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Nutrition Diagnosis

Subjects : health-sciences, nursing, health-fitness-nutrition

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Why are dietary adjustments sometimes necessary?
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Allows body to heal -To prepare diagnostic test -To prepare Surgical Procedure

2. Increased nutrient needs

3. Inadequate protein intake
Collecting food in the mouth - Spitting out food - Inability to control tongue - Coughing before or after swallowing - Choking - Excessive drooling - Regurgitation of food or liquid through nose - mouth or trach tube - Increased time required to eat
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
Diet hx of low intake
Before Putting anything in - Radiography - pH of aspirated fluids - Air injection and ausculation - Visual assessment of aspiration

4. What are the IV lipid emulsions for Parenteral Nutriton Solution?
High BUN - High BGL - High liver enzymes - Weight gain - Edema
High AST/GGT - Blood ETOH - diet hx of > 2 drinks/day - liver dx
Potential to become malnourished
IV lipid emulsions - Used as a concentrated energy source and to prevent the development of essential fatty acid deficiency - Kcal density of lipid solutions is useful when volume restriction is necessary

5. What is Fat-Controlled Diet?
Foods liquid at room or body temperature - Clear liquid plus milk - pudding - ice cream - soups - yogurt - Used to provide oral nourishment for patients - Difficulty chewing and swallowing solid foods - Commercial nutritional supplements often used
High BGL - Weight gain - High Hgb A1C - diet hx of energy dense food intake - Excess eating away from home
Weight status and trends - BUN - creatinine - serum chemistries - proteins - Fluid status - intake and output
Management of malabsorption - chronic pancreatitis - gallbladder disease - Medium chain triglycerides (MCTs) utilized with high intake of CHO and protein - Easy to digest - Restricts - High fat - additional fat in cooking - Enzyme replacement may be

6. What are the 3 levels of Dysphagia?
Food allergy diet - Common: nuts - eggs - cow's milk - shellfish - wheat - Gluten-restricted diet - Celiac disease (malabsorption syndrome) - Omits wheat - rye - barley - oats - buckwheat - malt - Allows rice and corn - Lactose-restricted - Primary i
Potential to become malnourished
Pureed - Mechanically altered - Advanced
Weight loss (5% in 1 month; 10% in 6 months) - Increased activity - dx: Parkinsons - cerebral palsy - dementia

7. What is Regular/General Diet?
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases
Individualized diets based on swallowing ability and food preference - Evaluate ability to swallow solids and liquids: often done by speech therapist who can also aid in teaching the patient swallowing techniques - Features of food to consider and mo
Foods that are easy to chew - digest - and absorb - Used during transition from liquid diets to regular or general diets - Foods low in fiber - Only lightly seasoned - Not appropriate for patients requiring mechanical soft diets
Low chol - alb - prealb - elytes/minerals - vitamins - Weight loss - Low BMI - Diet hx of low intake - fever - dx: Crohn's - AIDS - burns

8. What is 'Diet as Tolerated'?

9. Predicted Excessive Nutrient Intake
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support
Kcal count -24 hr recall -Food records
Biochemical parameters indicating excessive nutrient intake - Knowledge deficit - Meds affecting appetite - Nutrition in Patient Care
Weight loss (5% in 1 month; 10% in 6 months) - Increased activity - dx: Parkinsons - cerebral palsy - dementia

10. Excessive alcohol intake
High AST/GGT - Blood ETOH - diet hx of > 2 drinks/day - liver dx
Before Putting anything in - Radiography - pH of aspirated fluids - Air injection and ausculation - Visual assessment of aspiration
Weight Loss - dx: AIDS - TB - AN
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH

11. Inadequate enteral nutrition infusion
Ketone breath - Diet hx low CHO - Dx: liver - pancreas - celiac's disease
Potential to become malnourished
Low cholesterol - Low Ca - High PTT - Low Cu/Zn/Fe - Weight loss - Dehydration
CHO 55-60% - protein 10-20% - lipid <30% - fiber 20-35 grams - Evaluate glucose levels - serum lipids - kcalories - diet - insulin/medication

