NFMNT Chapter 7 Obtain Routine Nutrition Screening Data

1. Nutrition Fundamentals and Medical
Nutrition Therapy
Obtain Routine Nutrition Screening Data
Corresponds with
LEARNING PLAN 7
Copyright 2016 Association of Nutrition and Foodservice
Professionals

2. 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

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

4. 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 Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7
 Nutrition Intervention
» Action steps to correct a
nutrition problem
- Planning and implementation
 Nutrition Monitoring and
Evaluation
» Follow-up to determine how
interventions are working

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

6. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

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

8. Brain Break
 Calculate the IBW of a male client with a large frame and
a height of 6’2”
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7
IBW = 106 lbs. for first 5 feet + 6 lbs. for each inch over 5 feet
106 lbs. + (6 X 14) = 106 + 84 lbs. = 190
Add 10% to the total for large frame: 190 X 10% = 19lbs
Answer: IBW = 209 lbs.

9. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

10. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

11. 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

12. Biochemical Tests
» Serum Albumin
» Serum Prealbumin
» Serum Transferrin
» Total Lymphocyte count (TLC)
» Fasting Blood Sugar/Glucose
(FBS or FBG)
» Glycosylated Hemoglobin
(HbA1C)
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7
» 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

13. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

14. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

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

16. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

17. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

18. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

19. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Obtain Routine Nutrition Screening Data • Learning Plan 7

20. 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
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

21. Changing Fluid Needs
 Fever
 Draining wounds
 Diarrhea
 Vomiting
 Hyperventilation
 Respirator
 Excessive perspiration
 Pressure ulcer (states II, III, IV)
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
 Congestive heart failure
 (CHF)
 Cardiac disease
 Renal disease
 Edema or ascites
Factors increasing fluid needs Factors decreasing fluid needs