Term
| Health Care Team function |
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Definition
Primarily function of dietician & dietetic technicians (if present)
Often some responsibility falls on nurses
Identify those with nutritional problems
Alert proper health care professionals
Provide info on health status & personal histories |
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Term
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Definition
Evaluation of several factors that influence or reflect nutritional health
Often in large setting (hospital) it is difficult to assess nutrition individually
Can do Nutritional Screening
Tool to quickly identify those clients which need a complete nutritional assessment
Will discuss later
Evaluate current nutrition status
Determine how client’s age, health, lifestyle and socioeconomic status affect nutrient needs |
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Term
| sources of data for assessment |
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Definition
1.historical info
2.physical exam
3.anthropometric measurement
4.Biochemical analysis |
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Term
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Definition
B–vitamin deficiencies often lead to mental problems
Confusion, apathy, fatigue, delirium, irritability
Example) severe niacin deficiency pellagra dementia (3 D’s)
Example) Folate (especially) & B12 deficiencies depression and dementia
May or may not be the cause in elderly |
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Term
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Definition
Information typically taken for each drug:
1) Name of drug/supplement
2) Dosage
3) Frequency of medication
4) How long has the person been taking the drug
5) Why are they taking it?
6) Signs of any negative or positive effects
7) Method taken (oral, subcutaneous, etc.) |
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Term
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Definition
alter food intake (adhd)
alter intestinal motility
alter metabolism
alter excretion |
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Term
Drugs that Alter Metabolism:
Structural Analogs
Enzyme Activity
Nutrients and Medications |
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Definition
A) Structural Analogs
Example) Vitamin K & Coumadin = inhibits action of vitamin K in blood clotting
Example) Methotrexate can lead to folate deficiencies
B) Alter Enzyme Activity - can contribute to dangerous, pharmacologically active substances
Example) Those on MAOI Inhibitors can no longer inactivate tyramine
C) Nutrients can ensure that medications work properly
Example) Fosamax (prevents osteoporosis) depends on vitamin D & calcium |
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Term
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Definition
Can help person change eating behavior and lose weight
Mood information
Occasions (party, holiday)
Behaviors while eating (watch TV, while driving, sitting at table with family)
If establishing blood glucose control,
Drug administration
Physical activity
Results of glucose monitoring
Food tolerance (amount of food that can be tolerated)
Symptoms when eating |
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Term
| Nutrient Intake what you're looking for: |
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Definition
Compare to standards (RDA, DRI, AI)
Are they getting too little or too much of each nutrient?
Too much caffeine or alcohol?
All food groups represented?
Types and amounts of each energy nutrient? |
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Term
| Disadvantage of food analysis |
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Definition
can’t tell what nutrients are actually being absorbed
Portion sizes may be correct
Client may see no difference in ¾ cup vs. 2 cups
Nutritional content of foods in databases are averages |
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Term
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Definition
A) Fluid Retention
Symptoms – Edema, high BP (depends on blood volume), increased urine output, weight gain
B) Dehydration
Symptoms – sunken eyes & checks, dry mucous membranes, loss of skin elasticity, weak & rapid pulse, thirst, weight loss |
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Term
| Anthropometric Measurements |
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Definition
- measures of body composition and development
Compare values to standards (average population)
All measurements should be recorded immediately to prevent forgetting
A) Measures of Growth and Development
B) Measures of Body Fat & Lean Tissue
C) Other Non-Anthropometric Measurements |
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Term
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Definition
for adults, doesn’t actually reflect health status
But for growing infants and children, it is important
Malnutrition delays stunts growth
a) Measuring Board - for infants & small children
Moving footboard to measure length
b) Often in hospital can hold head against headboard,
Mark a blanket where feet are (this is less accurate but quick)
c) Scale – bare feet (socks)
Best if back is flat against wall
Stand erect
Heels together
Line of sight horizontal (don’t tilt head)
d) Self-reported – “ How tall are you?”
