Copyright 2002, Delmar, A division of Thomson Learning Chapter 7 Nutritional Assessment

Copyright 2002, Delmar, A division of Thomson Learning

Chapter 7

Nutritional Assessment


Competencies Describe the recommended dietary

allowances for adequate nutritional intake for all age groups.

Identify nutritional differences for different age groups.

Perform a nutritional history and physical assessment.

(continues)


Competencies Perform anthropometric

measurements. Describe the most common

pathophysiologies for abnormal findings.

Describe laboratory analyses needed and their clinical significance to the nutritional assessment.


Dietary Guidelines Recommended dietary allowances

(RDA) Food guide pyramid

Six food groups Fats, oils, and sweets: use sparingly Milk, yogurt and cheese: 2–3 servings/day Meat, poultry, fish, eggs: 2–3 servings/day

(continues)


Dietary Guidelines

Vegetables: 3–5 servings per day Fruits: 2–4 servings per day Breads, cereal, rice, pasta: 6–11

servings per day


Nutrition Through the Life Cycle Children

Daily needs change based on age group

Infants Rapid growth and development Preferred to breast feed for first 12

months

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Nutrition Through the Life Cycle

Assess reflexes—sucking, rooting, swallowing

Assess physical development


Infant Feeding Guidelines Introduce foods one at a time Begin with foods that are least

allergenic Avoid egg whites and citrus

fruits until 12 months old Avoid honey in infants under 12

months


Nutritional Assessment of Infants Breastfed? How often? How long? Bottle-fed? How often? How much? Formula preparation? Storage? How does the infant respond to

eating? Constipation? Diarrhea? Is the infant ever put in bed with a

bottle?


Nutritional Guidelines for Toddlers Physical growth slows Increased independence Small portions Offer one new food at a time Serving size 1–2 tbsp for each year

of age Routine mealtimes


Nutritional Guidelines for Preschoolers Independence May become a picky eater Offer food choices Serve small servings Finger foods Routine mealtimes Involve in food preparation


Nutritional Guidelines for School-Age Children Erratic growth and eating patterns Strong food preferences Balanced diet Limit highly sweetened snacks and

foods


Nutritional Assessment of Young Children Concerns with child’s eating? Child’s food preferences? Involvement in sports? Physical

activity? Child’s meal schedule? Balanced diet? Food allergies?


Nutritional Guidelines for Adolescents Period of rapid growth and change Fluxuating nutritional needs Concerns with body image Risks for eating disorders Adjustments to caloric needs based

on physical activity level


Nutritional Assessment of Adolescents Participation in physical activity? Adhere to a specific diet or meal plan? Skip meals? Satisfaction with current weight? Consumption of snacks? Have you ever induced vomiting, used

laxatives, diuretics, or diet pills to control weight?


Nutritional Guidelines for Young and Middle-Aged Adults Growth and caloric needs stabilize Eating habits may be influenced by

activity levels, life stressors Nutritional risks for development of

disease Obesity Osteoporosis (continues)


Nutritional Guidelines for Young and Middle-Aged Adults

Type 2 Diabetes Mellitus Atheroschlerosis


Nutritional Assessment of Young and Middle-Aged Adults Caloric intake? Adherence to specific diet? Satisfaction with current weight? Physical activity? Consumption of snacks? Typical meal patterns?


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Nutritional Guidelines for Pregnant and Lactating Women Role of proper nutrition in

development of healthy infant Target weight gain for pregnancy Iron supplements Prenatal vitamins


Nutritional Guidelines for Pregnant and Lactating Women Folic acid Additional caloric intake for

pregnancy and lactation Adhere to food guide pyramid Fluid consumption


Nutritional Assessment of Pregnant Women Prepregnancy weight? Ideal body weight (IBW)? Use of supplemental vitamins? Consumption of caffeine, artificial

sweeteners, alcohol? Presence of constipation, nausea,

vomiting, or heartburn? Presence of food cravings?


Nutritional Guidelines for the Older Adult Decreased caloric requirements Adhere to food guide pyramid,

except consume decreased portion size

Encourage to eat in a sitting position Encourage adequate fluid intake and

high fiber diet

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Nutritional Guidelines for the Older Adult Nutritional risk factors

Difficulty chewing or swallowing Decreased appetite Decreased ability to feed self Decreased taste and smell Decreased esophageal emptying time


Nutritional Assessment of Older Adults Presence of physical limitations that

affect eating? Difficulty chewing or swallowing? Presence of dental problems? Difficulty obtaining or preparing

foods? Do you eat alone?


Cultural Differences in Nutrition Cultural beliefs related to the

consumption of food Religious beliefs related to the

consumption of food Food restrictions Periods of fasting


Components of a Nutritional Assessment Nutritional history Physical assessment Anthropometric measurements Laboratory data Diagnostic data


Nutritional History General diet information

Changes in past 12 months Ability to obtain and prepare foods Food preferences Adherence to particular diet Consumption of fast foods

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Nutritional History Food intake history

24-hour recall Food diary

Calorie count Evaluation of adequacy of diet

Food guide pyramid


Physical Assessment Head to toe Assess for subjective and

objective signs and symptoms of poor nutritional status


Signs and Symptoms of Poor Nutritional Status Subjective data

Fatigue Weight changes Changes in appetite Weakness Changes in bowel habits

(continues)


Signs and Symptoms of Poor Nutritional Status Objective data

Weight changes Dry, rough, scaly skin Dry, cracked lips Swollen, bleeding gums Edema Decreased muscle tone


Anthropometric Measures Height Weight Ideal body weight, percent IBW Percent weight change Triceps skinfold BMI Mid-arm circumference Waist/hip ratio


Laboratory Data Hematocrit and hemoglobin Cholesterol and triglyceride levels Transferrin, TIBC, iron Total lymphocyte count Albumin and prealbumin Glucose Creatinine and nitrogen


Diagnostic Data Radiographic studies

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Copyright 2002, Delmar, A division of Thomson Learning Chapter 7 Nutritional Assessment