Medical Nutrition Therapy: Exam 2

What type of historical information is collected during a nutrition assessment?

1. medical history 2. medication and supplement history 3. personal and social history 4. food and nutrition history(diet history)

What are the four steps of the nutrition care process

1. nutrition assessment 2. nutrition diagnosis 3. nutrition intervention 4. nutrition monitoring and evaluation.

List and describe the 3 effects of illness on nutrition status

1. reduced food intake 2. impaired digestion and absorption 3. altered nutrient metabolism and excretion

IBW (ideal body weight): Female

100 lb+ 5lb for every inch over 60 inches +/- 10%

IBW (ideal body weight): Male

106 lb+ 6lb for every inch over 60 inches +/- 10%

what are the 4 major ways diet information is collected from a patient?

24 hour dietary recall, frequency questionnaire, food record, direct observation

What does a nutrition assessment involve?

5 categories (food/nutrition-related history, anthropometric measurements, biochemical data/medical tests/procedures, nutrition-focused physical findings, client history)

How is a nutrition assessment different than a nutrition screen?

A nutrition screening is the initial marker to see if a patient is or is at risk for malnutrition and the nutrition assessment is the plan for diet and implementation of that plan

How does a modified diet differ from a regular diet?

A regular diet is not adjusted at all and a modified diet is altered in some way.

nutrition counseling explanation

A supportive process characterized by a collaborative counselor-patient relationship, to establish food, nutrition, and physical act. priorities, goals, and individualized action plans that acknowledge and foster responsibility for self-care to treat an existing condition and promote health

Describe the A,B,C,D of a nutrition assessment

A: Anthropometric data; B: biochemical data; C: clinical/physical signs; D: diet history

What is the ADIME format for charting?

Assessment, Diagnosis, Intervention, and Monitoring and evaluation

Describe complementary and alternative medicine

Complementary and alternative medicine (CAM) are therapies that do not include medication and have not been scientifically validated. Page 174

What is the difference between complementary and alternative medicine?

Complementary medicine is when therapies are used together with conventional medicines. Alternative medicine is when therapies are used in place of conventional medicines.

Explain the relationship between Coumadin and Vitamin K

Drugs and nutrients interact and alter metabolism by acting as a structural analog( mimics the same compounds) p 167

explain how drugs alter excretion

Drugs and nutrients may each increase or decrease losses of the other in urine Drugs and nutrients may interact and cause toxic side effects

Adjusted Body Weight Equation

IBW + [0.25 x (CBW-IBW)]

What is a low fat diet?

Limits dietary fat to low (<50 g/day) or very low (<25 g/day) intakes.

What population group is at highest risk for herb-drug interactions, why?

Older adults (65+) are at the highest risk due to many of them already taking 3 or more prescription drugs over the course of a year.

What does P, E and S stand for?

P- Problem, E- etiology, S- signs/symptoms

What is a PES statement?

PES statement to describe the problem, its root cause, and assessment data that provide evidence for the nutrition diagnosis

What kind of foods are on a clear liquid diet?

Popsicle, broth, sodas, apple juice, jello

Why is % of UBW an important calculation?

The % UBW is more effective than the %IBW because in overweight individuals the %IBW may fail to show significant weight loss and in underweight persons it may overstate the degree of weight loss.

D for Diagnosis (ADIME notes)

The diagnosis section lists and prioritizes the nutrition diagnoses

Why should tyramine foods be avoided if a patient is on a MAO inhibitor?

When people who take MAO's consume excessive tyramine, the increased tyramine in the blood can induce a sudden release of stored norepinephrine causing severe HA, rapid heartbeat, and a dangerous rise in blood pressure.

What is edema?

a condition characterized by an excess of watery fluid collecting in the cavities or tissues of the body.

Describe a modified diet

a diet that contains foods altered in texture, consistency, or nutrient content or that includes or omits specific foods, may also be called therapeutic diet

nutrition education explanation

a formal process to instruct or train a patient/client in a skill or to impart knowledge to help patients/ clients voluntarily manage or modify food, nutrition and physical activity choices and behavior to maintain or improve health

What is PEM or protein-energy malnutrition

a state of malnutrition characterized by depletion of tissue proteins and energy stores, usually accompanied by micronutrient deficiencies

Describe the Nutrition care Process.

a systematic approach used by dietetics professionals to evaluate and treat nutrition related problems.

