Nutritional Assessment Ch 11 HM Jarvis

What are the various methods for collecting current dietary intake information?

-24 hour recall -food diary -food frequency questionnaire -direct observation

Food diary

written record of everything consumed for a certain period of time. It is most accurate if you teach the individual to record info immediately after eating. Potential problems: -noncompliance -inaccurate recording -atypical intake on recording days - conscious alteration of diet on recording period.

24 hour recall

Recount what and how much eaten in the past 24 hours A questionnaire is used to recall what was eaten in last 24 hours Prone to error: individual or family may not recall type or amount, truth may be altered, snack foods may go unreported, food may be atypical

What are some signs of malnutrition?

Skin: dry, flaky, scaly, cracks, lesions Hair: Dull, dry, sparse, corkscrew hair Eyes: Foamy plaques, dryness, pale, red Lips: Cheilosis (cracked lips), ulcers Tongue: Beefy red, pale, atrophic, hypertrophic Gums: Bleeding Nails: Brittle, ridged or spoon shaped (koilonychia) Musculoskeletal: Pain in calves, thighs, osteomalacia , rickets, joint pain, muscle wasting Neurologic: peripheral neuropathy, disorientation or irritability, decreased reflexes

anthropometric measurements of the arm

SkinfoldThickness (TSF) Triceps measurement of skinfold with calipers Provides estimate of body fat stores or the extent of obesity or malnutrition Mid Upper Arm Circumference (MAC) Estimates skeletal muscle mass and fat stores May not work well with saggy skin

What factors create differences in food intake?

Socioeconomic status Work schedule Religion Ethnic background

Developmental considerations

Special needs of pregnant women, infants and children Adolescents Body ideal Anabolic steroid use Snacks Binging/purging Aging adult- what factors affect the way you eat?

define over nutrition

caused by the consumption of nutrients-especially calories, sodium, and fat- in excess of body needs. A major nutritional problem today--> over nutrition can lead to obesity and is a risk factor for heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers and osteoarthritis.

Food frequency questionnaire

information is collected on how many times a day, week, mos. a particular food is eaten. -provides an estimate of usual intake disadvantages: -does not quantify amount of intake - relies on a person or family member's memory to be able to recall food that was eaten

what is optimal nutritional status?

is achieved when sufficient nutrients are consumed to support day to day body needs and any increased metabolic demands due to growth, pregnancy, or illness. Persons's having optimal nutritional status are more active, have fewer physical illnesses, and live longer than persons who are malnourished.

types for detecting nutritional problems in the physical aspect

Chronic illnesses Draining wounds Obesity or wt gain of 20% above normal Unplanned wt loss of 20% below normal Cystic fibrosis GI disturbances Anorexia/bulimia Chemo, radiation Pregnancy Burns

Define nutritional status

refers to the degree of balance between nutrient intake and nutrient requirements. This balance is affected by many factors, including physiologic, psycho-social, developmental, cultural, and economic.

Life style factors can be detected problems in nutrition. Name some factors

Financial problems Mobility impairment Transportation problems

clinical signs of nutritional assessment

General Appearance: obese, cachectic Ht/Wt/BMI Table 11-5 : Clinical signs are late manifestations of malnutrition Assess key body systems - skin, hair, mouth, lips, eyes Laboratory data needed to make diagnosis

laboratory data

Objective info that can detect nutritional deficiencies and confirm subjective findings Best lab indicators of nutritional status Hgb: men 14 - 18; women 12- 16 g/dl; detect iron deficiency anemia Hct: men 37-49%; women 36-46%; detect iron status Cholesterol: evaluates fat metabolism and assess risk of CV disease - < 200 mg/dl. Triglycerides: normal 40 -200mg/dl; screen for hyperlipidemia Total lymphocyte count: normal 1800-3000 cells/mm3; important indicator of visceral protein status and therefore cell immune function Serum albumin: normal 3.5-5.5g/dl; assess visceral protein status Transferrin: normal 170 -250 mg/dl; an iron transport protein; reflects protein status more accurately than serum albumin; decreased values indicate depletion of protein stores or inadequate protein production Nitrogen: normal is nitrogen intake and excretion should be equal. Used to measure protein nutritional status C-Reactive protein - inflammatory status - not noted in blood of healthy people

summary assessment of nutrition

Obtain health history Obtain dietary history Inspect skin, hair, eyes, oral cavity, nails, and musculoskeletal and neurologic system Measure height, weight and anthropometric measures Review relevant labs Offer health promotion teaching Healthy diet Exercise Food handling Limit fat, sugar, alcohol, salt

What questions do you ask during a nutritional health history?

Previous med problems Surgical hx: recent surgery, trauma, burns Current meds Weight loss/gain (intentional or unintentional) Allergies Alcohol or tobacco use Eating patterns; food choices Family hx: Obesity, diabetes, metabolic disorders (↑chol)

abnormal findings

Excessive weight loss Anorexia: lack of appetite despite a physiologic need for food. May be due to GI or endocrine disorder, illness, anxiety, chronic pain Anorexia nervosa: psychological condition in which person severely restricts food intake Excessive weight gain Obesity: due to caloric excess more than 20% above ideal weight Marasmus Due to inadequate intake of protein and calories or prolonged starvation Kwashiorkor: Due to diets high in calories but that contain little or no protein ie: low protein diets, fad diets Rickets Due to vitamin D and calcium deficiencies (pg 218) Increase incidence. Why?

detecting nutritional problems in drugs and diets

Fad diets Steroid, diuretic, antacid use Alcohol intake Strict vegetarian diet Laxative abuse

what are the 4 parts of nutritional assessment?

Health history Clinical signs - body system assessment Laboratory tests Anthropometric measurements

anthropometric measures

Height and Weight Body Mass Index (BMI) - indicator of obesity or protein calorie malnutrition 18.5 - 24.9 = normal for adults 25-29.9= overweight >30 = Obese Waist to Hip Ratio - body fat distribution Waist Circumference >35 inches women and >40 in men - increases risk

Purposes of nutritional assessment

Identify individuals malnourished(under or over) or risk of developing malnutrition Provide data to develop a nutrition plan of care to prevent/minimize malnutrition development Establish baseline data for evaluating effectiveness of nutritional care

nutrition screening

Identify those at nutrition risk Weight loss, inadequate food intake, recent illness Perform comprehensive nutrition assessment for those at risk Screening Tools -Admission Nutrition Screening Tool -Nutrition Screening Initiative

what do you watch for during a nutritional assessment?

Watch for nutrition-related complaints: weight gain loss changes in energy level changes in appetite, or taste Dysphagia: difficulty swallowing GI tract problems (nausea, vomiting or diarrhea)

direct observation

observing the feeding and eating process can detect problems not readily identified through standard nutrition interviews

define undernutrition

occurs when nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day to day needs or added metabolic demands. Vulnerable groups: infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults are at risk for impaired growth and development, lowered resistance to infection and disease, delayed would healing, longer hospital stays, and higher healthcare costs.