12. What is the long-term nutritional biochemical analysis? What are the values?
GI problems - Diarrhea - Nausea and vomiting - Cramping - Distention - Constipation - Mechanical complications - Tube displacement - Tube obstruction - Pulmonary aspiration - Mucosal damage
Serum Albumin- (visceral protein status) Normal Value: 3.5-5 g/dl 2.8-3.5- compromised protein status <2.4- possible protein malnutrition
Biochemical parameters indicating suboptimal nutrient intake - Estimated intake less than needs - Cultural or religious practices - Knowledge deficit - Meds affecting appetite
Food allergy diet - Common: nuts - eggs - cow's milk - shellfish - wheat - Gluten-restricted diet - Celiac disease (malabsorption syndrome) - Omits wheat - rye - barley - oats - buckwheat - malt - Allows rice and corn - Lactose-restricted - Primary i

13. Less than optimal parenteral infusion
Diet hx of low plant food intake
Abnormal liver function tests - Abnormal levels of nutrient - Weight gain or weight loss - Edema - Nausea - Intolerance
Foods liquid at room or body temperature - Clear liquid plus milk - pudding - ice cream - soups - yogurt - Used to provide oral nourishment for patients - Difficulty chewing and swallowing solid foods - Commercial nutritional supplements often used
IV lipid emulsions - Used as a concentrated energy source and to prevent the development of essential fatty acid deficiency - Kcal density of lipid solutions is useful when volume restriction is necessary

14. Predicted suboptimal energy intake
Reports or observations of energy intake less than needs - Projected change in ability to procure or consume adequate energy - Knowledge deficit - Projected increase in physical activity
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term
Monitor patient's nutritional status - Monitor I&O - Fluid balance - lung sounds - s/s dehydration - etc. - Monitor IV - Change solution bag every 24 hours to decrease infection rate - CVC dressing change q 72 hours - Monitor Blood Chemistry - Fluid
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry

15. What are the assessments for Enteral Feedings?
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
High BGL - Weight gain - High Hgb A1C - diet hx of energy dense food intake - Excess eating away from home
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Anthropometric data -Clinical data -Dietary intake assessment

16. Predicted Suboptimal Nutrient Intake
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Before Putting anything in - Radiography - pH of aspirated fluids - Air injection and ausculation - Visual assessment of aspiration
Biochemical parameters indicating suboptimal nutrient intake - Estimated intake less than needs - Cultural or religious practices - Knowledge deficit - Meds affecting appetite
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30

17. Inconsistent carbohydrate intake
Abnormal liver function tests - Abnormal levels of nutrient - Weight gain or weight loss - Edema - Nausea - Intolerance
High/low BGL - Meds - Insulin use -
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO

18. Why is it important to know primary/secondary nutritional risk?
Food items that minimize elimination patterns by reducing fecal volume - Restricted - High fiber foods - Milk and milk products - Fried foods - Pepper - Alcohol - Heavy seasonings
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support
High/low BGL - Meds (steroids) - Diet hx
Poor nutrition prevents or delays recovery from injury.

19. Excessive enteral nutrition infusion
High BUN - High BGL - High liver enzymes - Weight gain - Edema
Foods that are easy to chew - digest - and absorb - Used during transition from liquid diets to regular or general diets - Foods low in fiber - Only lightly seasoned - Not appropriate for patients requiring mechanical soft diets
Renal disease or liver disease - Limit protein - Limit potassium - phosphorus - Sodium and Fluid restrictions - Emphasizes high biologic value - Minimum level of CHOs needed to spare protein
Weight gain - Diet hx of energy dense food intake

20. Decreased nutrient needs
High/low BGL - Meds - Insulin use -
High chol - PO4 - GFR <90 - High BUN - Edema - Dx: kidney/liver
Abnormal liver function tests - Abnormal levels of nutrient - Weight gain or weight loss - Edema - Nausea - Intolerance
TJC requires screenings within 48hrs

