Inman Notes Domain 4

steps in NCP

assess

diagnose

intervene

monitor

evaluate

(ADIME)

SGA

subjective global assessment

subjective global assessment

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

MNA

mini nutrition assessment

mini nutrition assessment

evaluates independence, medications, number of full meals consumed each day, protein intake, fruits and vegetables, fluids, mode of feeding

for 65yrs and older

NSI

Nutrition Screening Initiative (elderly)

GNRI

Geriatric Nutritional Risk Index

Geriatric Nutritional Risk Index

serum albumin, weight changes

MST

Malnutrition Screening Tool

Malnutrition Screening Tool

recent wt loss, recent poor dietary intake

acute hospitalized adult population

NRS

Nutrition Risk Screening

nutrition risk screening

% wt loss, SMI, intake

medical-surgical hospitalized, >70yrs

MUST

Malnutrition Universal Screening Tool

Malnutrition Universal Screening Tool

BMI, unintentional weight loss, effect of acute disease on intake for more than 5 days

hamwi formula (women)

100lbs for first 5 ft + 5lbs for every inch

+/- 10% for small or large frames

hamwi formula (men)

106lbs for first 5 ft + 6lbs for every inch

+/- 10% for small or large frames

% wt change equation

usual wt - actual wt(current)/ usual wt

significant wt loss

10% in 6 months

arm muscle area (AMA)

measures skeletal muscle mass (somatic protein)

important to measure in growing children

BMI classifications

18.5-24.9 normal

25-29.9 overweight

30+ obese

waist circumference predicts central adiposity, which evaluates risk for what?

diabetes and hypertension

waist to hip ratio (WHR)

WHR of 1.0+ in men or 0.8+ in women is indicative of android obesity

and an increased risk for obesity-related diseases (DM2, HTN)

nutrition focused physical exam techniques

inspection (observation)

palpation (touch)

auscultation (listening)

percussion

serum albumin normal

3.5-5.0g/dL

serum albumin levels above normal is indicative of?

dehydration

is serum albumin a good reflective measure of current protein intake?

no, it has a long half-life

serum transferrin

- normal: >200mg/dL

- visceral protein that transports iron to bone marrow to produce hgb

- level rises w/ anemia (good for IDing anemia)

- not useful measure of PRO status

prealbumin

- normal: 16-40mg/dL

- short half-life, picks up changes quickly

- limited usefulness in screening/assessment

hematocrit

men 42-52%

women 37-47%

pregnant women 33%

newborns 44-64%

volume of packed cells in whole blood

hemoglobin

men 14-17g/dL

women 12-15g/dL

pregnant women >11g/dL

iron-containing pigment of RBC

serum ferritin

men 12-300ng/mL

women 10-150ng/mL

iron storage

serum creatinine

normal: 0.6-1.4mg/dL

related to muscle mass, measure somatic protein

may indicate renal disease, muscle wasting

blood urea nitrogen (BUN)

normal: 10-20mg/dL

related to PRO intake

indicator of renal disease

Normal BUN:Creatinine ratio

10-15:1

C-reactive protein (CRP)

marker of acute inflammatory stress

as it declines, indicated when nutritional therapy would be beneficial

sedentary activity factor

1.2

active activity factor

1.3

stressed activity factor

1.5

Megestrol acetate

appetite stimulant

oral contraceptives

decrease folate, B6, C

Loop Diuretics

deplete thiamin, potassium, magnesium, calcium, sodium

Thiazide diuretics

decrease potassium and magnesium

absorb calcium

methotrexate

decrease folate

Lithium Carbonate (antidepressant)

- increased appetite, weight gain

- maintain consistent sodium and caffeine intake to stabilize levels (if sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity)

warfarin sodium (anticoagulant)

- antagonizes vitamin K (consistent intake essential)

- avoid ginkgo biloba extract (GBE), garlic, ginger (may increase bleeding)

- avoid high doses of vitamin A and E

propofol

administered in oil, consider fat calories

1.1kcal/cc

check TG levels

cyclosporine (immunosuppressant)

hyperlipidemia, hyperglycemia, hyperkalemia, hypertension

isoniazid (treats TB) INH

depletes pyridoxine

peripheral neuropathy

don't take with food

interferes with vitamin D, calcium, phosphorus

elavin (antidepressant)

sedative effect

weight gain

increased appetite

vitamin B6 and protein

- decrease effectiveness of L-dopa (levodopa) which controls symptoms of Parkinson's disease

- take drug in morning with limited protein (competes with drug for absorption sites)

tyramine

HTN if taken with MAOI (monoamine oxidase inhibitor)

HRA

health risk appraisal

health risk appraisal

survey categorizing a populations' general health status (used in worksites, govt agencies as a health education or screening tool)

morbidity

disease rate

mortality

death rate

infant mortality rate

infant deaths under 1 year of age, expressed as the number of deaths per 1000 live births

incidence

# NEW cases of disease over a period of time / total # of people at risk

prevalence

total # of people with disease during a period of time / average number of people

nutrition survey

examination of a population group at a particular point of time

- considered a cross-sectional exam; pin-points problems

- determines prevalence of condition of characteristic at a specific time

nutrition surveillance

continuous collection of data to evaluate nutrition status

- identifies proble, sets baseline, sets priorities, detects changes in trends

- uses ht, wt, hct, hgb, serum cholesterol

- ongoing system linked to active health programs (WIC, CDC, etc.)

