what are three ways in which illness and treatment affect nutrition status
reduce food intake, impaired digestion and absorption, altered nutrient metabolism and excretion
role of MD
responsible for meeting all of the pts medical needs; diet order
role of RN
screen pt for nutrition problems, participate in nutrition and dietary assessments, direct pt care, encourage pt to eat, record pt food intake, answer questions
role of RD
provide medical nutrition therapy, nutrition, and dietary assessment, dx problems, develop/implement/evaluate nutrition care plans, menus, dietary counseling
role of RDT
work in partnership with RD, supervising foodservice operations, inventory, quality control
what info helps ID pt with risk for malnutrition
recent weight loss and change in appetite
6 consensus malnutrition characteristics
unintentional weight loss, evidence of inadequate intake, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, reduced hand grip strength
describe nutrition assessment
collection/analysis of health related data, historical, dietary assessment, anthropometric, biochemical, physical examination
describe nutrition diagnosis
PES, unintentional weight loss, excessive /low kcal intake, issues swallowing
describe nutrition intervention
care plan, counseling, change intake, change medications
describe nutrition monitoring/evaluation
determine effectiveness of plan, follow pt progress, adapt changes
what types of data are included in historical information
age, current complaint, past medical problems, ongoing medical treatments, surgical history, family medical history, chronic disease risk, mental/emotional health
24 hour recall
guided interview, multiple pass (quick list, help to remember foods often forgotten), weakness - may not be typical, inaccurate recall, only for one day
food frequency questionnaire
foods and beverages regularly consumed during a specific time period, weakness - relies on memory, special population groups may not have their foods on the list
food record
diary written account of foods and beverages consumed during a specified time period, usually several consecutive days
direct observation
food intakes directly observed and analyzed 0-100%, nurses conduct pt kcal count
what does ht and wt tell us
BMI
what does waist measurement tell us
body fat
what does head circumference tell us
brain development in infants
what does serum protein tell us
protein-energy status, but also liver function, metabolic stress, and inflammation
what does albumin tell us
gauge severity of inflammation/illness, slow to reflect change, not a sensitive indicator
what does transferrin tell us
increases as iron status worsens and vice versa, not reliable for PEM if iron deficiency is also present, decreases with inflammation
what does pre-albumin and retinol-binding proteins tell us
decreases with inflammation/metabolic stress, decrease rapidly during PEM, respond quickly to improved protein intakes, expensive, not routine
red blood cell count in males
4.3-5.7
red blood cell count in females
3.8-5.1
hemoglobin in males
13.5-17.5
hemoglobin in females
12-16
hematocrit in males
39-49%
hematocrit in females
35-45%
mean corpuscular volume
80-100 this helps to distinguish microcytic and macrocytic anemia
MCHC
31-37%
where do signs of malnutrition first appear
where cells are quickly turned over (GI, skin, and hair)
edema
fluid retention, infection, injury, or use of certain meds, impaired circulation, organ dysfunction, diseases of the heart
physical signs of edema
weight gain, facial puffiness, swelling of limbs, abdominal distension, tight fitting shoes
causes of dehydration
vomiting, diarrhea, fever, sweating, excessive urination, blood loss, injuries to skin
symptoms of dehydration
thirst, weight loss, dry skin or mouth, reduced skin tension, dark yellow/amber urine, low urine volume