NFMNT Chapter 7 Obtain Routine Nutrition Screening Data

Nutrition Fundamentals and Medical Nutrition Therapy

Obtain Routine Nutrition Screening Data

Corresponds with LEARNING PLAN 7Copyright 2016 Association of Nutrition and Foodservice Professionals

7

Objectives

Identify the goal of nutrition screening

Explain the difference between nutrition screening and nutrition assessment

Use established guidelines to distinguish between routine and at-risk clients Identify appropriate data to be gathered

Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

Gather client data from relevant sources (e.g. medical record, referrals

Complete client forms (e.g., MDS)

Comply with federal regulations related to evaluating client status and care

Calculate nutrient intake

Document relevant nutrition related information (e.g. laboratory

Nutrition Care Process (NCP)

Provided by The Academy of Nutrition and Dietetics

Provides a standardized process of providing care to clients

Chapter 9 focuses on Step 1 - Nutrition Assessment


Nutrition Care Process (NCP)

Nutrition Assessment» Nutrition screening (data

collection) - CDM, CFPP» Nutrition Assessment – RDN

Nutrition Diagnosis» Utilize standardized

terminology defined by the Academy of Nutrition and Dietetics


Nutrition Intervention» Action steps to correct a

nutrition problem- Planning and implementation

Nutrition Monitoring and Evaluation» Follow-up to determine how

interventions are working

Nutrition Assessment

Nutrition screening is initial step

Systematic method to identify individuals at-risk for nutrition problems

Primary responsibility of a Certified Dietary Manager

Based on indicators» Built upon statistical data known to be associated with risk

- E.g. Clients <90 percent of their ideal body weight = rate of complications from surgery

The more indicators “flagged,” the higher the risk


Nutrition Screening

Specific indicators» Numbers, measurements, diagnosis, usual food intake,

laboratory data» A - B - C - D

- Anthropometric measurements- Biochemical tests- Clinical data- Diet history

» Number of ‘flagged’ indicators determine next step


Anthropometric Measurements

Height and Weight – accuracy is critical» Do not ask the client to ‘tell you’ their height» Do not use a weight from a previous facility as your admission

weight

Ideal Body Weight (IBW)» Hamwi Formula

- Men : IBW = 106 lbs. for first 5 feet + 6 lbs. per inch over 5 feet- Women: IBW = 100 lbs. for first 5 feet + 5 lbs. per inch over 5 feet

Frame Size» Wrist measurement» Elbow breadth


Brain Break

Calculate the IBW of a male client with a large frame and a height of 6’2”


IBW = 106 lbs. for first 5 feet + 6 lbs. for each inch over 5 feet106 lbs. + (6 X 14) = 106 + 84 lbs. = 190

Add 10% to the total for large frame: 190 X 10% = 19lbs

Answer: IBW = 209 lbs.

Weight

Actual weight» what the person weighs right now

Percent of IBW» how closely the client resembles the ideal » (Actual weight ÷ IBW ) x 100 = % IBW

Percent of weight change» a ‘snapshot’ of weight change over a period of time» [(Usual weight - Actual weight) ÷ Usual weight] x 100

Body Mass Index (BMI)» A proportion of weight to height» Determination of lean body mass

Skinfold Thickness


Brain Break

Using the client from the last Brain Break, calculate the percent of IBW if the client’s current weight is 185 lbs.; then calculate the percent weight change knowing that the client’s usual weight is 200 lbs..

» Percent of IBW = (Actual weight ÷ IBW) x 100- 185 ÷ 209 = .885 x 100 = 89%

» Percent weight change = (Actual weight – IBW) ÷ usual weight x 100- (185 – 209) = 24lbs ÷ 200 = .12 x 100 = 12 percent


BMI Classifications BMI has limitations but is most commonly used in assessment

BMI Classifications for both Men and Women

Underweight BMI<18

Healthy Weight BMI 20-25

Overweight BMI 25-29.9

Obese BMI >30

BMI is often calculated via computer system or listed on charts

Calculate by hand:» Height in inches x height in inches = height in inches squared. BMI =

Weight ÷ Height in inches squared x 703.

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Biochemical Tests

» Serum Albumin» Serum Prealbumin» Serum Transferrin» Total Lymphocyte count (TLC)» Fasting Blood Sugar/Glucose

(FBS or FBG)» Glycosylated Hemoglobin

(HbA1C)


» Hemoglobin (Hgb or Hb)» Hematocrit (HCT)» Serum Cholesterol, HDL, LDL,

Serum Triglyceride (TG)» Serum Potassium (K)» Blood Urea Nitrogen (BUN)

Normal ranges for laboratory values are determined by the facility. The following tests have nutritional significance

Clinical Information

Diagnosis

Skin status

Physical symptoms or conditions

Medicine » Food/drug interactions

Medical and social factors

Tube feeding

Note The above information is usually located in the Medical Record


Brain Break

The CDM has gathered the following information» Client is underweight by 15% in last six months; client has constant

diarrhea; Serum Prealbumin is 11; client is taking Atenolol and Furosemide.

Why might this client be flagged for further nutrition assessment?

» Client may have some protein depletion based on the clinical data; weight loss over three months should be flagged according to CMS


Diet History Food record

» 24-hour recall

Food frequency questionnaire

Calorie count/Nutrient intake analysis

Intake and Output (I/O) record

Meal observation

Cultural influences

Religious beliefs

Living arrangement and support system


Nutrition Assessment

RDN completes a nutrition assessment if the nutrition screening obtained by the CDM indicates an assessment is appropriate

Comprehensive approach to determine nutritional status, dependent upon the results of the nutrition screening

Estimation of nutrient needs» Basal Energy Expenditure (BEE)

- Estimation of caloric needs including activity and healing» Estimation of daily protein needs» Estimation of daily fluid needs

Utilize a standardized form to ensure consistent data collection


Brain Break

Using the formula in your textbook (figures 9.14 and 9.15), calculate the BEE for the following client» 66 year old woman» 5’ 6” tall» 137 lbs. with recent surgery to repair a hip fracture


Brain Break

Answers to BEE» First step is to change lbs.. and inches to kg and cm

- 655 + (9.6 x [137 ÷ 2.2]) + (1.8 x [66” x 2.54]) =- 655 + (9.6 x 62.27) + (1.8 x 167.64) – (4.7 x 66) =- 655 + 597.8 + 301.75 – 310.2 = 1244


Brain Break

Answers to BEE» Second step is to add the activity and injury factors:

- Use the lowest activity factor since she is recovering from surgery; then use the injury factor for someone following surgery with bone fracture

- 1244 x .2 = 249- 1244 x .35 = 435 - 1244 + 249 + 435 = 1933 is the correct BEE


Fluid Requirements

Fluid requirements may vary based on conditions

Average Adults » 30 mL/kg body weight

For Adults with Infection or Draining Wounds » 35 mL/kg body weight

For Adults with CHF or Renal Disease» 25 mL/kg body weight


Changing Fluid Needs

Fever

Draining wounds

Diarrhea

Vomiting

Hyperventilation

Respirator

Excessive perspiration

Pressure ulcer (states II, III, IV)


Congestive heart failure

(CHF)

Cardiac disease

Renal disease

Edema or ascites

Factors increasing fluid needs Factors decreasing fluid needs

Education

NFMNT Chapter 7 Obtain Routine Nutrition Screening Data