Chapter 11: Nutritional Assessment

Nutritional Screening Skills

*Malnutrition Screening Tool:* adult acute care patients *Mini-nutritional Assessment:* older adults in long term care and community settings

8.) Why ask about *vitamin/mineral supplements*?

*vitamin/mineral supplements* have harmful side effect if taken in large amounts

2.) *Usual weight* Why are people w/ recent weight loss or who are obese at risk?

- *underweight individuals* are vulnerable bc their fuel reserves are depleted - *Excess weight carries* risk of hypertension, diabetes, heart disease, and cancer

What methods are used for collecting current dietary intake information?

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

What are some other foods prohibited in HInduism?

- Alcohol - garlic and onions by some - red colored foods (e.g. tomatoes) by some

10.) Why ask about *alcohol and illegal drug use*?

- Alcohol contains "empty calories" devoid of nutrients - Alcohol blocks absorption of some nutrients

What foods can people of *Seventh-Day* *Adventists* not eat?

- All pork and pork products - shellfish - meat, dairy products, and eggs, by some - highly seasoned foods

What beverages are prohibited in Mormon?

- alcoholic beverages - caffeinated beverages (e.g. coffee, tea, sodas) - medicines containing caffeine, stimulants or alcohol (Anacin, NoDoz, Nyquil)

11.) Why ask about *Exercise* and activity patterns?

- caloric and nutrient needs ↑ with competitive sports and manual labor - sedentary lifestyles lead to excess weight gain

Which nutrients are required to meet adolescent physical growth, endocrine, and hormonal changes?

- caloric and protein requirement; specifically calcium and iron

2.) Why should you ask adolescents about caffeinated, energy boosting drinks?

- contain large amounts of caffeine, stimulants or herbal products

What are important cultural factors to consider during assessement?

- definition of food - frequency - # of meals - amount and types of food eaten

What does a *comprehensive nutritional assessment* intail?

- dietary history - clinically information - physical examinations for clinical signs - anthropometric measures - laboratory tests

What are the benefits of *direct observation*?

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

7.) Why ask about *food allergies* or *intolerances*?

- food allergies are ↑ and of ↑ing health concern - intolerances such as gluten and lactose may cause nutrient deficiencies (diarhea)

What signs are typical of metabolic syndrome?

- high bp - increased waist circumference - hyperglycemia

1.) *Eating Patterns* - # of meals/snacks - kind and amount of food eaten - Fad, special diet

- if misconceptions are present, begin gradual instructions to build self-care of healthy eating patterns - many alternative diets are not supported by scientific safety or efficacy

People with *undernutrition* are susceptible to which conditions?

- impaired growth and development - lowered resistance to infection and disease - delayed wound healing - longer hospital stays - higher health care costs

¹/₃ of in-patient hospitals are at risk of mal-nutrition. What adverse outcomes are associated with this condition?

- impaired wound healing - increased infection risk - suppression of immune system - functional loss w/ increased fall risk - ↑ risk of pressure ulcers - ↑ hospital stays - ↑ mortality

What is the impact of drinking alcohol, using illegal drugs, and smoking *during pregnancies*?

- low birth rates - failure to thrive

1.) Why should you ask about *present weight* among adolescents?

- obesity may precipitate fad dieting and malnutrition - ↑ body awareness may cause eating disorders (anorexia nervosa & bulemia)

8.) Why ask about *herbal and botanical products*?

- often not reported - have adverse effects

Which terms describe nutritional status?

- optimal nutritional status - undernutrition - overnutrition

What factors render a child at risk for *overweight and obesity*?

- overweight or obese parent - low income family - maternal smoking during pregnancy - large for gestational age birth weight - rapid weight gain from birth - 5 months

Who should you gather additional history from *Infants and Children*?

- person responsible for food preparation (parent, caregiver, daycare center)

What types of nutritionally relevant changes occur during adolescence?

- physical growth - endocrine - hormonal changes

What normal physiologic changes can affect the nutritional status in older adults?

- poor dentition - decreased visual acuity - decreased saliva production - slowed GI motility - decreased GI absorption - diminished olfactory and taste sensitivity

What additional history should you gather for *Adolescents*?

- present weight - use of anabolic steroids - overweight & obesity factors - age of 1st menstruation

What psychosocial and behavioral outcomes are related to adolescent obesity?

- problems w/ body image - self esteem - social isolation - discrimination - depression - decreased quality of life

4.) Why ask about *overweight* and *obesity* risk factors?

