FCS 362 - Exam 1 Study Guide

What to expect: A true/ false, multiple choice questions, short answer questions, one case study.
What to bring: a pencil (or two) and a calculator
Medical Terminology: Units 1-4

Nutrition Care Process

 Know all four steps of the Nutrition Care Process
o Nutrition Assessment
 Obtain information to obtain nutrition related problems
o Nutrition Diagnosis
 Identify and label the problem
 Determine cause
 State signs and symptoms
o Nutrition Intervention
 Planned actions designed to remedy nutrition diagnosis/problem
 Formulate goals and action
 Implement action
o Nutrition Monitoring and Evaluation
 Quantify progress made by the patient in meeting nutrition care goals
 Select or identify quality indicators
 Monitor and evaluate resolution of diagnosis

 Explain why the Academy transitioned to the NCP and standardized terminology
o Wanted to establish a universal language between all healthcare practitioners

 List the critical thinking skills needed by the RDN

o Determining important and relevant data to collect
o Determining the need for additional information
o Selecting assessment tools and procedures that match the situation
o Applying assessment tools in valid and reliable ways
o Validating the data

 Give an example of what could happen if the RDN does not utilize critical thinking skills during the
nutrition assessment
o The dietitian could give a miss diagnosis or completely not know the diagnosis and the
patient would go untreated and continue living with a problem.

Nutrition Screening
 Describe the purpose of nutrition screening.
o Determine nutrition risk in patients

 List tools that are used to perform nutrition screening.

o Minimum Data Set
o Malnutrition Screening Tool
o Malnutrition Universal Screening Tool (MUST)
o Nutrition Risk Score
o Mini Nutritional Assessment
Nutrition Assessment
 Food/ Nutrition- Related History
o List the information obtained under this domain
 Food and nutrient intake
 Food and nutrient administration
 Medication
 Alternative medicine use
 Knowledge and beliefs
 Food and supplies availability
 Physical activity
 Nutrition quality of life

o Compare and contrast methods used for assessing food and nutrient intake. Describe pros,
cons, and situations in which each method would be most appropriate.
 The 24-hour food recall can be good to quickly assess a patient’s food intake
 But it also just shows you one day out of all days
 The food frequency questionnaire gives you a better idea of what people eat
normally
 People can lie during both these forms of getting diet intake

o Explain where you would obtain information related to food/ drug interactions.
 Acute Care Hospitals
 Ambulatory Clinics
 Emergency Rooms
 Short Stay Units
 Long-term care facilities
 Rehab Facilities
 Home Care

 Anthropometric Measurements
o List the measurements obtained for populations (adult vs. pediatric).
 Adult: Height, Weight, Waist Circumference, Body Fat Distribution, Body
Composition,
o Anthropometric calculations (i.e. BMI, IBW, %IBW, %UBW, %Wt. Loss).
 IBW
 Males: 106 lbs + 6 lbs/inch over 5 ft.
 Females: 100 lbs + 5 lbs/inch over 5 ft.
 % IBW = (Current wt./IBW) x 100
 %UBW = (current/UBW) x 100
 BMI: wt in kg/ht in m^2
 Underweight: <18.5,
 18.5-24.9: normal
 25-29.9: overweight
 30-34.9: obesity 1
 35-39.9: obesity 2
 40+: extreme obesity
 %Wt. loss = UBW – (current weight/UBW) x 100
o Know classifications for severe weight loss in acute illness or injury.
 5% “significant” >5% “Severe” in 1 month
 7.5% ‘significant >7.5% ‘severe’ in 3 months
  10% ‘significant >10% ‘severe’ in 6 months

 Biochemical Data, Medical Tests and Procedures.

o Explain how you would approach and interpret the biochemical data.
 I would look over the amounts of each thing tested carefully and make sure
everything is in normal range
 If there is something out of range then I will look into what could be the causes and
maybe talk to the client and see if there have been any major changes
o List markers of inflammation
 C-reactive protein
 Ferritin
 Albumin
 Transferrin
 Prealbumin
 Retinol-binding protein

o Explain negative and positive acute phase reactants

 Positive
 C-reactive protein (CRP)
o Inflammatory biomarkers
o Increases during acute stress (within 4-6 hours)
o Wait until CRP decreases to begin nutrition therapy
 Ferritin
o Increases during acute stress (within 1-2 days and peaks at 3-5 days)
 Negative Acute Phase Reactants
 Albumin
 Transferrin
 Prealbumin
 Retinol-binding protein

 Nutrition Focused Physical Findings

o List the information under this domain
 Vital signs
 Muscle mass loss
 Loss of subcutaneous fat
 Nutrition impact symptoms
 Nausea
 Diarrhea
 Vomiting
 Constipation
 Stomatitis
 Mucositis
 Alterations in taste or smell
 Anxiety
 Pressure ulcers
 Grip strength change
 Fluid accumulation
o Describe the Nutrition Focused Physical Exam
 The Nutrition Focused Physical Exam is used to determine if there is malnutrition
(significant subcutaneous fat loss and to determine if there are significant
micronutrient deficiencies physically visible).
o How are fat stores assessed?
 The buccal fat pads (under eyes)
 Triceps/biceps
 Ribs, lower back, midaxillary line

o How are muscle stores assessed?

