Test Bank for Nutrition Essentials for Nursing Practice 9th Edition by Dudek

Test Bank for Nutrition Essentials for Nursing Practice
9th Edition by Dudek


What role do nurses play in nutritional care? - ANSWER - screen hospitalized
patients to identify those at nutritional risk
- serve as a liaison between dietitian and physician
- available as a nutrition resource when dietitians are not
- reinforce nutrition counseling provided by the dietitian
- basic nutrition education

Nutrition screening - ANSWER - a quick look at a few variables to identify
individuals who are malnourished or who are at risk for malnutrition so that an in-
depth analysis can follow
- can be custom designed for a particular population or a specific disorder
- no universally agreed upon tool that is valid and reliable at identifying risk of
malnutrition in all populations at all times

Role of the Joint Commission (JCAHO) - ANSWER - sets health-care standards and
accredits health-care facilities that meet those standards
- specifies that nutrition screening be conducted within 24 hours after admission
- allows facilities to determine screening criteria, how risk is defined, and who
performs the screening

Malnutrition - ANSWER - "bad nutrition"
or any nutritional imbalance including overnutrition
- in practice, usually means undernutrition or inadequate intake of protein and/or
calories that causes loss of fat stores and/or muscle wasting

Nutrition Screen - Acute Care - ANSWER Common parameters in hospital setting:
- dementia?
- difficulty swallowing?
- advanced age? (80+ years)
- abnormal BMI?
- nausea/vomiting?
- decreased appetite?

Nutritional Assessment - ANSWER - an in-depth analysis of a person's nutritional
status (by dietitian)
- in the clinical setting, nutritional assessments focus on *moderate- to high-risk*
patients with suspected or confirmed protein-energy malnutrition
- patients who are identified to be a low or no nutritional risk are re-screened within a
specified period of time to determine if status has changed
- referred to as the nutrition care process
=> 4 steps (ADIME): Assessment Diagnosis
Intervention Monitoring/
Evaluating

,ABCD of an Assessment - ANSWER *A*nthropometric data
*B*iochemical data
*C*linical data
*D*ietary data

Anthropemetric data - ANSWER - physical measurements
- BMI (body mass index)
=> formula:
wt.(kg) / ht.(m)^2
***1 kg = 2.2 lb. and 1 in. = 2.54 cm***
=> healthy: 18.5 -24.9
=> underweight: < 18.5
=> overweight: 25 - 29.9
=> obese: > 30
- IBW (ideal body weight)
=> Females: 100 lb. + 5 lb.(x), for every inch over 5 ft.
=> Males: 106 lb. + 6 lb.(x), for every inch over 5 ft
- % change in wt.
=> unintentional
=> formula:
((usual body wt. - current body wt.) / (usual)) x 100
- Estimating calorie and protein needs

Anthropometric Data: What skews weight measurements? - ANSWER - hydration
status
=> dehydration (lose fluid weight)
- edema
- anasarca
- fluid resuscitation
- chronic liver or renal disease
- congestive heart failure (excess weight)

Anthropometric Data: Pros & Cons - ANSWER Pros:
- easy measurements
Cons:
- not always properly measured
- BMI does not take muscle mass into account
- Can still be malnourished

Body Mass Index (BMI) - ANSWER - an index of a person's weight in relation to
height used to estimate relative risk of health problems related to weight
- quick and easy to measure ht. and wt.
- requires little skill
- actual measures, not estimates, should be used whenever possible to ensure
accuracy and reliability
=> a patient's stated ht. and wt. should only be used when there are no other options

Weight Change - ANSWER - usually, weight changes are more reflective of chronic,
not acute, changes in nutritional status

, - "significant" unintentional weight loss:
--- 1 week: > 2% loss of body weight --- 1month: > 5%
--- 3 months > 7.5%
--- 6 months > 10 %

Estimating Calorie and Protein Needs - ANSWER - convert body weight from lb to
kg
- multiple weight (kg) by:
=> 30 cal/kg for most healthy adults
=> 25 cal/kg for elderly adults
=> 20-25 cal/kg for obese adults

***Healthy adults need 0.8 g protein/kg***

Biochemical Data: Common Lab Values for Protein - Calorie Malnutrition: -
ANSWER *Diagnostic Markers of Malnutrition*
Albumin:
- half-life of 21 days
- sensitive to fluid balance
- negative acute phase protein (levels decrease in response to inflammation and
physiological stress)
- not specific/sensitive to just malnutrition
Prealbumin:
- half-life of 3 days (shorter half-life => favorable marker of acute change in
malnutrition; more sensitive than albumin)
- visceral protein store
- negative acute phase protein (levels decrease in response to inflammation and
physiological stress)
- much more expensive than albumin
- not specific/sensitive to just malnutrition
*- Albumin and prealbumin are not valid criteria for assessing protein status because
they become depleted from inflammation and physiological stress.*
*- Although their usefulness in diagnosing malnutrition is limited, they may help
identify patients at high risk for morbidity, mortality, and malnutrition. *
*- Because they are not specific for nutritional status, failure of these levels to
increase with nutrition repletion does not meant that nutrition therapy is
inadequate.***

Clinical Data - ANSWER - physical signs and symptoms of malnutrition
=> nonspecific, subjective, and develop slowly
=> physical signs and symptoms of malnutrition develop only after other signs of
malnutrition, such as laboratory values and weight changes, are observed
- Pros: can see results on physical exam
- Cons: considered suggested, not diagnostic, of malnutrition

Clinical Data: Physical Symptoms Suggestive of Malnutrition - ANSWER - hair that
is dull, brittle, or dry, or falls out easily
- swollen glands of neck and cheeks
- dry, rough, or spotty skin that may have a sandpaper feel
- poor or delayed wound healing or sores