- risk factors may be present during gestation, at birth, during infancy, progress to obesity in childhood, adolescence, and adulthood

What recommendations should you make to encourage a child to eat to improve dietary intake?

- use small portions, finger foods, simple meals - nutritious snacks

What are the parameters for a nutrition screening?

- weight and weight history - conditions associated with increased nutritional risk - diet information - routine laboratory data

What aspects does the subjective aspect of the nutritional assessment inquire about?

1.) Eating patterns 2.) Usual Weight 3.) Changes in appetite, taste, smell, chewing, swallowing 4.) Recent surgery, trauma, burns, infection 5.) Chronic Illnesses 6.) Nausea, vomiting, diarrhea, constipation 7.) Food allergies or intolerances 8.) Medications and/or nutritional supplements 9.) Patient-centered care 10.) alcohol or illegal drug use 11.) Exercise and activity patterns 12.) family history

What additional history should you gather for *Infants and Children*?

1.) Gestational nutrition 2.) Breastfed or bottle fed 3.) Child's willingness to eat prepared food 4.) overweight and obesity risk factors

What are the advantages to breastfeeding?

1.) fewer food allergies and intolerances 2.) reduced likelihood of overfeeding 3.) less cost than commercial infant formulas 4.) increased mother-infant interaction time

What are the potential problems with *food diaries*?

1.) non-compliance 2.) inaccurate recording 3.) atypical itake on the recording days 4.) conscious alteration of diet during the recording period

What are the sources of limitations around the *24-hour recall* assessment?

1.) the individual or family member may not be able to recall the type or amount of food eaten 2.) intake w/in the last 24 h may be atypical of usual intake 3.) individual or family member may alter the truth for a variety of reasons 4.) snack items and use of gravies, sauces, and condiments may be underreported

What is the easiest and most popular method for obtaining infornation?

24-hour recall - elicit specific information over a period of time

What is considered overweight for adults?

25 or greater = overweight 30 = obesity

How much weight gain is recommended during pregnancy?

25-30 lbs for those who are normal weight

What meat products are prohibited to consume in *Orthodox Judaism*?

All pork and pork products - Meat not slaughtered according to ritual - Shellfish (e.g. crab, lobster, shrimp, oyster) - dairy products and meat in the same meal

What is overweight for children?

BMI at or above the 85th percentile based on age- and gender specific charts (Obesity is 95%)

What types of meat are prohibited in *Hinduism*?

Beef, pork, and some fowl

What days of the month do Mormons have restrictions on when they can eat?

First Sunday of each month

6.) Why ask about *nausea*, *vomiting*, *diarrhea* or *constipation*?

GI symptoms interfere w/ nutrient intake or absorption

Culture and Genetic Nutritional Assessment

I. Culture and Genetics II. Dietary Practices of Selected Groups

Developmental competence

I. Infants and children II. Adolescence III. Pregnancy and Lactation IV. Adulthood V. Aging Adult

Which immigrant population has an increased risk of becoming overweight?

Latin immigrants

What is a major factor in infant morbidity and mortality?

Low birth weight <2500 g

Are the caloric needs of an adolescent met by 3 meals a day?

No, nutritious snacks are required[

Should children younger than 2 years drink low fat or skim milk?

No; children's brain as of age 2 year has reached 50% of adult size- fat is important for normal growth and CNS development

What types of meat are prohibited in Islam?

Pork and pork products Meat not slaughtered according to ritual

9.) *Patient Centered Care* - Meal Preparation? - transportation for travel to market? - adequate income for food purchase?

Poverty and lack of access to nutritious groceries interfere w/ ingestion of adequate amounts of food or usual diet

3.) Why ask about *the child's willingness to eat what you prepare?*

Preschoolers form lifelong food habits and have increasing growth.

When are food and beverages prohibited to consume before sunset in Islam?

Ramadan

T/F Cow's milk is not recommended for infants until about 1 year of age.

True- may cause GI and kidney problems, and is a poor source of iron and vitamins C and E

Who is more at risk for undernutrition?

Vulnerable groups: infants, children, pregnant women, recent immigrants, people with low incomes, hospitalized people, and aging adults

2.) Why ask if the infant is *breastfed or bottle fed*?

Well nourished infants have appropriate physical and social growth

When does undernutrition occur?

