1. Nutrition Care and Assessment
Chapter 13
Nutrition Care and Assessment
© 2007 Thomson - Wadsworth

2. Nutrition in Health Care
Health problems
Alter nutrition needs
Can lead to malnutrition
Poor nutrition status
Can influence the course of disease & body’s response to treatment
Hospitalized patients
40-60% with acute illness are malnourished
Others decline in nutrition status within 3 weeks
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3. How Illness Affects Nutrition Status
Reduced food intake
Nausea
Inflammation of mouth
Medications can cause GI upset
Interferes with digestion & absorption
Alters metabolism & excretion
Dietary restrictions for some surgeries or chronic illnesses
Drain on financial resources
Unable to prepare food
Emotional upset
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4. Responsibility for Nutrition Care
Physicians
Prescribe diet orders
Nurses
Screen patients
Participate in nutrition assessments
Provide direct nutrition care
Other team members such as pharmacists & speech therapists consult
Registered Dietitians
Provide medical nutrition therapy
Assess, diagnose, develop,implement & evaluate nutrition care plans
Plan & approve menus
Provide education
Registered Dietetic Technician
Assist the Registered Dietitians
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5. Identifying Risk for Malnutrition
Nutrition screening
Identifies persons at risk for nutrition problems
Must be done 24 hours after admission
Should be completed in 5-15 minutes
Screening
Medical diagnosis
Medical record
Physical measurements
Lab reports
Diet history
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6. Planning Care The Nutrition Care Process The Nursing Process
Nutrition assessment
Nutrition diagnosis
Nutrition intervention
Nutrition monitoring & evaluation
The Nursing Process
Assessment
Nursing diagnosis
Outcome identification & planning
Implementation
Evaluation
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8. The Nutrition Care Process
Assessment
Medical, social, & dietary histories
Anthropometric data
Biochemical analysis
Physical exam
Diagnosis
Actual or potential
Problem, etiology, signs & symptoms
Intervention
Dietary changes
Nutrition education
Medication changes
Monitoring & evaluation
May need to modify the plan
Must be flexible
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9. Historical Information
Medical history
Age
Gender
Weight
Prescription drugs
OTC medications
Dietary supplements
Type of illness
Social history
Cultural heritage
Financial concerns
Who prepares and shops for food
Living situation
Diet history
Food intake
Meal patterns
Physical problems
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10. Dietary Assessment Methods
24-hour recall
All foods & beverages
Time of day eaten
Amounts consumed
Food preparation
Typical day?
Food frequency questionnaire
Food record
Recorded over several days
Recorded as consumed
Does not rely on memory
Direct observation
Calorie counting
Time consuming
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11. Food Frequency Questionnaire
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12. Anthropometric Data Height: Adults Length Weight Head circumference
Infants
< 24 months
Weight
BMI
% Usual body weight
% Ideal body weight
Head circumference
Assesses brain development
< 3 years of age
Circumference of waist & limbs
Evaluates body fat
Evaluates muscle mass
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18. Biochemical Analysis Provides information about
Protein-energy nutrition
Vitamin & mineral status
Fluid & electrolyte balance
Organ functioning
Analysis of blood & urine samples
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19. Plasma Proteins Albumin Transferrin
Albumin
Most abundant
Slow to reflect changes in status
Transferrin
Transports iron
Indicates PEM & iron status
Slow to detect changes in status
Prealbumin & retinol-binding protein
Also called transthyretin
Responds quickly to changes in protein status
Expensive test
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20. Fluid Imbalance Edema Diseases of heart, kidney, liver, lungs
Weight gain
Facial puffiness
Swelling limbs
Abdominal distention
Tight-fitting shoes
Diseases of heart, kidney, liver, lungs
Dehydration
Thirst
Dry skin or mouth
Reduced skin tension
Dark yellow or amber urine with low volume
Fever, sweating, vomiting, diarrhea, burns
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21. Assessment of Nutrition Status
Functional Assessment
Exercise tolerance
Respiratory muscle strength
Immunity
Integrating assessment data
Subjective Global Assessment (SGA)
Combines historical information with results of physical examination
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