

How is the NCP different from standardized care?

Standardized care infers that all pts recieve the same care.

At what age do you start using BMI for age charts and why?

Start at age 2 when accurate stature can be obtained

Men IBW - SMALL !! frame

Subtract 10%

Women IBW - SMALL !! frame

Subtract 10%

% weight change formula

UBW - CBW / UBW x 100

What is the Nutrition Care criteria?

What it is compared against Criteria to which the indicator is compared (nutrition prescription/goal or a reference standard) Ex - Criteria is "pt to consume >50% of meals and supplements" - how are they gonna meet the indicator

Is critical thinking a reasoning process? And what is included?

Yes critical thinking is a reasoning process where ideas are produced and evaluated. It includes the ability to conceptualize, think rationally, think creatively, be inquiring, and think autonomously (freedom to act independently).

Data reviewed during the assessment is reviewed during _____ steps of the _____

all, NCP

Physical findings are

anthropometric measurements

*TSF* - *triceps skinfold thickness* measures...

body *fat* reserves, *CALORIE reserves*

Anthropometric measurements =

body structure

Indicators are...

clearly defined markers that can be observed and measured

Each step of the ADIME requires ______ thinking

critical

Centimeters to meter conversion

divide cm by 100

Centimeters to inches conversion

divide cm by 2.54

Inches to meters conversion

divide inches by 39.37 to get meters

*SGA* (Subjective Global Assessment)

history, intake, weight change, *GI symptoms*, *functional capacity*, *physical appearance*, *edema*, & *primary diagnosis*

Food frequency lists measure...

how often an item is consumed

Assessment data indicators are compared to...

identified standards and criteria for interpretation and decision-making

When is *AMA* (arm muscle area) important to measure?

in *growing children* (useful in identifying possible *PEM*)

Assessment measures...

indicators and compares against criteria

What does critical thinking us? 4 items

it integrates facts, informed opinions, and active listening and observations

Outcome of screening determines the ____ _____ _____

level of care

Nutrition screening is use of preliminary nutrition assessment techniques to identify people who are...

malnourished or at risk for malnutrition

______ provides the *basis* for the *nutrition diagnosis*

nutrition *ASSESSMENT*

makes *comparisons* between *data collected* & reliable *standards* is an *on-going, dynamic process* that involves *continual reassessment* & analysis of patient/client/group needs

nutrition *assessment*

Indicators are *also used* to *monitor and evaluate* progress towards...

nutrition outcomes

Nutrition assessment is initiated by...

referral/screening of individuals or groups for nutritional risk factors

Joint commission does not mandate a METHOD of...

screening

*AMA* - *arm muscle area* measures

skeletal *muscle* mass, *SOMATIC protein*

According to the Campinha-Bacote model, cultural _____ is the the ability for health care providers to obtain an accurate and culturally relevant history and conduct a physical assessment.

skill

*somatic* vs *visceral* protein

somatic= *skeletal muscle* visceral= *NON-muscular* protein making up *organs*, structural components & *blood* (e.g. transport/storage proteins, albumin, transferrin, CRP, etc)

*MNA* (Mini Nutritional Assessment)

specifically for ELDERLY pt's (*≥65 yrs*)- evaluates *independence*, *medications*, *# of full meals* consumed each day, *protein intake*, fruits & vegetables, *fluid*, mode of feeding

FOR SCREENING TO BE EFFECTIVE, MECHANISM MUST BE ACCURATE BASED ON

specificity - can it ID patients without a condition? Sensitivity - can it ID those who have the condition?

BMI formula

weight (kg) / height (m^2)