1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrition in Nursing Chapter 1

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutritional Screening Nutritional screen –Quick look at a few variables to judge a client’s relative risk for nutritional problems –No accepted universal tool –JCAHO mandates that screen must be done within 24 hours of admission to the hospital

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutritional Screening (cont’d) Comprehensive nutritional assessment –Moderate to high risk at screening referred to dietitian for assessment –Nutritional care process: 4 steps oAssessment oNutritional diagnosis oImplementation oMonitoring and evaluation

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutritional Screening (cont’d) Comprehensive nutritional assessment (cont’d) –Different from nursing care plan oDietitians can get most of information from nursing admission assessment oDietitians interview patients and/or families to obtain a nutrition history –Helps to differentiate: oNutrition problems caused by inadequate intake from those caused by illness or its treatments

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutritional Screening (cont’d) Comprehensive nutritional assessment (cont’d) –Dietitians oCalculate estimated calorie and protein requirements based on the assessment data oDetermine nutritional diagnoses that define the nutritional problem, etiology, and signs and symptoms oMay also determine the appropriate malnutrition diagnosis o Formulate nutrition interventions

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition Assessment –Data classified as ABCD: oAnthropometric oBiochemical oClinical oDietary data –Client’s medical-psychosocial history is also evaluated for its impact on nutritional status

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Anthropometric data –Physical measurements of the body –Body mass index o“Healthy” or “normal” BMI is defined as 18.5 to 24.9 oAbove or below related to health risks –“Ideal” body weight –Edema or dehydration skews accurate weight measurements –Recent weight change

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Biochemical data –No single test is both sensitive and specific for protein-calorie malnutrition –Biochemical data may help support the diagnosis of a nutritional problem

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Albumin –Often used to assess protein status –Serum levels may be maintained until malnutrition is in a chronic stage –Low albumin may indirectly identify patients who may benefit from nutrition assessment and intervention Prealbumin –Thyroxin-binding protein –More sensitive indicator of protein status –More expensive to measure

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Clinical data –Physical signs and symptoms of malnutrition observed in the client –Most signs cannot be considered diagnostic –Physical signs and symptoms of malnutrition can vary in intensity among population groups because of genetic and environmental differences –Physical findings occur only with overt malnutrition

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Dietary data –Nurse should ask, “Do you avoid any particular foods?” –Nurse should not ask, “Are you on a diet?” Medical psychosocial history –May shed light on factors that influence intake, nutritional requirements, or nutrition counseling

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Medication –Both prescription and over-the-counter drugs have the potential to affect and be affected by nutritional status –At greatest risk for development of drug-induced nutrient deficiencies include those who: oHabitually consume fewer calories and nutrients than they need oHave increased nutrient requirements including infants, adolescents, and pregnant and lactating women oAre elderly oHave chronic illnesses

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) At greatest risk for development of drug-induced nutrient deficiencies include those who (cont’d): –Take large numbers of drugs (five or more), whether prescription drugs, over-the-counter medications, or dietary supplements –Are receiving long-term drug therapy –Self-medicate –Are substance abusers

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Nursing diagnosis –Provide written documentation of the client’s status –Serve as a framework for the plan of care that follows Planning: client outcomes –Outcomes, or goals, should be measurable, attainable, specific, and client centered –Focus on the client, not the health care provider –Keep in mind that the goal for all clients is to consume adequate calories and protein using foods they like and tolerate as appropriate

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Nursing interventions –Nutrition therapy oDiet is a four-letter word with negative connotations oUsually general suggestions to increase/ decrease, limit/avoid, reduce/encourage, or modify/maintain aspects of the diet because exact nutrient requirements are determined on an individual basis oNutrition theory does not always apply to practice

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Nutrition (cont’d) Nursing interventions (cont’d) –Client teaching oClients in clinical settings may be more receptive to nutritional advice oHospitalized patients are also prone to confusion about nutrition messages Monitoring and evaluation –Monitoring precedes evaluation –Evaluation assesses whether client outcomes were achieved

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Physical Signs & Symptoms of Malnutrition Hair is dull, brittle, dry, or falls out easily Swollen glands of neck and cheeks Dry, rough, or spotty skin Poor or delayed wound healing or sores Thin appearance with lack of subcutaneous fat Muscle wasting Edema of lower extremities Weakened hand grasp Depressed mood Abnormal heart rate/rhythm and BP Enlarged liver or spleen Loss of balance and coordination

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses With Nutritional Relevance Altered nutrition: more than body requirements Altered nutrition: less than body requirements Altered nutrition: risk for more than body requirements Constipation Diarrhea Fluid volume excess Fluid volume deficit

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses With Nutritional Relevance (cont’d) Risk for aspiration Altered oral mucous membrane Altered dentition Impaired skin integrity Noncompliance Impaired swallowing Knowledge deficit Pain Nausea