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Nutrition and Health Assessment Techniques, Exams of Dietetics

A.T. Still University of Health Sciences (ATSU)Dietetics

An overview of various nutrition and health assessment techniques, including the use of clustered data, food diaries, 24-hour recalls, food frequency lists, and nutrient intake surveys. It also discusses programs and initiatives related to food and nutrition, such as the national school lunch program, the expanded food and nutrition education program, and the supplemental nutrition assistance program. Topics related to nutritional deficiencies, gastrointestinal disorders, liver function, and other health conditions. It highlights the importance of comprehensive assessment and the role of healthcare professionals in addressing nutritional and health-related concerns.

Typology: Exams

2024/2025

Available from 10/22/2024

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CDR Exam Domain II - Nutrition Care for

Individuals and Groups

True or False: Data reviewed during assessment is reviewed during ALL steps of the NCP -

TRUE

What is the purpose of nutrition screening? -

to identify people who are malnourished or at risk for malnutrition

How long is nutrition screening? -

brief (5-10 minutes)

What is reviewed during nutrition screening? -

hx, labs, wt, physical signs

For screening to be accurate what must it be based on? -

specificity (ID patients without a condition) and sensitivity (ID patients with a condition)

What does TJC mandate in regards to nutrition screening? -

- TIME FRAME WITHIN 24 HOURS OF ADMISSION

- does not mandate the method of screening

What is the SGA screening tool and what does it measure? -

- Subjective Global Assessment

- history, intake, GI symptoms, functional capacity, physical appearance, edema, weight change

What is the MST screening tool and what does it measure? -

- Malnutrition Screening Tool

- acute hospitalized population, recent weight loss, poor dietary intake

1 | P a g e

Discover Exams of Dietetics A.T. Still University of Health Sciences (ATSU)

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CDR Exam Domain II - Nutrition Care for

Individuals and Groups

True or False: Data reviewed during assessment is reviewed during ALL steps of the NCP - TRUE What is the purpose of nutrition screening? - to identify people who are malnourished or at risk for malnutrition How long is nutrition screening? - brief (5-10 minutes) What is reviewed during nutrition screening? - hx, labs, wt, physical signs For screening to be accurate what must it be based on? - specificity (ID patients without a condition) and sensitivity (ID patients with a condition) What does TJC mandate in regards to nutrition screening? -

TIME FRAME WITHIN 24 HOURS OF ADMISSION
does not mandate the method of screening What is the SGA screening tool and what does it measure? -
Subjective Global Assessment
history, intake, GI symptoms, functional capacity, physical appearance, edema, weight change What is the MST screening tool and what does it measure? -
Malnutrition Screening Tool
acute hospitalized population, recent weight loss, poor dietary intake

What is the MUST screening tool and what does it measure? -

Malnutrition Universal Screening Tool
BMI, unintentional wt loss, effect of acute disease on intake for more than 5 days What are the components of nutritional assessment? -
REVIEW data for factors that affect nutritional and health status
Use CLUSTERED assessment data (food and nutrition related hx, anthropometrics, lab/medical tests, NFPE)
Comparison of data to IDENTIFIED STANDARDS What is a food record? - food diary, record of everything eaten in a specific period of time What are concerns with 24 hour recall? - underreporting and over-reporting What are food frequency lists and when should they be used? -
how often an item is consumed
community setting, intakes on large numbers of people What is the Hamwi formula? -
used to calculate IBW
Men = 106 lb + 6 lb for every inch over 5ft
Women = 105 lb + 5 lb for every inch over 5ft What is the formula for % wt change? - (USUAL WEIGHT) - (CURRENT WEIGHT)/(USUAL WEIGHT) x 100 What constitutes significant wt change? -
5% in one month
7.5% in 3 months

during inflammation liver synthesizes CRP at expense of PAB
LIMITED USEFULNESS What is the normal range for serum hematocrit and what does it measure? -
- M = 42-52%, W = 36-48%
volume of packed cells in whole blood What is the normal range for serum Hgb and what does it measure? -
- M = 14-18mg/dL, W = 12-16mg/dL
iron containing pigment of RBC What is the normal range for serum ferritin and what does it measure? -
- F = 10-150ng/mL, M = 12-300ng/mL
indicates size of iron storage pool What is the normal range for serum creatinine and what does it measure? -
- M = 0.6-1.2mg/dL, W = 0.5-1.1mg/dL
r/t muscle mass (somatic protein) What is the normal range for serum BUN and what does it measure? -
- 10-20mg/dL
related to protein intake, indicator of renal disease
BUN to creatinine ratio 10-15:1 is normal What is the normal range for urinary creatinine clearance and what does it measure? -
- 115±20ml/min
measures GFR What is the normal range for total lymphocyte count and what does it measure? -
- 2700 cell/cu mm
measures immunocompetency

