Nutritional Needs of a client

By Mr. Manasseh Mvula4th year BSc student

General objective

At the end of this lecture, a student should have knowledge on meeting basic client nutritional needs.

Specific Objectives

At the end of this lecture, a student should be able to;

• Define nutrition and nutritional status• State four (4) methods that can be used in

assessment of nutritional status• Describe in detail the four (4) approaches

used to assess the nutritional status

Cont’d

• Outline factors influencing diet requirements and intake• Explain general guidelines on food

preparation and serving

Introduction

0Nutrition (also called nourishment) is the provision, to cells and organisms of the materials necessary in the form of food to support life (Williams S.R., 1995). 0Nutrition concerns the food people eat

and how their bodies use it.

Cont’d

0Nutritional status is the balance between the intake of nutrients by an organism and the expenditure of these in the processes of growth, reproduction, and health maintenance (Williams S.R., 1995).

Assessment of Nutritional status

0Nutritional assessment of the client is an integral part of the total health assessment because food and fluid are the basic biologic needs (Wilson and Giddens, 2005).

0Commonly summarized by the mnemonic "ABCD," which stands for Anthropometric measurement, Biochemical or laboratory tests, Clinical indicators, and Dietary assessment.

Anthropometric method0Anthropometry is a measurement system of

size and makeup of the body (Potter and Perry, 2005).

0Approaches are usually non-invasive and generally assess the size or body composition of an individual.

0For adults, body wt and ht are used to evaluate overall nutritional status and to classify individuals as at healthy or non-healthy weights

Cont’d

0The most recent classification is to use Body Mass Index (BMI, in kg/m2).

0BMI, regardless of population, is normal at 18.5 to 25.0 kg/m2, overweight at 25.0 to 29.9 kg/m2, and obese at over 30.0 kg/m2.

0In general BMI greater than 30 is assumed to be due to excessive adiposity.

Cont’d0 In children, growth charts, have been developed to allow

clinicians to assess weight-and height-for-age, as well as weight-for-height.

0 For children, low height-for-age is considered stunting, while low weight-for-height indicates wasting.

0 In addition to wt and ht, measures of Mid Upper Arm Circumference (MUAC)and skin fold measured over the triceps muscle at the mid-arm are used to estimate fat and muscle mass.

0 Anthropometric measures of nutritional status can be compromised by other health conditions eg oedema characteristic of some forms of malnutrition can conceal wasting by increasing body weight.

Stretch time…

Biochemical or laboratory tests

0No single biochemical and laboratory test is diagnostic for malnutrition (Potter and Perry, 2005).

0The tests provide objective data to nutritional assessment

Cont’d

0The tests most commonly used are: Serum proteins- tests include Hb which

provide information regarding red blood cells and can provide information on iron and Vit B12 deficiency. Others are blood glucose which reflect carbohydrate metabolism.

Cont’d

Urine tests- urinary Cr reflects a persons’ total muscle mass. The greater the muscle mass the greater the excretion of Cr.

Total lymphocyte count- certain nutrient deficiencies and forms of protein-calorie malnutrition can depress the immune system.

Clinical indicators

0A nurse performs a nutritional screen An assessment performed to identify clients

at risk for malnutrition or those undernourished.

0This is a quick physical examination that assesses body systems because effects of improper nutrition affect all body systems and can give clues to malnutrition.

Cont’d

0A nurse can assess the general appearance for cachexia and apathy, CVS for heart rate and BP, GI system for anorexia, indigestion and constipation.0 The nurse can also assess the hair, skin,

face and neck, lips, gums, teeth, eyes and nails.

Dietary Assessment

0This is a more specific diet history used to assess the client’s actual and potential needs (Potter and Perry, 2005).

0Components:Diet

Number of meals per dayFood preferences and preparation practices

Components cont’d

Unpleasant symptomsIndigestion, heartburn, gas

AllergiesChewing and swallowingAppetiteElimination

Factors influencing Diet requirements and Intake

Age Children normally require a lot of

carbohydrates, proteins and vitamins for proper growth and repair.

For infants for example, breast milk is the ideal food and they require to be fed whenever necessary.

Cont’d

Religious practices Some religious practices like Rastafarians

encourage adoption of vegetarian diets.

Cultural practices Some cultural practices forbid intake of

certain foods for example some cultures in Zambia forbid pregnant women to eat eggs.

Cont’dOccupation and Physical Activities Nutrients give the energy needed to perform the daily

activities of living. The amount of energy used by the body is the energy

expenditure and this varies widely from individual to individual.

When we do more work, our body requires more energy to keep our bodies healthy

Workers like army recruits, builders and athletes need more food that contains more nutrients such as carbohydrates, protein and fats.

Cont’d

Environment’s Weather For example on the weather, people are

more likely to consume more food during the cold rather than hot weather.

People tend to eat more during the cold season.

Cont’d

Disease Disease states like, burns and malnutrition

require a special diet if healing is to take place.

Other factors include social and economic status.

Preparation and serving of food to patients

0Food should be prepared in a hygienic manner to prevent food poisoning.

0It is important to always prepare food that a patient prefers and enjoys although some patients may require health education on the type of food to avoid drug interactions and malnutrition.

Cont’d

0On serving, food should be attractive in appearance.

0Serving food neatly can stimulate the client’s appetite.

0 It is good practice to ensure that the client receives and eats their prescribed diet.

0Cultural and religious aspects of patients should be taken into consideration as well as the level of consciousness.

Take home points

0Nutrition is the provision, to cells and organisms of the materials necessary in the form of food to support life whereas Nutritional status is the balance between the intake of nutrients by an organism and the expenditure of these in the processes of growth, reproduction, and health maintenance.

Cont’d0Nutritional assessment of the client is an

integral part of the total health assessment because food and fluid are the basic biologic needs.

0The purpose of the nutritional assessment is to identify patients at risk for malnutrition and those with poor nutritional status.

0Four main methods exist for nutritional assessment namely anthropometric, biochemical, clinical indicators and dietary assessment abbreviated as ABCD.

Cont’d

0Nutrition being the basic biologic need, is affected by many factors some of which include age and culture.

0Finally, when preparing food for the patient, it is best practice to prepare food according to the patient’s preference and taking into account factors like culture and religion.

Assignment

0Read and write brief notes on the importance of meeting the client basic nutritional need.

References

0Potter, A,P and Perry, A,G(2005), Fundamentals of Nursing, 6th Edition, Mosby, USA.

0Wilson S.F, Giddens J.F (2005), Health Assessment for Nursing Practice, 3rd edition, Elsevier Mosby, USA

0Williams S.R (1995), Basic Nutrition and Diet Therapy, 10th edition, Mosby publishers, USA

End of LectureHave a blessed day