21. What are the confirmations of tube placement?
Foods liquid at room or body temperature - Clear liquid plus milk - pudding - ice cream - soups - yogurt - Used to provide oral nourishment for patients - Difficulty chewing and swallowing solid foods - Commercial nutritional supplements often used
Serum and urine creatinine and BUN (somatic muscle protein) -ELEVATED if muscle is broken down Normal Values: -Serum Creatinine: 0.5-1.2mg/100ml -BUN: 10-20 mg/ml
Low cholesterol - Low Ca - High PTT - Low Cu/Zn/Fe - Weight loss - Dehydration
Before Putting anything in - Radiography - pH of aspirated fluids - Air injection and ausculation - Visual assessment of aspiration

22. What is Pureed Diet?
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support
Provides essential nutrients in blenderized form - Clients who are unable to chew or swallow - Can be used long-term
Serum Albumin- (visceral protein status) Normal Value: 3.5-5 g/dl 2.8-3.5- compromised protein status <2.4- possible protein malnutrition
Low chol - alb - prealb - elytes/minerals - vitamins - Weight loss - Low BMI - Diet hx of low intake - fever - dx: Crohn's - AIDS - burns

23. Inadequate fiber intake
High BGL - Weight gain - High Hgb A1C - diet hx of energy dense food intake - Excess eating away from home
Renal disease or liver disease - Limit protein - Limit potassium - phosphorus - Sodium and Fluid restrictions - Emphasizes high biologic value - Minimum level of CHOs needed to spare protein
Diet hx of low fiber intake - Constipation/low stool volume
High chol - PO4 - GFR <90 - High BUN - Edema - Dx: kidney/liver

24. What are Dysphagia 'warning signs'?
Food allergy diet - Common: nuts - eggs - cow's milk - shellfish - wheat - Gluten-restricted diet - Celiac disease (malabsorption syndrome) - Omits wheat - rye - barley - oats - buckwheat - malt - Allows rice and corn - Lactose-restricted - Primary i
High/low BGL - Meds - Insulin use -
Potential to become malnourished
Collecting food in the mouth - Spitting out food - Inability to control tongue - Coughing before or after swallowing - Choking - Excessive drooling - Regurgitation of food or liquid through nose - mouth or trach tube - Increased time required to eat

25. What is Dysphagia? What are some of the acute/progressive causes?

26. Inadequate oral food/ beverage intake
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term
14 days of admission
Low HDL - High TSH - High Mg - High PO4 - Diet hx of xs intake - Liver damage - GI distress
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH

27. Excessive or inappropriate protein intake
High BUN - Low GFR - Poor growth - Deranged AA ratios - diet hx high PRO or AA supplement
Height/length -Weight -BMI -Body Measures (skin fold thickness)
Reports or observations of energy intake less than needs - Projected change in ability to procure or consume adequate energy - Knowledge deficit - Projected increase in physical activity
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry

28. What is Full-Liquid Diet?
Monitor patient's nutritional status - Monitor I&O - Fluid balance - lung sounds - s/s dehydration - etc. - Monitor IV - Change solution bag every 24 hours to decrease infection rate - CVC dressing change q 72 hours - Monitor Blood Chemistry - Fluid
Foods liquid at room or body temperature - Clear liquid plus milk - pudding - ice cream - soups - yogurt - Used to provide oral nourishment for patients - Difficulty chewing and swallowing solid foods - Commercial nutritional supplements often used
High chol - amylase/lipase - liver function tests - Diet hx high fat
Foods that are easy to chew - digest - and absorb - Used during transition from liquid diets to regular or general diets - Foods low in fiber - Only lightly seasoned - Not appropriate for patients requiring mechanical soft diets

29. Inadequate fat intake
High chol - PO4 - GFR <90 - High BUN - Edema - Dx: kidney/liver
Individualized diets based on swallowing ability and food preference - Evaluate ability to swallow solids and liquids: often done by speech therapist who can also aid in teaching the patient swallowing techniques - Features of food to consider and mo
Weight Loss - dx: AIDS - TB - AN
Caused by disease

30. What is Enteral Nutrition? Why preferred over Parenteral Nutrition?
High AST/GGT - Blood ETOH - diet hx of > 2 drinks/day - liver dx
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Provides essential nutrients in blenderized form - Clients who are unable to chew or swallow - Can be used long-term