decreased in PCM What is the normal range for CRP and what does it measure? -
- measure of acute inflammatory stress
as it declines, indicates when nutritional therapy would be beneficial
when elevated CRP DECREASES, PAB INCREASES What is the normal range for prothrombin time and what does it measure? -
- 11-12.5 seconds
anticoagulants prolong PT
evaluates clotting adequacy
change in vitamin K will alter rate What is the TEE for sedentary, active, and stressed pt's? -
- sedentary = BEE x 1.
active = BEE x 1.
stressed = BEE x 1. What is EER? -
- Estimated Energy Requirements
average dietary intake predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height, and level of PA consistent with good health What is the effect of megestrol acetate? - appetite stimulant What is the effect of dextroamphetamine (adderall)? - appetite suppressant, anorexia, nausea, wt loss What is the effect of orlistat? - decreased fat absorption by binding lipase; vitamin/mineral supplementation

What is the effect of steroids? - decrease bone growth, CHO intolerance What is the effect of methotrexate? - decreased folate What is the effect of lithium carbonate (antidepressant)? -

increased appetite, wt gain
maintain consistent sodium and caffeine intake to stabilize levels (if sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity) What is the effect of anticoagulants (warfarin sodium/coumadin)? -
antagonizes vitamin K (consistent intake essential)
avoid ginkgo biloba extract (GBE), garlic, ginger (may increase bleeding)
avoid high dose vitamin A, E What is the effect of propofol? - administered in oil, consider fat kcal (1.1kcal/ml), check TG What is the effect of phenobarbitol? - decreased folic acid, vitamin B12, vitamin B6, vitamin K, vitamin D What is the effect of cyclosporine (immunosuppressant)? - HLD, hyperglycemia, hyperkalemia, HTN What is the effect of isoniazid/INH (treats TB)? -
depletes vitamin B
peripheral neuropathy, do not take with food, interferes with Vitamin D, calcium, phosphorus What is the effect of elavil (antidepressant)? - sedative effect, weight gain, increased appetite

What is the effect of vitamin B6 and protein? -

decreased effectiveness of l-dopa (levodopa) which controls symptoms of parkinson's disease
take drug in the morning with limited protein (competes with drug for absorption sites) What is the drug-nutrient effect of calcium? - binds tetracycline (antibiotics) What is the drug-nutrient effect of tyramine? - HTN if taken with MAOI (monoamine oxidase inhibitor)
eliminate dopamine and restrict Tyramine (monoamines)
MAOI interact releasing norepinephrine which elevates BP
restrict aged, fermented, dried, pickled, smoked, or spoiled foods
avoid hard, aged cheese (cheddar, swiss), sauerkraut, some sausages, lunch meats, tofu, miso, Chianti wine
limit sour cream, yogurt, buttermilk
OK to have cottage cheese, cream cheese
GOOD ADVICE is to buy, cook, and eat fresh foods What is the effect of curcumin (turmeric)? -
may reduce inflammation, antioxidant
in curry powder Describe what population is considered inexperienced, moderately experienced, and very experienced based on educational readiness assessment -
inexperienced = young children, some adults lacking nutrition training
moderately experienced = teachers, health educators, patients already instructed
very experienced = "nutrition experts", limit audience participation at first; establish YOURSELF as nutrition expert What are the steps in obtaining and assessing community and group nutrition status indicators? -

Define nutritional surveillance - continuous collection of nutrition data What is the NSI (Nutrition Screening Initiative) - promote nutrition and improve nutritional care for the ELDERLY to identify nutritional problems early What is the DETERMINE checklist? -

identifies factors putting people at nutritional risk
Disease, Tooth loss, Economic hardship, Reduced social contact, Multiple medications, Involuntary weight loss/gain, Needs assistance in self-care, Elder years above age 80
Level I = needs more comprehensive assessment
Level II = specific info on NUTRITIONAL STATUS What is the NNMRRP? -
National Nutrition Monitoring and Related Research Program
includes all data collection and analysis activities of the federal government related to measuring the health and nutritional status, food consumption, attitudes about diet and health
jointly run by the USDHHS (United Stated Department of Health and Human Services) and USDA What is PedNSS? -
Pediatric Nutrition and Surveillance System
monitors growth and nutritional status, infant-feeding practices (up to 17 years, emphasis on birth- 5 years)
Run by UNDHHS What is PNSS? -
Pregnancy Nutrition Surveillance System
low income, high risk pregnant women
counts # of women who breast-feed
identify and reduce pregnancy related health risks
Run by UNDHHS