When nutritional reserves are depleted and/or when when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands

What is metabolic syndrome?

a cluster of conditions — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels — that occur together, increasing your risk of heart disease, stroke and diabetes

Individuals identified to be at nutritional risk during screening should undergo-

a comprehensive nutritional assessment

What is sarcopenia?

age-related loss of muscle mass

What is sarcopenic obesity?

age-related loss of muscle mass combined with an increase of body fat

What are the food restrictions of buddhists?

all meat

8.) What medications impair nutrient digestion, absorption, and metabolism?

analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives, antineoplastic drugs, steroids, and oral contraceptives

When is the most rapid period of growth in the life cycle?

birth- 4 months of age

How is nutritional intake accounted for during hospitalization?

calorie counts of nutrients consumed and/or infused

5.) Why ask about *Chronic Illnesses*?

cancer treatment or chronic illnesses affect nutrient use and carry 2x the risk for nutritional deficits

3.) Why ask about *Changes in appetite,* *taste,* *smell,* *chewing,* *swallowing*

changes interfere w/ adequate nutrient intake

Which lifestyle behaviors can lead to hypertension, obesity, atherosclerosis, cancer, osteoporosis in adulthood?

cigarette smoking, stress, lack of exercise; excessive alcohol intake, and diets high in saturated fat, cholesterol, salt, and sugar and low in fiber

4.) Why ask about *recent surgery, trauma, burns, infections*?

conditions have caloric and nutrient needs that are 2 or 3x greater than normal

What causes overnutrition?

consumption of nutrients, especially calories, sodium, and fat, in excess of body needs

What are the side effects of energy-boosting drinks?

dehydration, high BP, and HR, and sleep problems

What chronic illnesses affect nutrient use?

diabetes mellitus, pancreatitis, or malabsorption

When can Orthodox Jews not eat leavened bread and cake?

during Passover

What foods should you tell a child to avoid?

foods likely to be aspirated: hot dogs, nuts, grapes, round candies, popcorn

What are the risks of *Overnutrition*?

heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers, and osteoarthritis

What kind of mother may have problems with feeding or questions about whether the infant is receiving adequate food?

inexperienced mothers

Which nutrients are needed during pregnancy?

iron, folate, and zinc

12.) Why ask about a *family history* or heart disease, osteoporosis, cancer, gout, GI disorders, obesity, or diabetes?

long-term nutritional deficiencies or excesses may first appear as these diseases - early identification permits dietary and activity modifications when the body can recover

What are some of the risk factors of sarcopenic obesity?

loss of muscle strength and function, decreased quality of life, physical frailty, and increased mortality rates

What are the food restrictions of catholics?

meat by some denominations on Ash Wednesday, Good Friday, and other holy day

What types of foods are recommended for Aging adults?

nutrient dense food (milk, cheese, and peanut butter)

When can Orthodox Jews not eat food and beverages?

on Yom Kippur

When is breastfeeding recommended for full term infants?

one full year; breast milk is ideally formulated to promote normal infant growth and development

Which allergy is of specific concern?

peanut allergy

Who tends to have optimal nutritional status?

people who are: - more active - have fewer physical illnesses - live longer than people who are malnourished

2.) Why should you ask adolescents about *anabolic steroid use*?

performance-enhancing agents are used in junior high, high school, and college

What are the adverse effects of anabolic steroid use?

personality disorders (aggressiveness), liver, and other organ damage

What factors influence *nutritional status*?

physiologic, psychosocial, developmental, cultural, and economic factors

Why ask about *Gestational Nutrition*?

poor gestational nutrition, low maternal weight gain, and maternal alcohol and drug use are *factors in low birth weight,* *birth defects*, and *delayed growth* and *development*

What are the risk factors for undernutrition in older adults?

poor physical or mental health, social isolation, alcoholism, limitied functional ability, poverty, and polypharmacy

What are the benefits of the Dietary Reference Intakes (DRIs)?

prevent deficiencies; reduce risk for chronic diseases

What type of exercise is needed to combat sarcopenia?

resistance training

What types of beverages are prohibited in Islam?

tea, coffee, alcoholic beverages, alcoholic products

What is nutritional status?

the balance between nutrient intake and nutrient requirement

What are common nutrition related problems of new immigrants?

undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia, scurvy, and dental caries

A nutritional screening is an easy way of assessing what risks among pt?

weight loss, inadequate food intake, or recent illness

When is optimal nutritional status achieved?

when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands caused by growth, pregnancy, or illness

When is a food diary most accurate?

when you teach the individual to record information immediately after eating