What foods should be avoided if a patient is on a MAO inhibitor

aged cheeses, aged or cured meats, beer, fermented vegetables, fish or shrimp sauce, prepared soy foods, soy sauce, and yeast extracts

plasma protein test

altered by metabolic stress, pregnancy, kidney function, zinc status, and medications

Describe a nutrition screen

an assessment procedure that helps identify patients who are malnourished or at risk for malnutrition.

symptoms and effects of illness that cause reduced food intake

anorexia due to illness; nausea and vomiting: pain with eating; mouth ulcers or wounds; difficulty chewing or swallowing; depression or psychological stress; inability to feed oneself

What medical conditions is the high calorie, high protein diet appropriate for?

cancer, AIDS, burns, trauma, reverse malnutrition, improve nutritional status, or promote weight gain.

treatments that cause altered nutrient metabolism and excresion

chemotherapy; uses of diuretics (increased urination and nutrient excretion); side effects of other medications (can affect nutrient function)

coordination of nutrition care explanation

consultation with, referral to, or coordination of nutrition care with other health care providers, institutions, or agencies that can assist in treating or managing nutrition-related problems

What is a clear liquid diet?

contains clear fluids or foods that are liquid at room temperature and leave minimal residue in the colon; short term only

I for intervention (ADIME notes)

describes treatment goals and expected outcomes, specific interventions, and the patient's responses to nutrition care

What is a diet manual?

details exact foods and preparations for modified diets

What are some safety issues related to herbal products?

diarrhea, nausea, and vomiting, liver damage, heart arrhythmia, high blood pressure, anxiety, and seizures

Converting lbs to kg

divide by 2.2

converting cm to inches

divide cm by 2.54

explain how drugs alter metabolism

drugs and nutrients may each alter activity of enzymes that metabolize others

explain how drugs alter nutrient absorption

drugs may bind to nutrients alter stomach acidity interfere with nutrition transport in the intestinal cells, Foods may alter stomach emptying rate after stomach acidity binds to drugs

how does edema impact albumin levels?

edema lowers albumin levels

How does edema impact albumin levels

edema will impact albumin because when there is fluid retention it dilutes the substances and therefore lowers the lab values.

symptoms and effects of illness that cause altered nutrient metabolism and excretion

elevated metabolic rate; muscle wasting; changes in hydration; prolonged immobilization; nutrient losses due to excessive bleeding, diarrhea, or frequent urination

pros food frequency questionnaire

examines long-term food intake seasonal variability should not affect results, method is inexpensive to administer, completed after food is consumed.

Percent Ideal Body Weight (% IBW)

first calculate IBW and then (actual body weight/IBW)x100

What are the 4 categories of nutrition intervention?

food and/or nutrient delivery, nutrition education, nutrition counseling, coordination of nutrition care

What modifications are made to foods for a mechanical soft diet?

foods that are pureed, mashed, ground, minced, or soft textured.

What type of information is collected in a nutrition screen?

health related data ( admission data, anthropometric data, functional assessment data, historical information, laboratory test results, signs and symptoms)

Athropometric data

height (or length), weight, body composition, circumference of head, waist, and limps

A for Assessment (ADIME notes)

height, weight, BMI, weight loss, illnesses

Explain how drugs alter food intake

increase appetite/ decrease appetite, alter taste sensation causing GI discomfort

CRP or C-Reactive Protein

increases with arterial inflammation,cancer,obesity, and heart attack

food and/or nutrient delivery explanation

individualized approach for food/nutrient provision

Malnutrition is associated with an increased risk of _____?

infection

symptoms and effects of illness that cause impaired digestion and absorption

inflammation associated with conditions; insufficient secretion of digestive enzymes or bile salts; altered structure or function of intestinal mucosa

What are the 3 categories of nutrition diagnoses?

intake, clinical, and behavioral/environmental

pros of dietary recall

interview occurs after food is consumed, so method does not influence dietary choices, results are obtained quickly, easy to conduct.

