RD Exam - Domain 2 with Accurate
Solutions
Nutrition Care Process - ANS-Standardized consistent structure and framework used to
provide nutrition care.
Assess
Diagnose
Intervene
Monitor
Evaluate
ADIME
Nutrition Screening - ANS-Use of preliminary nutrition assessment techniques to identify
people who are malnourished or who are at risk for malnutrition
Labs, Hx, Wt, Physical Signs
Screening and referral bring people into the nutrition care process
Joint Commission - ANS-Nutrition risk identified in hospitalized patients with 24 hours of
admission, but does not mandate a method of screening patients
Screening Tools - ANS-Subjective Global Assessment (Hx, Intake, GI, Functional
Capacity, Physical Appearance, Edema, Wt)
Mini Nutritional Assessment (Independence, Medication, # meals, Protein, Fruits/Veg)
Nutrition Screening Initiative (Elderly)
Nutrition Assessment - ANS-Provides the basis for the nutrition diagnosis
Review
Cluster
Identify
Requires critical thinking skills
Indicators - ANS-Clearing defined markers that can be observed and measured
,Nutrition care criteria - ANS-What indicators are compared against
Dietary Intake Assessment - ANS-Diet Hx
Food Recall
24 Hour Recall
Food Frequency
Nutrition Focused Physical Exam - ANS-Hair: thin, sparse, dull, dry, brittle - indicators of
vitamin C, protein deficiency
Eyes: pale, dry, poor vision - vitamin A, zinc, or riboflavin deficiency
Lips: swollen, red, dry, cracked - riboflavin, pyridoxine, niacin deficiencies
Tongue - smooth, slick, purple, white - vitamin or iron deficiencies
Gums - sore, red, swollen, bleeding - vitamin C deficiency
Teeth - missing, loss - Ca deficiency, poor intake
Skin - pale, dry, scaly - iron, folic acid, zinc deficiency
Nails - brittle, thin - iron/protein deficiency
Serum albumin - ANS-3.5-5 g/dl visceral protein
- above normal range indicative of dehydration
-long half life, does not reflect current protein
Serum transferrin - ANS-> 200 mg/dl visceral protien
- rises with iron deficiency
- transports iron to bone marrow
- used to diagnose anemia
TTHY transthyretin, PAB prealbumin - ANS-* 16-40 mg/dl
short half life
during inflammation liver synthesizes CRP at expense of PAB
RBP retinol-binding protein - ANS-3-6 mg/dl
circulates with prealbumin
short half life 12 hrs
HCT hematocrit - ANS-Men 42-52 %
Women 35-47 %
Pregnant Women 33%
volume of packed cells in whole blood
, HgB hemoglobin - ANS-men 14-17 gm/dl
women 12 - 15 gm/dl
pregnant <11
iron containing pigment of red blood cells
erythrocytes are produced in the bone marrow
Serum ferritin - ANS-10-150 ng/ml F
12-300 ng/ml M
indicates size of iron storage pool
Serum creatinine - ANS-0.6-1.4 mg/dl
related to muscle mass
may indicate renal disease with BUN
CHI creatinine height index - ANS-80% norml
estimates lean body mass
BUN blood urea nitrogen - ANS-10-20 mg/dl
related to protein intake
indicatory of renal disease
TLC - ANS-total lymphocyte count > 2700
decreased in protein-energy malnutrition
CRP c-reactive protein - ANS-marker of acute inflammation
Acute viral hepatitis - ANS-inflammation, jaundice, nausea, fatigue
increase fluids
50-55 CHO
1-1.2 g protein/kg
moderate fat
MVI w/ B,C,K,zinc
Cirrhosis - ANS-high protein .8-1 g/kg, in stress 1.5 g/kg
high calorie 25-35 kcal/kg
moderate to low fat 25-40%
esophageal varicies can occur when blood cannot enter through portal vein, causing
portal HTN, which forces blood back up in the system, increasing pressure in small
esophageal veins, restrict fiber if varicies are present
ascites occurs when blood cannot leave the liver
Solutions
Nutrition Care Process - ANS-Standardized consistent structure and framework used to
provide nutrition care.
