Malnutrition Risk Screening in the Settings of Acute Illness or Injury, Chronic Illness, and in the Context of Social or Environmental Circumstances

Transcription

1 Malnutrition Risk Screening in the Settings of Acute Illness or Injury, Chronic Illness, and in the Context of Social or Environmental Circumstances ANDREA NS BUCKINGHAM, MS MONTANA DIETETIC INTERN MONTANA STATE UNIVERSITY

2 Objectives! Identify! Risk-screening criteria prior to assessment! Illustrate! Risk-screening criteria throughout assessment! Indicate! Context! Diagnosis! Progression

3 Introduction! What is?! Under- verses over-nutrition! Protein and energy inadequacy! Micronutrient inadequacy! Severe versus non-severe (moderate)! Who is affected by?! All demographics! Low-, middle-, and high-income (Steiber et al., 1335)

4 Introduction continued! What are the risk factors for?! Acute illness or injury! Chronic illness! Social or environmental circumstances " Food insecurity (Pooler et al., 2)

5 Introduction continued! Why should healthcare professionals care?! Improve complications! Improve mortality rates! Improve financial costs (Correia & Waitzberg, 238; Norman et al., 6)

6 P/C risk screening characteristics! Energy intake! Interpretation of weight loss! Body fat! Muscle mass! Fluid accumulation! Grip strength (Mordarski & Wolff, 4-5)

7 P/C characteristic- energy intake! Acute illness or injury! < 75% for > 7 days! 50% for 5 days! Chronic illness! < 75% for 1 month! 75% for 1 month! Social/environmental circumstances! < 75% for 3 months! 50% for 1 month (Mordarski & Wolff, 4)

8 P/C characteristic- weight loss Acute Illness or Injury Chronic Illness Social or environmental circumstances Non-severe (moderate) Severe Non-severe (moderate) Severe Non-severe (moderate) Severe % time % time % time % time % time % time wk. >2 1 wk. 5 1 mo. >5 1 mo. >5 1 mo. >5 1 mo. 5 1 mo. >5 1 mo mo. >7.5 3 mo. >7.5 3 mo. >7.5 3 mo mo. >7.5 3 mo mo. >10 6 mo. >10 6 mo. >10 6 mo year >20 1 year >20 1 year >20 1 year (Mordarski & Wolff, 4; Hickson, 2)

9 P/C characteristic- weight loss 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 1 week 1 month 3 months 6 months 12 months

10 P/C characteristicbody fat loss and muscle wasting Acute Illness or Injury Non-severe (moderate) Severe Chronic Illness Non-severe (moderate) Severe Social or environmental circumstances Non-severe (moderate) Severe Mild Moderate Mild Moderate Mild Moderate (Mordarski & Wolff, 5)

11 Fat loss and muscle wasting! Fat! Orbital! Triceps! Ribs! Muscle! Temple! Clavicle! Hand! Calf

12 P/C characteristicfluid accumulation Edema Depth Time for rebound Degree 1+ 2 mm indent Disappear rapidly Mild pitting mm indent 15 seconds to rebound Moderate pitting mm indent 30 seconds to rebound Moderately severe pitting mm indent >60 seconds to rebound Severe pitting (Mordarski & Wolff, 5 & 22)

13 P/C characteristic- grip strength %20&%20Test%20Strength.htm Hand-Dynamometer (Mordarski & Wolff, 5)

14 S/S of Micronutrient Malnutrition! Head and Neck! Hair! Eyes! Face! Oral cavity! Lips! Tongue! Gums! Taste! Teeth! Nails! Skin! Gastrointestinal! Skeletal system! Muscular system! Nervous system

15 Context, Diagnosis, and Progression of Malnutrition! Multiple contexts! Acute injury and chronic illness! Acute injury and environmental circumstance! Chronic illness and environmental circumstance! Patient must have 2 characteristics! Chronic condition 3 months

16 Conclusions! Malnutrition is a public health problem! Can affect anyone! Assessing risks and their context! Acute! Chronic! Social/Environmental! RD role- identify and intervene

17 Thank You! Presentation attendees! Coleen Kaiser and Anna Diffenderfer! Fellow dietetic interns! Family and friends

18 Open Discussion Questions or comments?

19 Works Cited! Hickson, M. Malnutrition and aging. Postgraduate Medical Journal: vol. 82, no. 963, 2006, pp Google Scholar, doi: /pgmj ! Mordarski, B. & Wolff, J. Nutrition Focused Physical Exam Pocket Guide: Putting it All Together. Academy of Nutrition and Dietetics, 2015.! Steiber, A., Hegazi, R., Herrera, M., Zamor, M.L., Chimanya, K., Pekcan, A.G., Redondo-Samin, D.C.D., Correia, M.I.T.D., & Ojwang, A.A. Spotlight on Global Malnutrition: A Continuing Challenge in the 21 st Century. Journal of the Academy of Nutrition and Dietetics: vol. 115, no. 8, 2015, pp Academy of Nutrition and Dietetics, Pooler, J., Levin, M., Hoffman, V., Karva, F., & Lewin-Zwerdling, A. Implementing Food Security Screening and Referral for Older Patients in Primary Care: A Resource Guide and Toolkit. AARP Foundation & Impaq International, 2016.! Correia, M.I.T.D. & Waitzberg D.L. The impact of on morbitity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical Nutrition: vol. 22, no. 3, 2003, pp Elsevier, Norman, K., Pichard, C., Lochs, H., & Pirlich. Prognostic impact of disease-related manlnutrition. Clinical Nutrition: vol. 27, 2008, pp Elsevier, doi: /j.clnu