Test Bank For Nutrition Essentials for
Nursing Practice 9th Edition Chapter 1-24
Complete Guide .2
What role do nurses play in nutritional care? - answers - 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 - answers - 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) - answers - 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 - answers - "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 - answers Common parameters in hospital setting:
- dementia?
- difficulty swallowing?
- advanced age? (80+ years)
- abnormal BMI?
- nausea/vomiting?
- decreased appetite?
Nutritional Assessment - answers - 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 - answers *A*nthropometric data
*B*iochemical data
*C*linical data
*D*ietary data
Anthropemetric data - answers - 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? - answers - hydration status
=> dehydration (lose fluid weight)
- edema
- anasarca
- fluid resuscitation
- chronic liver or renal disease
- congestive heart failure (excess weight)
Anthropometric Data: Pros & Cons - answers Pros:
- easy measurements
Cons:
- not always properly measured
- BMI does not take muscle mass into account
- Can still be malnourished
Body Mass Index (BMI) - answers - 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 - answers - 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 - answers - 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: - answers
*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 - answers - 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 - answers - 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
- thin appearance with lack of subcutaneous fat
- muscle wasting (decreased size and strength)
- edema of the lower extremities
- weakened hand grasp
- depressed mood
- abnormal heart rate, heart rhythm, or blood pressure
- enlarged liver or spleen
- loss of balance and coordination
Dietary Data: Methods of Assessing Dietary History - answers - Ask valid and reliable
questions:
=> "Has the type or amount of food you've eaten recently changed?" rather than "How
is your appetite?"
=> "Do you avoid any particular foods?" rather than "Are you on a diet?" (avoid the word
"diet" because it tends to have negative connotation)
=> How many meals and snacks do you eat in a 24-hour period?
=> Do you have any food allergies/intolerances? If so, what are they?
=> Do you eat foods from all 5 food groups (grains, fruits, vegetables, dairy, protein)?
=> Who prepares the meals?
=> How much alcohol do you consume daily?
=> Do you have enough food to eat?
=> What types of vitamin, mineral, herbal, or other supplements do you use and why?
Medical and Psychosocial History - answers May shed light on factors that influence
nutrition status through:
- intake
- nutritional requirements
- nutrition counseling needs
Psychosocial History - answers Psychological factors:
- depression
- eating disorders
- psychosis
Social factors:
- illiteracy
- language barriers
Nursing Practice 9th Edition Chapter 1-24
Complete Guide .2
What role do nurses play in nutritional care? - answers - 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 - answers - 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) - answers - 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 - answers - "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 - answers Common parameters in hospital setting:
- dementia?
- difficulty swallowing?
- advanced age? (80+ years)
- abnormal BMI?
- nausea/vomiting?
- decreased appetite?
Nutritional Assessment - answers - 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 - answers *A*nthropometric data
*B*iochemical data
*C*linical data
*D*ietary data
Anthropemetric data - answers - 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? - answers - hydration status
=> dehydration (lose fluid weight)
- edema
- anasarca
- fluid resuscitation
- chronic liver or renal disease
- congestive heart failure (excess weight)
Anthropometric Data: Pros & Cons - answers Pros:
- easy measurements
Cons:
- not always properly measured
- BMI does not take muscle mass into account
- Can still be malnourished
Body Mass Index (BMI) - answers - 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 - answers - 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 - answers - 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: - answers
*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 - answers - 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 - answers - 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
- thin appearance with lack of subcutaneous fat
- muscle wasting (decreased size and strength)
- edema of the lower extremities
- weakened hand grasp
- depressed mood
- abnormal heart rate, heart rhythm, or blood pressure
- enlarged liver or spleen
- loss of balance and coordination
Dietary Data: Methods of Assessing Dietary History - answers - Ask valid and reliable
questions:
=> "Has the type or amount of food you've eaten recently changed?" rather than "How
is your appetite?"
=> "Do you avoid any particular foods?" rather than "Are you on a diet?" (avoid the word
"diet" because it tends to have negative connotation)
=> How many meals and snacks do you eat in a 24-hour period?
=> Do you have any food allergies/intolerances? If so, what are they?
=> Do you eat foods from all 5 food groups (grains, fruits, vegetables, dairy, protein)?
=> Who prepares the meals?
=> How much alcohol do you consume daily?
=> Do you have enough food to eat?
=> What types of vitamin, mineral, herbal, or other supplements do you use and why?
Medical and Psychosocial History - answers May shed light on factors that influence
nutrition status through:
- intake
- nutritional requirements
- nutrition counseling needs
Psychosocial History - answers Psychological factors:
- depression
- eating disorders
- psychosis
Social factors:
- illiteracy
- language barriers