- data identifies needs and kind of intervention needed

NNMRRP

National Nutrition Monitoring and Related Research Program

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 USDHHS and USDA

Nutritional status and nutrition-related health measurement surveys (4)

PedNSS

PNSS

NHANES (including WWEIA & NFNS)

NFCS

PedNSS

Pediatric Nutrition Surveillance System

run by USDHHS

low income, high-risk children (birth-17yrs), emphasis on birth-5yrs

monitors growth and nutritional status, infant-feeding practices

PNSS

Pregnancy Nutrition Surveillance System

run by USDHHS

low-income, high-risk pregnant women

identify and reduce pregnancy-related health risks

NHANES

National Health and Nutrition Examination Survey

run by USDA

ongoing (repeated) survey to obtain info on health of American people

evaluates clinical, chemical and anthropometric data

WWEIA

What we eat in America (aka NFNS, national food and nutrition survey)

- Dietary intake comp of NHANES

-2 days 24 hr dietary recall with times of eating occasions and sources of food eaten away from home

-USDA conducts over-sampling of adults >60, African american, hispanics.

NFCS

nationwide food consumption surveys

run by USDA

to obtain info on food intake of individuals and total households from entire US

evaluates 7 nutrients

knowledge, attitudes and behavior assessment surveys (3)

BRFSS

YRBSS

health and diet survey

BRFSS

Behavioral Risk Factor Surveillance System

run by USDHHS

adults 18yrs+ residing in houses with telephones

phone interview collecting info on ht, wt, smoking/alcohol use, food frequency, preventable health problems, diabetes

YRBSS

Youth Risk Behavior Surveillance System

run by USDHHS

grades 9-12

prevalence of health risk behaviors among young people

TRUE/FALSE

BRFSS and YRBSS can monitor changes in health risk over time and can better target health promotion efforts to populations most at risk

TRUE

health and diet survey

run by FDA and USDHHS

telephone survey or randomly selected adults

tracks self-perception of relative nutrient intake levels, use of food lables, knowledge of fats and cholesterol, prevalence of supplement use, awareness of diet and disease (HTN and sodium intake)

TANF

temporary assistance for needy families

states determine the eligibility and benefits/services provided

USDA Commodity Food Donation/Distribution Program

provides foods to help meet nutritional needs of children and adults, strenghen agricultural market for products produced by farmers-

food given to school lunch, feed elderly, supplemental programs

CSFP

Commodity Supplemental Food Program

Commodity Supplemental Food Program

Administered by state health agencies (part of USDA Commodity Food Donation/ Distribution Program)

monthly commodity canned or packaged foods

low-income women (pregnant/ breastfeeding/ post-partum), infants and children up to 6 yrs, some elderly AT NUTRITIONAL RISK

TEFAP

The Emergency Food Assistance Program

The Emergency Food Assistance Program

(part of USDA Commodity Food Donation/ Distribution Program)

quarterly distributions of commodity foods by local, public or private non-profit agencies, food banks, soup kitchens, homeless shelters

supplements diets of low-income households

NSLP

National School Lunch Program

National School Lunch Program

run by USDA FNS

entitlement program to improve nutrition of children, especially from low-income families

utilize surplus production of foods, cash grants, and food donations

dollars reimburse schools on basis of # of meals served

NSBP

National School Breakfast Program

National School Breakfast Program

run by USDA

entitlement program

meals must meet dietary guidelines

ASP

After school snack programs

After school snack programs

run by USDA

provides healthy snacks

schools receive cash subsidies for each snack served

same eligibility as NSLP

SMP

Special Milk Program

Special Milk Program

run by USDA

encourage consumption of milk by children

provides subsidy for milk served to children at participating schools, child care centers, summer camps

SFSP

Summer Food Service Program

Summer Food Service Program

run by USDA FNS

entitlement program, purpose is to initiate, maintain or expand foodservice programs to children when school is not in session

CACFP

Child and Adult Care Food Program

Child and Adult Care Food Program

run by USDA

supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless shelters, nonresidential adult daycare centers

reimburses operators for meal costs at day care centers and neighborhood houses

provides commodity foods and nutrition education materials

must serve meals that meet the guideline; must offer free or reduced price to eligible

FFVP

Fresh Fruit and Vegetable Program

Fresh Fruit and Vegetable Program

run by USDA

introduces children to fresh fruits and vegetables; help develop eating habits that improve health, prevent obesity and subsequent chronic disease

free to children nationwide at select schools

WIC

Special Supplemental Nutrition Program for Women, Infants, and Children

Special Supplemental Nutrition Program for Women, Infants, and Children

run by USDA

for pregnant, postpartum, breastfeeding women; infants and children up to 5

provides food, nutrition education, referrals to other agencies for low-income mothers at nutritional risk

NOT an entitlement program

EFNEP

Expanded Food and Nutrition Education Program

Expanded Food and Nutrition Education Program

run by USDA

provides grants to universities that assist in community development

trains nutrition aids to educate the public

improves food practices in low-income homes with young children`

maternal and child health block grant

run by USDHHS (under title V of the social security act)

fosters public health nutrition programs at the state and local levels

provides training, consultation, funding

for women of child-bearing age, infants, children (state eligibility requirements)

healthy start

run by USDHHS

reduce infant mortality and improve health of low-income WIC and families

NSIP

Nutrition Services Incentive Program