Converting kg to lbs

kg x 2.2 = lbs

behavioral/environmental category for nutrition diagnoses

knowledge, attitudes, beliefs, physical environment, access to food, or food safety

biochemical data

lab values, factors influencing test results, certain tests

Describe prealbumin

levels may reflect illness or PEM, more responsive to changes in health status than albumin or transferrin, also more expensive

Describe albumin

levels may reflect illness or PEM, slow to respond to improvement or worsening of disease

What is a low sodium diet?

limits dietary sodium; degree of restriction depends on symptoms and disease severity

Why is monitoring and evaluation an important step in the nutrition care process?

monitoring and evaluation are important because this step identifies patient/client outcomes relevant to dx and intervention plans/goals

pre-albumin

more sensitive than albumin to change in protein status--not routine because its expensive

converting inches to cm

multiply inches by 2.54

What does NPO mean?

nothing by mouth

clinical category for nutrition diagnoses

nutrition problems that relate to medical or physical conditions

pros of direct observation

process does not rely on memory, method does not influence food intake, can be used to evaluate the acceptability of a prescribed diet.

pros of food record

process does not rely on memory, recording foods as they are consumed may improve accuracy of food intake data, process is useful for controlling intake because keeping records increases awareness of food choices

cons of direct observation

process is possible only in residential situations and it is labor- intensive

cons of dietary recall

process relies on memory, estimated food intake is common, foods may be omitted (alcohol and dessert), the time span of the food intake does not accurately represent usual intake, skill of interviewer affects outcome.

cons of food frequency questionnaire

process relies on memory, food lists often include common foods only, serving sizes are often difficult for respondents, calculated nutrient intakes may not be accurate, food lists for the general population and limited value in special population, method is not effective for short term food intake changes

What type of information is typically monitored in the monitoring and evaluation step?

providing evidence that the nutrition intervention is or is not changing the patient/clients behavior or status

treatments that cause impaired digestion and absorption

radiation therapy; gastrointestinal surgeries; side effects of medications on gastrointestinal tract structure or function

cons of food record

recording process itself influences food intake, under-reporting and portion size errors are common, process is time-consuming and burdensome for respondent, method requires literacy and the physical ability to write, seasonal changes in diet are not taken into account.

M for monitor (ADIME notes) & E for evaluation (ADIME notes)

records the patient's progress, changes in the patients condition and adjustments in the care plan

transferrin

responds to iron status and PEM increases as iron status decreases

treatments that cause reduced food intake

restrictive diets; bowel rest; surgical resection of head, neck, mouth, or esophagus; preparation for surgery or diagnostic tests; surgical wounds; side effects of medications (which can cause anorexia or gastrointestinal distress

What are some of the approaches discussed in class for long term dietary interventions?

short term achievable goals and behavior changes

albumin

slow to reflect change in nutrition status, because of large body pool and slow degradation, until someone gets to a chronic protein in energy malnutrition--levels fall after prolonged malnutrition

what is a nutrition care plan?

the end result or summary of the nutrition care process

what are some clinical signs of dehydration?

thirst, weight loss, dry skin or mouth, reduced skin tension, dark-colored urine, and low urine volume

What physical signs might a patient with edema have?

tightening of the skin due to swelling, puffy redness

What is the purpose of a nutrition screen?

to indicate the presence of PEM (protein-energy malnutrition)

intake category for nutrition diagnoses

too much or too little of a food or nutrient compared to actual or estimated needs

Describe tailored nutrition education

understanding and respecting where the client/patient is at in the stages of change (pre-contemplation, contemplation, implement, and maintain)

What health conditions might the low sodium diet be used for?

used in hypertension, heart failure, renal disease, and liver disease

who performs a nutrition screening?

usually a nurse, nursing assistant, RD, or NDTR

Describe effects of malnutrition on the body

weakens the immune function and compromises healing ability

BMI equation for adults

weight in lb/ height in inches^2 x 703.1

Describe foods eliminated on a low fiber diet

whole grain bread/cereal, nuts, most fresh fruit, dried fruit, dried beans and peas and many starchy vegetables.

Describe foods you would incorporate in a high calorie, high protein diet

whole milk, milkshakes, cheese, ice creams, all types of meat, protein bars, nuts and seeds, potatoes, corn, and peas.

how soon after admission is a nutrition screening completed?

within 24 hours