Chpt 13 - Nutrition Assessment - Lake-Sumter State … Documents... · PPT file · Web view2017-02-09 · Nutrition Care and Assessment ... Nutrition assessment Nutrition diagnosis

© 2007 Thomson - Wadsworth

Chapter 13

Nutrition Care and

Assessment


Nutrition in Health Care• Health problems

Alter nutrition needs

Can lead to malnutrition

• Poor nutrition statusCan influence the

course of disease & body’s response to treatment

• Hospitalized patients40-60% with acute

illness are malnourished

Others decline in nutrition status within 3 weeks


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


Responsibility for Nutrition Care

• 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

• Physicians Prescribe diet orders

• Nurses Screen patients Participate in nutrition

assessments Provide direct nutrition

care• Other team members

such as pharmacists & speech therapists consult


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

• ScreeningMedical diagnosisMedical recordPhysical

measurementsLab reportsDiet history


Planning Care• The Nutrition Care

ProcessNutrition

assessmentNutrition diagnosisNutrition

interventionNutrition

monitoring & evaluation

• The Nursing ProcessAssessmentNursing diagnosisOutcome

identification & planning

ImplementationEvaluation



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


Historical Information• Medical history

AgeGenderWeightPrescription drugsOTC medicationsDietary

supplementsType of illness

• Social historyCultural heritageFinancial concernsWho prepares and

shops for foodLiving situation

• Diet historyFood intakeMeal patternsPhysical problems


Dietary Assessment Methods

• 24-hour recallAll foods & beveragesTime of day eatenAmounts consumedFood preparationTypical day?

• Food frequency questionnaire

• Food recordRecorded over

several daysRecorded as

consumedDoes not rely on

memory• Direct observation

Calorie countingTime consuming


Food Frequency Questionnaire


Anthropometric Data• Height: Adults• Length

Infants< 24 months

• WeightBMI% Usual body

weight% Ideal body

weight

• Head circumferenceAssesses brain

development< 3 years of age

• Circumference of waist & limbsEvaluates body fatEvaluates muscle

mass







Biochemical Analysis• Provides information about

Protein-energy nutritionVitamin & mineral statusFluid & electrolyte balanceOrgan functioning

• Analysis of blood & urine samples


Plasma Proteins• Albumin

Most abundantSlow to reflect

changes in status• Transferrin

Transports iron Indicates PEM &

iron statusSlow to detect

changes in status

• Prealbumin & retinol-binding proteinAlso called

transthyretinResponds quickly

to changes in protein status

Expensive test


Fluid Imbalance• Edema

Weight gainFacial puffinessSwelling limbsAbdominal

distentionTight-fitting shoes

• Diseases of heart, kidney, liver, lungs

• Dehydration ThirstDry skin or mouthReduced skin tensionDark yellow or amber

urine with low volume• Fever, sweating,

vomiting, diarrhea, burns


Assessment of Nutrition Status

• Functional AssessmentExercise toleranceRespiratory

muscle strength Immunity

• Integrating assessment dataSubjective Global

Assessment (SGA)Combines

historical information with results of physical examination