Assess
Diagnose
Intervene
Monitor
Evaluate
ADIME
Nutrition Screening - ANS-Use of preliminary nutrition assessment techniques to identify
people who are malnourished or who are at risk for malnutrition
Labs, Hx, Wt, Physical Signs
Screening and referral bring people into the nutrition care process
Joint Commission - ANS-Nutrition risk identified in hospitalized patients with 24 hours of
admission, but does not mandate a method of screening patients
Screening Tools - ANS-Subjective Global Assessment (Hx, Intake, GI, Functional
Capacity, Physical Appearance, Edema, Wt)
Mini Nutritional Assessment (Independence, Medication, # meals, Protein, Fruits/Veg)
Nutrition Screening Initiative (Elderly)
Nutrition Assessment - ANS-Provides the basis for the nutrition diagnosis
Review
Cluster
Identify
Requires critical thinking skills
Indicators - ANS-Clearing defined markers that can be observed and measured
,Nutrition care criteria - ANS-What indicators are compared against
Dietary Intake Assessment - ANS-Diet Hx
Food Recall
24 Hour Recall
Food Frequency
Nutrition Focused Physical Exam - ANS-Hair: thin, sparse, dull, dry, brittle - indicators of
vitamin C, protein deficiency
Eyes: pale, dry, poor vision - vitamin A, zinc, or riboflavin deficiency
Lips: swollen, red, dry, cracked - riboflavin, pyridoxine, niacin deficiencies
Tongue - smooth, slick, purple, white - vitamin or iron deficiencies
Gums - sore, red, swollen, bleeding - vitamin C deficiency
Teeth - missing, loss - Ca deficiency, poor intake
Skin - pale, dry, scaly - iron, folic acid, zinc deficiency
Nails - brittle, thin - iron/protein deficiency
Serum albumin - ANS-3.5-5 g/dl visceral protein
- above normal range indicative of dehydration
-long half life, does not reflect current protein
Serum transferrin - ANS-> 200 mg/dl visceral protien
- rises with iron deficiency
- transports iron to bone marrow
- used to diagnose anemia
TTHY transthyretin, PAB prealbumin - ANS-* 16-40 mg/dl
short half life
during inflammation liver synthesizes CRP at expense of PAB
RBP retinol-binding protein - ANS-3-6 mg/dl
circulates with prealbumin
short half life 12 hrs
HCT hematocrit - ANS-Men 42-52 %
Women 35-47 %
Pregnant Women 33%
volume of packed cells in whole blood
, HgB hemoglobin - ANS-men 14-17 gm/dl
women 12 - 15 gm/dl
pregnant <11
iron containing pigment of red blood cells
erythrocytes are produced in the bone marrow
Serum ferritin - ANS-10-150 ng/ml F
12-300 ng/ml M
indicates size of iron storage pool
Serum creatinine - ANS-0.6-1.4 mg/dl
related to muscle mass
may indicate renal disease with BUN
CHI creatinine height index - ANS-80% norml
estimates lean body mass
BUN blood urea nitrogen - ANS-10-20 mg/dl
related to protein intake
indicatory of renal disease
TLC - ANS-total lymphocyte count > 2700
decreased in protein-energy malnutrition
CRP c-reactive protein - ANS-marker of acute inflammation
Acute viral hepatitis - ANS-inflammation, jaundice, nausea, fatigue
increase fluids
50-55 CHO
1-1.2 g protein/kg
moderate fat
MVI w/ B,C,K,zinc
Cirrhosis - ANS-high protein .8-1 g/kg, in stress 1.5 g/kg
high calorie 25-35 kcal/kg
moderate to low fat 25-40%
esophageal varicies can occur when blood cannot enter through portal vein, causing
portal HTN, which forces blood back up in the system, increasing pressure in small
esophageal veins, restrict fiber if varicies are present
ascites occurs when blood cannot leave the liver
