between laboratory test results and changes in nutritional status.
•Differentiate the role of medications and disease as each affects laboratory test results.
•Apply principles of Nutrition Care Process in the laboratory assessment of nutritional status
CDR Learning Codes that can apply to this course include 2100, 3000, 3020, 3060, 5000, 5010, 5020, 5030, 5040, 5050, 5080, 5090, 5100, 5230 or other applicable codes.
Information for Self-Study Course Participants
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Other Users:
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Overview
All steps of NCP can incorporate laboratory values. In the Nutrition Assessment step, practitioners are to review data, cluster nutrition care indicators and identify standards by which the data will be compared. Next, determine the Nutrition Diagnosis. Under the clinical domain, biochemical section, are the nutrition diagnosis specifically related to changes in laboratory values. Laboratory values may be incorporated into PES statements in the signs and symptoms section as well. In the final step of NCP, Nutrition Monitoring and Evaluation, laboratory data may be useful to determine if Nutrition Diagnoses are resolved or new ones are present. It is important to remember that requesting more laboratory testing does not always equate with best practices. Centers for Medicare (CMS) F-tag 314, Comprehensive Assessment under nutrition, malnutrition & hydration deficits states:
‘Although some laboratory tests may help clinicians evaluate nutritional issues in a resident with pressure ulcers, no laboratory test is specific or sensitive enough to warrant serial/repeated testing.
Serum albumin, prealbumin and cholesterol may be useful to help establish overall prognosis; however, they may not correlate well with clinical observation of nutritional status.’
Incorporating laboratory assessment as a tool to assess nutrition status is supported in the research literature and used by other medical team members. Laboratory Assessment of Nutritional Status: Bridging Theory & Practice is a reference to assist the healthcare practitioner in documenting the role of medical nutrition therapy through NCP.
Implications of Selected Laboratory Tests
Not all tests are appropriate for all patients, i.e. creatinine excretion cannot be used to evaluate muscle mass in patients with renal failure because the test assumes normal renal function. Remember that the overall medical condition of the patient, the current medications, and the psychoneuroimmunology must be considered in the interpretation of laboratory tests.
Changes in Nutritional Status
A single laboratory test may or may not reflect improved nutritional status once a medical nutrition therapy intervention program has begun. Changes in hydration status significantly affect the laboratory results. More than one laboratory test is required to accurately document changes in nutritional status. Using support data such as physical findings, changes in anthropometric data, reported symptoms and diet will increase confidence in laboratory results.
Impact of Inflammation
Inflammatory response occurs with or without infection. The classic signs are redness, swelling, pain, heat and loss of function. When the inflammation occurs in internal organs or structures, all the classic signs of inflammation may not be present. Inflammation triggers an immune response which initiates the release of both proinflammatory and anti-inflammatory cytokines. To combat the proinflammatory cytokines, the body must mobilize nutrient stores to produce acute phase proteins and T and B lymphocytes.
Acute Phase Proteins
Acute phase proteins are either positive or negative. In the presence of inflammation, with or without infection, the synthesis of positive acute phase proteins increases dramatically at the expense of the negative acute phase proteins. The concentration