Often very inaccurate (may be embarrassed about height) |
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Term
| Anthro: Head circumference |
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Definition
– infants & young children (up to age 3)
Indirect measure of brain development
Brain is 75% grown by age 2
Non-stretchable measuring tape around largest part of head (not nose)
Just above eyebrows, just above where ears attach
Around occipital prominence at back of head |
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Term
| Anthro: body fat and lean tissues |
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Definition
1) Fat fold (skin fold)
About ½ of each person’s fat is subcutaneous
Can be done at a number of sites, preferably triceps
Take average of three readings
Can compare to chart with percentiles
Recommended:
Men = 10 - 25%
Women = 18% - 32% |
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Term
| Anthro: Midarm circumferences |
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Definition
= indirect measure of muscle size
Measure midarm circumference around bicep and tricep
Midarm muscle circumference (cm) = midarm circumference (cm) – [0.314 x triceps skin fold (mm)]
Compare to chart with percentages in Table |
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Term
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Definition
= waist line / hips
A ratio >0.80 in women or ≥0.95 in men indicates a greater risk for developing obesity-related health problems |
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Term
Anthro: Hydrodensitometry
and Bioelectrical Impedance |
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Definition
underwater weighing
Accurate estimate of body fat
Disadvantages: expensive equipment, submerging some is impractical (very young, very old)
conduction of electricity through body
Lean tissue (muscle) has less impedance
Fat has more impedance
Hook up electrodes on wrist and ankles
Use mathematical equation to determine body fat
Reasonably accurate |
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Term
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Definition
measure nutrition status by muscle function
Use an instrument called a dynamometer
Grip as tightly as possible
Weak muscle could be caused by poor nutrition
Unless other conditions such as arthritis |
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Term
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Definition
measure immune function
Inject organisms under skin (usually 3 or 4 kinds) that will cause immune response
24-48 hrs later, form indurations (raised hard areas)
Appear in well-nourished
Minimal response or absent in those with PEM
But could also be due to metabolic stress, liver or kidney diseases, use of corticosteroids |
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Term
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Definition
Usually simultaneous multiple analysis (SMA) – several tests from one blood sample
Limitations
1) Must determine if health effect affects results independently of nutritional status
Example) dehydration dramatically raises values, while fluid retention dramatically lowers values
2) Low [blood] – may have primary deficiency or secondary to deficiency of another nutrient
3) Blood & urine concentrations represent recent intakes, not long term intakes
Blood concentration may be normal though tissue concentrations may be low |
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Term
| Protein Status: Serum proteins |
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Definition
Indication of energy status or treatment progress
Serum proteins reflect energy and protein status (availability of amino acids)
Made by liver, so they can also indicate liver function
Severe body stress (burns) = go into extracellular fluids, decrease serum concentrations |
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Term
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Definition
most abundant serum protein (more than 50% of serum proteins)
Cheapest, easiest way to check protein status
1) Acute Malnutrition - (kwashiorkor) adequate fat stores, low blood protein (albumin)
2) Chronic Malnutrition - (marasmus) low fat stores, adequate blood protein
If coupled to malnutrition, blood protein levels drop
3) Mixed Malnutrition - low fat stores, depleted blood protein
Can also be affected by liver or kidney disease
Eclampsia – fluid retention, hypertension, protein in urine, convulsions |
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Term
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Definition
– transports iron in blood
Reflects both protein & iron status
Slow to respond to changes in protein intake (like albumin)
Cause transferrin levels increase:
Iron deficiency Oral contraceptives
Pregnancy Hepatitis
Blood loss
Cause transferrin levels decrease:
PEM Metabolic stress
Liver disease Some antibiotics
Kidney disease |
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Term
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Definition
Rapid decrease when PEM
Much more expensive
Transthyretin decreases: PEM, Metabolic Stress, Hemodialysis, Hypothyroidism
Transthyretin increases: Kidney Disease, Use of Corticosteroids
RBP decreases: PEM, Vitamin A Deficiency, Metabolic Stress, Liver Disease, Cystic fibrosis
RBP increases: Kidney Disease |
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Term
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Definition
PEM compromises immune system
Inexpensive
Decrease total lymphocyte (WBC) counts:
PEM
Chemotherapy
Immunosuppressants
Corticosteroids |
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Term
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Definition
1. Health History
2.Diet History
3.Ht and Wt
4.lab Data |
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Term
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Definition
1) Altered Nutrition: At high risk for more than body requirement
2) Altered Nutrition: More than body requirements