What is NHANES? -

National Health and Nutrition Examination Survey
ongoing survey to obtain info on health of American people
evaluates clinical, chemical (Hgb, Hct, Cho), anthropometric nutritional data
NHANES III = adults 65 or over
WWEIA = What We Eat in America (dietary intake component of NHANES) What is the USDA NFCS? -
USDA Nationwide Food Consumption Surveys
obtain info on food intake of individuals and total households from entire US
evaluates 7 nutrients (protein, calcium, iron, thiamine, riboflavin, vit C, vit A What is the BRFSS? -
Behavioral Risk Factor Surveillance System
Adults 18 years and older residing in households with telephones
Run by USDHHS What is the YRBSS? -
Youth Risk Behavior Surveillance System
GRADES 9-
prevalence of health risk behaviors among young people
Run by USDHHS What is TANF? -
Temporary Assistance for Needy Families
helps needy families achieve self-sufficiency; time-limited; helps foster economic security and stability What is the USDA Commodity Food Donation/Distribution Program? -
food given to NSLP, eldery feeding, and supplemental food programs

What is the SFSP? -

Summer Food Service Program
ENTITLEMENT
run by FNS/USDA
purpose is to initiate, maintain, or expand food service programs to children and teens in low income areas when school is out
reimburses providers for meals served at central site, 18 and younger What is the CACFP? -
Child and Adult Care Food Program
supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless, shelters, nonresidential adult day care centers
eligibility same as NSLP
run by USDA What is the FFVP? -
Fresh Fruit and Vegetable Program
run by USDA
introduces children to fresh fruits and vegetables, help develop eating habits that improve health, and prevent obesity and subsequent chronic disease What is WIC? -
special supplemental nutrition program for Women, Infants, and Children
for pregnant, postpartum, breast-feeding women, infants and children up to 5
provides food, nutrition education, referrals
HEALTH EXAM REQUIRED
must meet income standards, be at nutritional risk (wt, ht, head circumference, Hgb, Hct), and in need of foods offered
NOT ENTITLEMENT (cap on the amount of federal dollars provided)
WIC FMNP (Farmers Market Nutrition Program) - coupons to purchase fresh, locally grown foods at farmers' markets

What is EFNEP? -

Expanded Food and Nutrition EDUCATION Program
provides grants to universities that assist in community development
trains nutrition aides to educate the public
DOES NOT PROVIDE FOOD What is the Maternal Child Health Block Grant -
fosters public health nutrition programs at state and local levels
women of child-bearing age, infants, children - state eligibility requirements
run by the USDHHS What is Healthy Start? -
program designed to reduce infant mortality and improve the health of low-income women, infants, children, and families
run by USDHHS What is NSIP? -
Nutrition Services Incentive Program
Administration on Aging (AoA)
developed services to foster independent living
OAA = Older Americans Act Nutrition Program - run by USDHHS, aged 60 and older REGARDLESS OF INCOME; one hot meal 5 days/week, providing 1/3 recommended intake What is SNAP? -
Supplemental Food and Nutrition Assistance Program
run by the USDA
ENTITLEMENT
largest food assistance program
assist low income with monthly benefits, net income must be below certain % of poverty level; income limits may vary by household size and are adjusted to the cost of living
nutritional risk NOT a consideration
also provides education

run by USDHHS What is NETP? -
- Nutrition Education and Training Program
run by USDA
provides nutrition education training to teachers and school food service personnel What is SFMNP? -
- Senior Farmers Market Nutrition Program
run by the USDA
cash grants to states to provide low income seniors (>60 years) with coupons to be exchanged for eligible foods at farmers markets, roadside stands, community supported agriculture programs (CSA)
nutrition education and information is provided (how to select, store, and prepare) What are Quasi-governmental agencies? -
- recieve both FEDERAL and PRIVATE FUNDS
Ex = American Red Cross, National Research Council What are non-governmental agencies? -
- Voluntary Health Agencies = private, non-profit organizations, chartered and licensed by a government agency; funded by contributions from citizens or organizations; Ex = American Heart Association
Professional Agencies = Academy of Nutrition and Dietetics
Foundations, Business, Industry What are International Agencies? - FAO (Food and Agriculture Organization)
raising worldwide levels of nutrition by increasing efficiency of production and distribution of foods What are the 3 domains for nutrition diagnosis? -
- Clinical = problems that relate to medical/physical condition
Intake = actual problems related to intake