31. What is Soft Diet?
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30
Prevents aspiration - Thickener added to liquids to created required thickness - Nectar/Syrup thick - Consistency of heavy syrup in canned fruit - Least restrictive - Cream based soups and most nutritional supplements - Honey thick - Consistency of h
Foods that are easy to chew - digest - and absorb - Used during transition from liquid diets to regular or general diets - Foods low in fiber - Only lightly seasoned - Not appropriate for patients requiring mechanical soft diets
GI problems - Diarrhea - Nausea and vomiting - Cramping - Distention - Constipation - Mechanical complications - Tube displacement - Tube obstruction - Pulmonary aspiration - Mucosal damage

32. What is Enteral Nutrition based on?

33. How long does TJC require resident screenings to be done during admission?
TJC requires screenings within 48hrs
Food items that minimize elimination patterns by reducing fecal volume - Restricted - High fiber foods - Milk and milk products - Fried foods - Pepper - Alcohol - Heavy seasonings
Technical complications - Pneumothorax - Septic complications - Local or systemic - Metabolic complications - Most common complication - Most common is hyperglycemia
Diet hx of aberrant CHO intake - Steroids - DM - Inborn errors

34. Imbalance of nutrients
Diet hx of low plant food intake
Diet hx of high intake - Diarrhea - Constipation - GI distress
Diet hx of low fiber intake - Constipation/low stool volume
High BUN - Low GFR - Poor growth - Deranged AA ratios - diet hx high PRO or AA supplement

35. How long should Nutritional screenings be done to residents being admitted?
14 days of admission
Collecting food in the mouth - Spitting out food - Inability to control tongue - Coughing before or after swallowing - Choking - Excessive drooling - Regurgitation of food or liquid through nose - mouth or trach tube - Increased time required to eat
Carbohydrate - Dextrose solutions - Available in initial concentrations of 5% to 70% - Mixed with amino acids and other nutrients to form the final solution - Protein - Mixture of essential and nonessential crystalline amino acids - Available wi
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term

36. Inadequate energy intake
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support
Monitor patient's nutritional status - Monitor I&O - Fluid balance - lung sounds - s/s dehydration - etc. - Monitor IV - Change solution bag every 24 hours to decrease infection rate - CVC dressing change q 72 hours - Monitor Blood Chemistry - Fluid
Weight status and trends - BUN - creatinine - serum chemistries - proteins - Fluid status - intake and output
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH

37. Inadequate mineral intake
Weight status and trends - BUN - creatinine - serum chemistries - proteins - Fluid status - intake and output
Low serum mineral levels - Physical signs of deficiency - Diet hx of low intake - Celiac disease - SBS - IBD
High chol - amylase/lipase - liver function tests - Diet hx high fat
Abnormal liver function tests - Abnormal levels of nutrient - Weight gain or weight loss - Edema - Nausea - Intolerance

38. Inappropriate intake of types of carbohydrates
14 days of admission
High/low BGL - Meds (steroids) - Diet hx
Low chol - alb - prealb - elytes/minerals - vitamins - Weight loss - Low BMI - Diet hx of low intake - fever - dx: Crohn's - AIDS - burns
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases

39. What are the complications of Parenteral Nutrition?
Low cholesterol - Low Ca - High PTT - Low Cu/Zn/Fe - Weight loss - Dehydration
Technical complications - Pneumothorax - Septic complications - Local or systemic - Metabolic complications - Most common complication - Most common is hyperglycemia
Diet hx of aberrant CHO intake - Steroids - DM - Inborn errors
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry

40. Inadequate carbohydrate intake

41. Inadequate parenteral nutrition infusion
Inadequate Intake
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30
Foods liquid at room or body temperature - Clear liquid plus milk - pudding - ice cream - soups - yogurt - Used to provide oral nourishment for patients - Difficulty chewing and swallowing solid foods - Commercial nutritional supplements often used
Indirect calorimetry measurement - Vitamin/mineral abnormalities in lab values - Inadequate weight gain - or unintentional weight loss Clinical evidence of vitamin/mineral deficiency

