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
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