3) Altered Nutrition: Less than body requirements |
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Term
| 2 GOALS of nutritional care plan |
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Definition
1) Meet the Nutritional Needs of Client
2) Educate Client |
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Term
| Content of Nutritional Care Plan1: nutrient needs |
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Definition
1. determine nutrient needs (BMR)
- indirect calorimetry (co2 expired/o2 inhaled)
b) Protein - can estimate needs based on nitrogen balance studies or monitoring serum proteins
Normal = 0.8 gm protein/Kg body weight
Following Surgery or Infection = 1.0-1.5 gm protein/Kg body weight
c) Vitamins & Minerals = largely unknown during illness
Can only estimate based upon RDA’s
Unless client is diagnosed with a specific nutrient deficiency |
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Term
| Content of Nutritional Care Plan: 2. Measureble Goals |
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Definition
Should be expressed in terms of measurable outcomes
The more precise, the better
Example) Not low or normal cholesterol, but cholesterol between 180-200
Allows you to better determine the success of plan
Other examples) Blood sugar, body weight, electrolytes |
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Term
| Content of Nutritional Care Plan: 3 Strategies |
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Definition
Example) Reducing dietary Calorie intake to 1,700 Calories
Example) Reducing total fat intake to 20% of total Calories
Example) Moderate exercise for 30 minutes three days a week |
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Term
| Content of Nut Care Plan: 4. Content of COunselling |
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Definition
Client must be informed of plan
Give instructions and suggestions for diet
Data you gathered during assessment can tell you:
Best way to present information to client
How much information to share with client
Level of client’s interest
Must be flexible with plan to accommodate clients goals, understanding & motivation
Note any possible nutrient–medication interactions and what to do if it happens |
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Term
| Content Nut Care Plan: 5. Time Frame |
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Definition
Example) Lowering cholesterol level to 180 in six months
Example) Reevaluating weight after three months |
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Term
| IMPLEMENTING a NUT care plan |
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Definition
Easier in an inpatient setting (hospital, care home)
Physicians order the diet for the client
Appropriate foods are delivered to client
Dietician plans and checks menus
Dietetic technicians can also check menus
Food service prepares food
Nurse has important role too
Have more contact with client
Have to answer client’s questions
Only answer if confident in answer, no guessing
Why it is important to learn and remember, not just cram for an exam |
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Term
| EVALUATE the effectiveness of a care plan |
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Definition
Must keep track of plan effectiveness
Example) What if client is on weight–loss program and doesn’t lose weight
Is he eating too much?
Is he too inactive?
As situation changes (improves or worsens), nutritional needs may change
May have to modify goals if client is unwilling or unable to comply |
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Term
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Definition
Need to include:
1) Document Nutritional Screening
2) Nutritional Assessment Data
Include evaluation of diet
3) Recommended Nutritional Therapy & Goals
4) Tolerance or Acceptance of Diet
5) Problems with Food Intake
6) Documentation of Client’s Diet Counseling
Including client’s response
7) Any planned follow up or referral |
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Term
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Definition
Provide appropriate amounts of energy, protein, carbohydrates, fat, vitamins, minerals and water
Also to provide food in appropriate forms
Example) If can’t chew, then provide soft foods
Example) If in a come, provide formula from a tube
Usually helpful to fit a diet to the symptoms that they relieve, rather than the disorder they have
People with different disorders can benefit from the same diet |
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Term
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Definition
Written by physician in medical record
Only one legally permitted to write diet order
Relies on health care team to make actual prescription (menus)
Orders need to be clear (when possible)
The more defined, the better
Pre-selected diets will be sent in most cases, unless it is defined
Example) NPO (non per os) – nothing be mouth
No food, water, medications
At least 8 hours before surgery and also after surgery to prevent aspiration
Materials regurgitated into lungs
Example) 1,000 mg sodium diet, 2,100 Calories |
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Term
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Definition
Components of specific diets may vary from institution to institution
Compiled by dietician
Should consult diet manual
For each specific diet:
How to order that diet
Describes foods allowed or restricted on that diet
Rationale (reasons) for that diet
Directions
Sample menus
Information on nutritional adequacy |
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Term
| Modified therapeutic diet |
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Definition
If a standard diet doesn’t fit client’s needs, can choose a Modified (Therapeutic) Diet
Might adjust consistency (liquid, pureed, soft)
Might adjust amounts of energy, nutrients, fluid
May include or eliminate certain foods
May adjust the number of meals |
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