NHHC chapter 13 powerpoint

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition Careand Assessment

Chapter 13


Nutrition in Health Care

• Correcting nutritional problems– May improve outcomes of medical treatments

and help to prevent complications• Poor nutrition status

– Weakens immune function– Compromises a person’s healing ability

• What are ways in which illness can affect nutrition status? (Figure 13-1)


Nutrition in Health Care (cont’d.)

• Illnesses and their treatments may lead to malnutrition– Causing a reduction in food intake– Interfering with digestion and absorption– Altering nutrient metabolism and excretion

• Dietary changes for acute illness– Temporary; can be tailored to individual’s

preferences and lifestyle



• Dietary changes for chronic illness– May require long-term adjustments in diet and

lifestyle• Challenges to nutritional status

– Health care costs: drain of financial resources– Insufficient space and equipment– Lack of strength and energy– Emotional health



• Responsibility for nutrition care– What are critical (clinical) pathways?– Physicians

• Responsible for meeting all of a patient’s medical needs: diet orders

– Nurses• Screen patients for nutrition problems• Participate in nutrition and dietary assessments• Members of nutrition support teams



• Responsibility for nutrition care– Registered dietitians

• Provide medical nutrition therapy• What are specific examples of their involvement?

– Registered dietetic technicians• Work in partnership with registered dietitians• Other roles may include supervising foodservice

operations, inventory, quality control, etc.



• Responsibility for nutrition care– Other health care professionals

• Pharmacists, physical therapists, occupational therapists, speech therapists, nursing assistants, home health care aides, and social workers

• Nutrition screening– Identifies patients who are malnourished or at

risk for malnutrition




• Nutritional screening– Subjective Global Assessment (Table 13-2)

• Nursing diagnoses– Clinical judgments about actual or potential

health problems that provide: basis for selecting appropriate nursing interventions




• Nutrition care process– Systematic approach to medical nutrition

therapy implemented by registered dietitians• Nutrition assessment: collection and analysis of

health-related data• Nutrition diagnosis: what is included in a diagnosis?• Nutrition intervention: appropriate plan• Nutrition monitoring and evaluation: determine

effectiveness



Nutrition Assessment

• Historical information– Sources

• Medical record• Interviewing the patient of caregiver

– Medical history– Medication and supplement history– Personal and social history– Food and nutrition history: diet history



Nutrition Assessment (cont’d.)

• Dietary assessment– Methods for obtaining food intake data (Table

13-6)– The 24-hour dietary recall

• Guided interview• Foods and beverages consumed during the

previous day• What is involved in the multiple-pass method?



• Dietary assessment– Food frequency questionnaire (Figure 13-3)

• Foods and beverages regularly consumed during a specific time period

• May collect qualitative only or semiquantitative information

• What are limitations of this tool?



• Dietary assessment– Food record

• Written account of foods and beverages consumed during a specified time period, usually several consecutive days

– Direct observation• Food intakes directly observed and analyzed• Nurses: conduct patients’ kcalorie counts



• Anthropometric data– Related to physical measurements of the

human body• Can reveal nutritional problems: overnutrition or

protein-energy malnutrition (PEM)– “How To” Measure Length and Height



• Anthropometric data– Body weight

• May reflect changes in body water due to illness• Involuntary weight loss: can be a sign of PEM• “How To” Measure Weight



• Anthropometric data– Head circumference

• Children up to three years old: assess brain growth and malnutrition

• Premature and small-for-gestational-age infants: track brain development

– Circumferences of waist and limbs• Waist: body fat evaluation• Limbs: muscle mass determination



• Anthropometric assessment– Infants and children

• Evaluate growth: periodic measurements of height (length), weight, and head circumference: plotted on growth charts

– Adults• Evaluate the nutritional risks associated with

illness: clinicians monitor both the total reduction in body weight and the rate of weight loss over time







• Anthropometric assessment– Adults

• In addition to body weight, why are skinfold and limb circumference measurements important in a nutrition assessment?



• Biochemical analyses– Information about protein-energy nutrition,

vitamin and mineral status, fluid and electrolyte balances, and organ function

– Typically blood and urine samples– Repeated measures

• Indicate improving or worsening condition– Routine laboratory tests (Table 13-9)



• Biochemical analyses– Serum proteins: protein-energy status– Albumin: gauge severity of illness– Transferrin: what is the correlation between

iron status and transferrin levels?– Prealbumin and retinol-binding protein

• Decrease rapidly during PEM • Respond quickly to improved protein intakes



• Physical examination– Interpreting physical signs of malnutrition

• Requires skill and clinical judgment– Clinical signs of malnutrition (Table 13-10)

• Where do signs of malnutrition most commonly appear on the body?



• Physical examination– Hydration status

• Fluid retention (edema)• Dehydration

– Functional assessment• Nutrient deficiencies sometimes impair

physiological functions: tests or procedures may be conducted to aid evaluation



• Physical examination– Functional assessment

• Examples: skin’s response to antigens; hand-grip strength; and exercise tolerance

• Case Study – Nutrition Screening and Assessment

Education

NHHC chapter 13 powerpoint