Behavioral-Environmental = related to knowledge, access to food, and food safety Define each aspect of the PES statement -
- Problem (diagnostic label) = adjective that describes the human response (altered, impaired, increased risk of)
Etiology = cause/contributing factor (...related to)
Signs/Symptoms = signs are objective data, symptoms are subjective data (...as evidenced by) What factors need to be considered when deciding on a nutrition diagnosis? (6) -
- select the MOST IMPORTANT AND URGENT problem to be addressed
can you resolve or improve the nutrition diagnosis for this person/group?
if you have diagnoses from 2 domains INTAKE always trumps
is the etiology selected the root cause that can be addressed with nutrition intervention? or can you at least lessen the S/S?
will measuring the S/S indicate if the problem is resolved or improved? are the S/S specific enough to monitor and document resolution or impairment of the nutrition diagnosis?
does the nutrition assessment data support a particular nutrition diagnosis with a typical etiology and S/S? What are the four components of nutrition diagnostic reference sheets? -
- the problem or nutrition diagnosis label
definition of the label to differentiate a discrete problem area
etiology
S/S What is the difference between altered GI function and impaired nutrient utilization? -
- Altered GI function looks at problems inside the GI tract with changes in DIGESTION, ABSORPTION, AND/OR ELIMINATION
Impaired nutrient utilization refers to problem of METABOLISM OF NUTRIENTS once they have entered the circulatory system What should the nutrition intervention aim to do? -

When does a discharge plan begin? -

DAY ONE OF HOSPITAL STAY
discharge note includes summary of nutrition therapies and outcomes What is an ulcer, what is the treatment? -
eroded mucosal legion
treatment = antacids (H2 blocker, decreases acid secretion), antibiotics to eradicate H. pylori
diet = as tolerated, well-balanced, avoid late night snacks (bc of lying down), omit cayenne pepper and black pepper, large amounts of chili powder, avoid excess caffeine and etoh What is a hiatal hernia, what is the treatment? -
protrusion of a portion of the stomach above the diaphragm into the chest
treatment = small bland feedings
diet = avoid late night snacks, caffeine, chili powder, black pepper What is dumping syndrome, what is the treatment? -
follows a gastrectomy (Billroth I, Billroth II); when rapidly hydrolyzed carbohydrates enter the jejeunum, water in drawn in to achieve osmotic balance, causing a rapid decrease in vascular fluid (BP drops) and blood sugar rises, overstimulating insulin and causing alimentary hypoglycemia
treatment = SMF, dry foods, fluids before and after meals; restrict hypertonic concentrated sweets; 50-60% complex CHO and protein at each meal, moderate fat; B12 injections may be needed; lactose may be poorly tolerated due to poor transport What is billroth I? - gastroduodenostomy, attaches the remaining stomach to the duodenum What is billroth II? -
gastrojejunostomy, attaches the remaining stomach to the jejunum
when food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced so there is little pancreatic secretion
calcium (most rapid absorption in duodenum) and iron absorption (requires acid) are adversely affected

What deficiencies follow a gastrectomy? - deficiencies of iron, B12, folate, calcium, vitamin D, thiamine, and copper What is gastroparesis, what is the treatment? -

delayed gastric emptying (surgery, diabetes, viral infections, obstructions), leading to moderate to severe hyperglycemia
treatment = prokinetics (erythromycin, metoclopramide) increase stomach contractility; SMF, pureed food, avoid high fiber, avoid high fat, avoid caffeine, mint, alcohol
bezoar formation may be due to undigested food or medications What is tropical sprue, what is the treatment? -
bacterial, viral, parasitic infection leading to chronic GI disease, intestinal lesions, and may also affect stomach
causes diarrhea, malnutrition, deficiency of B12 and folate r/t decreased B12 and intrinsic factor
treatment = antibiotics, high kcal, high pro, B12 injections and oral folate supplements What is non-tropical sprue/celiac disease/gluten-induced enteropathy, what is the treatment? -
reaction to gliadin that affects jejunum and ileum
malabsorption, macrocytic anemia, wt loss, diarrhea, steatorrhea, IDA
treatment = (gliadin free) gluten-restricted diet; corn, potatoes, rice, soybean, tapioca, arrowroot, carob bean , guar gum, flax, amaranth, millet, teff, quinoa What is constipation, what is the treatment? -
sometimes due to atonic colon (weakened muscles)
treatment = high fluid, high fiber, exercise What is diverticular disease, what is the treatment? -
diverticulosis = presence of diverticula (small mucosal sacs that protrude through the intestinal wall r/t structural weakness); treatment is high fiber diet
diverticulitis = when diverticula become inflamed (result of food and residue accumulation and bacterial action); treatment is CL, low-residue or elemental, gradual return to high fiber What is the AI for fiber? -

Nutrition and Health Assessment Techniques, Exams of Dietetics

Related documents

Partial preview of the text

Download Nutrition and Health Assessment Techniques and more Exams Dietetics in PDF only on Docsity!

CDR Exam Domain II - Nutrition Care for

Individuals and Groups