 Temporalis region
 Clavicle bone region
 Pectoralis major
 Deltoid
 Trapezius
 Clavicle and acromion bone region
 Deltoid
 Patellar region
 Quad
 Anterior Thigh region
 Quad
 Posterior calf region
 Gastrocnemius muscle
 Scapular bone region
 Trapezius
 Supraspinus
 Infraspinus
 Dorsal hand
 Interosseous muscle
o How are micronutrient deficiencies assessed?
 Skin
 Hair
 Eyes
 Nails
 Oral Cavity
 Perioral

 Client History
o List the information under this domain
 Personal History
 Medical/health /family history
 Social history
 Treatments/therapy
 Medications
 Surgeries

 Comparative Standards (listed as “Assessment, monitoring and evaluation tools in the Snapshot)
o Estimate energy needs using a predictive equation.
 Noncritically ill: Mifflin-St. Jeor Equation
 Men: RMR = (9.99W) + (6.25H) – (4.92A) + 5
 Women: RMR = (9.99W) + (6.25H) – (4.92A) -161
  Critically ill: Penn State equation (nonobese and obese <60 yrs)
 RMR = [(BMR x 0.96) x (VE x 31)] + (Tmax x 167) – 6212
 Critically ill: Penn State equation (obese >60 yrs)
 RMR = [(BMR x 0.71) x (VE x 64)] + (Tmax x 85) – 3085
o Estimate protein needs.
 1.2 g protein / kg actual body weight
 DRi: 0.8g/kg
 Adult maintenance: 0.8-1.0 g/kg
 Older adults: 1.0 g/kg
 Renal Disease
 Pre-dialysis: 0.6-0.8 g/kg
 Hemodialysis: 1.2-1.3 g/kg
 Peritoneal dialysis: >1.3 g/kg
 Hepatitis: 1-1.5 g/kg
 Cancer: 1-1.5 g/kg
 Pulmonary disease: 1.2-1.5 g/kg
 BMI: >27, 1.5-2 g/kg IBW

o Estimate fluid needs.

 RDA: 1mL fluid/ kcal of estimated needs
 Ml/kg method
 100ml for first 10 kg of body weight
 50 ml for second 10 kg body weight
 Age < or = 50 years: 20 ml for each additional kg of wt.
 Age > 50 years: 15 ml for each additional kg of wt
 Body surface method
 1500 ml per square meter of body surface area

o Interviewing
o List and describe possible barriers to communication
 The participant is uncomfortable
 The participant won’t answer the questions completely
 The interviewer is talking too much
 Both parts aren’t actively listening
o Identify types of communication styles that promote a supportive environment (i.e.
descriptive rather than evaluative)
 Descriptive
 Support situation rather than reprimand the problem
 Problem oriented
 Address problem and ask why the problem is occurring
 Provisional
 Being polite and professional
 Egalitarian
 Getting on same level as client/being supportive
 Empathetic
 Help to understand the situation/’feel for’ the person
o Know the parts of an interview and components of each
 Opening
 Introductions- nature and purpose of interview
 Sets tone
  Set time frame
 Establish rapport
 Discuss purpose
 Exploration
 Gather information
 Explore problems
 Explore thoughts and feelings
 Continue rapport
 Closing
 Express appreciation
 Review purpose
 Ask for comments/questions
 Plan future contacts
o Be familiar with question types (open, closed, etc.) and the various types of responses
(hostile, reassuring, etc.)
 Open
 Less threatening
 Less efficient
 Closed
 ‘yes’ or ‘no’ restrictive
 Interviewer has more control
 Takes less time
 Primary
 Introduces topics or new discussion
 Secondary
 Follow-up
 Get more info
 Show that you are listening
 Neutral
 Doesn’t suggest an answer
 Leading
 Direct the respondent toward one answer

 Understanding
 Understand and recreate the message in your own frame of reference
 Probing
 Clarify or gain additional information
 Confrontation
 Authority-laden; tactfully call attention to inconsistency
 Evaluate
 Makes a judgement about feelings or response s
 Hostile
 Anger or frustration; leads to antagonism or humiliation
 Reassuring
 Prevent client form working through feelings; ‘it’s okay’