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KEY CONCEPTS

KEY CONCEPTS

  • image Malnutrition encompasses both undernutrition and overnutrition (obesity), although the term is most often used to refer to undernutrition.

  • image Nutrition screening is distinct from nutrition assessment; an effective screening process should be designed to quickly and consistently identify those with preexisting malnutrition or those at risk for malnutrition.

  • image A comprehensive medical, surgical, and dietary history and a nutrition-focused physical examination (NFPE) are essential components of a comprehensive nutrition assessment.

  • image Anthropometrics, physical measurements of the size, weight, and proportions of the human body, are important parameters used to assess nutrition status.

  • image Laboratory assessment of nutrition status must be interpreted in the context of clinical status and acute and chronic inflammation.

  • image Macronutrient or micronutrient deficiencies or toxicities or risk factors for these deficiencies or toxicities can be identified by a comprehensive nutrition assessment.

  • image Evidence-based patient-specific goals should be established considering the patient's clinical condition and the need for maintenance or repletion in adults and continued growth and development in children.

  • image Validated predictive equations are most often used to determine energy requirements; however, if available, indirect calorimetry is the most accurate bedside method to determine energy requirements.

  • image Daily protein needs are based on age, sex, nutrition status, disease state, and clinical condition.

  • image Drug–nutrient interactions can affect response to drug therapy and nutrition status.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Watch the video entitled “Malnutrition Matters: A Call to Action for Providers Caring for Adult Patients.” This 15-minute video, sponsored by the American Society for Parenteral and Enteral Nutrition, is useful to enhance student understanding of malnutrition, the etiology of malnutrition, and identification of malnourished patients. This will aid in the COLLECT and ASSESS steps in the patient care process.

INTRODUCTION

Nutrition care is an essential component of quality patient care. Nutrition screening and assessment are integral components of the nutrition care process. No single clinical or laboratory parameter is an absolute indicator of nutrition status, so information must be collected and analyzed from a number of sources. This chapter reviews tools most commonly used for accurate, relevant, and cost-effective nutrition screening and assessment, including various methods used to determine patient-specific macro- and micronutrient requirements, and potential drug–nutrient interactions.

CLASSIFICATION OF NUTRITION STATUS

image Malnutrition encompasses both undernutrition and overnutrition (obesity), although the term is most often used to refer to undernutrition. Malnutrition is a consequence of nutrient imbalance. In general, deficiency states can be classified as those involving protein, energy, or single nutrients such as individual vitamins or trace elements. Many terms have been used to define malnutrition leading international nutrition experts to propose standardization of nomenclature for both adults and children.1,2 Starvation-associated malnutrition, marasmus, results from prolonged inadequate intake, absorption, or utilization of protein and energy. It can occur in patients with an inadequate food supply, anorexia nervosa, major depression, and malabsorption syndromes (Fig. 158-1). Somatic ...

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