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Assessment of Nutritional Status Sara Mitchell, RN, Ph.D., CPNP November 3, 2006.

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Presentation on theme: "Assessment of Nutritional Status Sara Mitchell, RN, Ph.D., CPNP November 3, 2006."— Presentation transcript:

1 Assessment of Nutritional Status Sara Mitchell, RN, Ph.D., CPNP November 3, 2006

2 Nutritional facts The prevalence of obesity has ________in the past 10 year by more that ____ About 97 million adult Americans are overweight or obese More than _______________are overweight

3 Nutritional facts Five of the leading causes of death in this country all diet related

4 Nutritional facts Over the past 30 years portions sizes have increased dramatically. The standard plate size was once 10inches but is now 12 inches

5 Food nourishes the body to: Provide _______for necessary activities Provide for the _______& ________of body tissue _________body processes

6 The Macronutrients Carbohydrates Protein Fat

7 The Micronutrients Vitamins Minerals Electrolytes

8 Resting energy expenditure (REE ) Uses the largest proportion of total energy expenditure by the body

9 Physical activity Constitutes the second largest proportion of total energy expenditure by the body

10 CategorySymptomsDiseases Decreased caloric intake  Loss of appetite o early satiety  Change in taste/dry or sore mouth & tongue  Difficulty chewing or swallowing  Nausea or vomiting  Self imposed diet  Social isolation/depression  Dysmobility  Gingivitis/poor dentition  Gastroparesis  Obstruction  Eating disorder  Malignancy Maldigestion/malabsorption  Diarrhea  Fatty, malodorous stools  Change in bowel habits  Food particles in stool  Pancreatic insufficiency  Crohn’s disease  Short bowel syndrome  Lactose intolerance  Celiac disease Impaired metabolism/increased requirements  Fever  Increased or decreased appetitie  AIDS  Pneumonia/sepsis  Major surgery or trauma  Hyperthyroidism  Chronic liver, renal, or pulmonary disease Increased losses/excretion  Draining fistulas or open wounds  Diarrhea  Increased urination  Excessive vomiting  Burns  Occult GI bleeding  Hemodialysis  Diabetes (glucosuria) Physiologic categories associated with weight loss Swartz, M.H. (2006) Textbook of Physical Diagnosis and History Examination (8 th ed.) Saunders: Philadelphia, PA

11 HerbCommon UseSide Effects & Interactions EchinaceaTreatment and prevention of URI’sRash, pruritus, dizziness St. John’s wortTreatment of mild to moderate depression GI upset, photosensitivity Gingko bilobaTreatment of dementiaMid GI distress, headache, possible anticoagulant effects GarlicTreatment of hypertension; hypercholesterolemia; atherosclerosis GI upset, gas, reflux, nausea, allergic reaction, antiplatelet effects Saw palmettoTreatment of benign prostatic hyperplasia Uncommon GinsengGeneral health promotionHigh does may cause diarrhea, hypertension; insomnia; nervousness. Siberian ginseng may alter digoxin level GoldensealTreatment of URI’sDiarrhea, hypertension, vasoconstriction AloeTopical application for dermatitis, herpes May delay wound healing after topical application; diarrhea and hypokalemia with oral use ValerianTreatment of insomnia, anxietyFatigue, tremor, headache Commonly Used Herbs and Their Side Effects Swartz, M.H. (2006) Textbook of Physical Diagnosis and History Examination (8th ed.) Saunders : Philadelphia, PA

12 Drugs Commonly associated with weight gain Antidepressants Lithium Antipsychotics  Phenothiazines  butyrophenones Anticonvulsants  Valporic acid  Carbamazepin Antidiabetics  Insulin  Sulfonylureas  thiazolidinediones Steroid hormones  Corticosteroid derivatives  Megestrol acetate  Estrogen

13 Questions to guide nutritional assessment Does nutrition contribute to the cause, severity, or treatment of the illness? How has the illness affected the patient’s diet and nutritional status? Does the patient see a relationship between diet and disease? Was the patient ever advised to follow a special diet or use other nutritional therapy?

14 Components of a nutritional assessment Nutritional health History Dietary Assessment Anthropometric measurements Biochemical & laboratory assessment Physical examination

15 Obesity-Focused History

16 Red Flags suggesting an eating disorder Weight preoccupation Poor-self-esteem, perfectionist personality Chronic medical illness Family history of eating disorders Use of appetite suppression and/or laxitives Cultural pressure for thinness or outstanding performance Athlete driven to excel Food cravings, restrictions Compulsive/binge eating Difficulties with communication

17 Special groups of people Infants & Children Adolescents Pregnant Women Older Adults

18 Food practices of some ethnic groups

19 “Hot” & “Cold” foods from a cultural perspective Depending on the “hot” and “cold” nature of the illness, some foods may be avoided.

20 Body Mass Index BMI = weight (kg)/height (meters) 2 or BMI = weight (pounds)/height (inches) 2 x 703 Obesity defined as a BMI of 25 kg/m 2 or higher

21 Waist-to-Hip Ratio Waist-to-hip ratio = Waist circumference ___________________________________________________________ Hip circumference A waist-to-hip ratio of 1 or greater in men or.8 or greater in women is indicative of android (upper body obesity) and increasing risk for obesity-related diseases and early mortality


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