42. What is Primary Nutrition Risk?
Inadequate Intake
Elevated BUN:creatinine ratio - Hyperglycemia - Hypercapnia - Elevated liver enzymes - Weight gain - Edema - Meds that reduce energy requirements or impair metabolism
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Prealbumin- (visceral protein status) Normal Value: 16-40 g/dl Compromised Protein status: 10-15 g/dl Possible protein malnutrition: <10 g/dl

43. What are the Carb and Protein Parenteral Nutrition Solutions?
Low chol - alb - prealb - elytes/minerals - vitamins - Weight loss - Low BMI - Diet hx of low intake - fever - dx: Crohn's - AIDS - burns
Carbohydrate - Dextrose solutions - Available in initial concentrations of 5% to 70% - Mixed with amino acids and other nutrients to form the final solution - Protein - Mixture of essential and nonessential crystalline amino acids - Available wi
Low serum mineral levels - Physical signs of deficiency - Diet hx of low intake - Celiac disease - SBS - IBD
High chol - amylase/lipase - liver function tests - Diet hx high fat

44. What is Low-Residue Diet?
Food items that minimize elimination patterns by reducing fecal volume - Restricted - High fiber foods - Milk and milk products - Fried foods - Pepper - Alcohol - Heavy seasonings
Potential to become malnourished
Biochemical parameters indicating excessive nutrient intake - Knowledge deficit - Meds affecting appetite - Nutrition in Patient Care
Serum Albumin- (visceral protein status) Normal Value: 3.5-5 g/dl 2.8-3.5- compromised protein status <2.4- possible protein malnutrition

45. What is Dysphagia Nutritional Therapy?
Caused by disease
Monitor patient's nutritional status - Monitor I&O - Fluid balance - lung sounds - s/s dehydration - etc. - Monitor IV - Change solution bag every 24 hours to decrease infection rate - CVC dressing change q 72 hours - Monitor Blood Chemistry - Fluid
Individualized diets based on swallowing ability and food preference - Evaluate ability to swallow solids and liquids: often done by speech therapist who can also aid in teaching the patient swallowing techniques - Features of food to consider and mo
Prealbumin- (visceral protein status) Normal Value: 16-40 g/dl Compromised Protein status: 10-15 g/dl Possible protein malnutrition: <10 g/dl

46. What is Protein-Controlled Diet?
Weight Loss - dx: AIDS - TB - AN
14 days of admission
Renal disease or liver disease - Limit protein - Limit potassium - phosphorus - Sodium and Fluid restrictions - Emphasizes high biologic value - Minimum level of CHOs needed to spare protein
Height/length -Weight -BMI -Body Measures (skin fold thickness)

47. How do you manage TPN?

48. What else do you check with biochemical tests?
Diet hx of low plant food intake
Regular diet with attention to texture - Consistency of food can be varied according to the patient's ability to chew and swallow - Foods chopped - ground - mashed - or pureed - Patient's needs should be evaluated - Modifying consistency according to
Anthropometric data -Clinical data -Dietary intake assessment
Potential to become malnourished

49. What is the other biochemical analysis and values?
High BUN - High serum osmolality - High Na - Weight loss - Thirst
Diet hx of high intake - Diarrhea - Constipation - GI distress
Serum and urine creatinine and BUN (somatic muscle protein) -ELEVATED if muscle is broken down Normal Values: -Serum Creatinine: 0.5-1.2mg/100ml -BUN: 10-20 mg/ml
Technical complications - Pneumothorax - Septic complications - Local or systemic - Metabolic complications - Most common complication - Most common is hyperglycemia

50. What is the assessment of nutritional risk approach? (abcd)
Ketone breath - Diet hx low CHO - Dx: liver - pancreas - celiac's disease
Abnormal liver enzymes - Fatty liver - Weight gain/loss - Edema
Weight gain - Diet hx of energy dense food intake
A- Anthropometric approach B- Biochemical Tests C- Clinical Observations D- Diet Evaluations (Kcal - 24 hr recall etc)