© 2007 Thomson - Wadsworth Chapter 13 Nutrition Care and Assessment.

© 2007 Thomson - Wadsworth

Chapter 13

Nutrition Care and

Assessment

© 2007 Thomson - Wadsworth

Nutrition in Health Care

• Health problemsAlter nutrition

needsCan lead to

malnutrition

• Poor nutrition statusCan influence the

course of disease & body’s response to treatment

• Hospitalized patients40-60% with acute

illness are malnourished

Others decline in nutrition status within 3 weeks

© 2007 Thomson - Wadsworth

How Illness Affects Nutrition Status

• Reduced food intake Nausea Inflammation of

mouth Medications can

cause GI upset

• Interferes with digestion & absorption

• Alters metabolism & excretion

• Dietary restrictions for some surgeries or chronic illnesses

• Drain on financial resources

• Unable to prepare food

• Emotional upset

© 2007 Thomson - Wadsworth

Responsibility for Nutrition Care

• Registered Dietitians Provide medical

nutrition therapy Assess, diagnose,

develop,implement & evaluate nutrition care plans

Plan & approve menus Provide education

• Registered Dietetic Technician Assist the Registered

Dietitians

• Physicians Prescribe diet orders

• Nurses Screen patients Participate in nutrition

assessments Provide direct nutrition

care

• Other team members such as pharmacists & speech therapists consult

© 2007 Thomson - Wadsworth

Identifying Risk for Malnutrition

• Nutrition screening Identifies persons at

risk for nutrition problems

Must be done 24 hours after admission

Should be completed in 5-15 minutes

• ScreeningMedical diagnosisMedical recordPhysical

measurementsLab reportsDiet history

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Planning Care

• The Nutrition Care ProcessNutrition

assessmentNutrition diagnosisNutrition

interventionNutrition

monitoring & evaluation

• The Nursing ProcessAssessmentNursing diagnosisOutcome

identification & planning

ImplementationEvaluation

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

The Nutrition Care Process

• Assessment Medical, social, &

dietary histories Anthropometric data Biochemical analysis Physical exam

• Diagnosis Actual or potential Problem, etiology,

signs & symptoms

• Intervention Dietary changes Nutrition education Medication

changes

• Monitoring & evaluation May need to

modify the plan Must be flexible

© 2007 Thomson - Wadsworth

Historical Information

• Medical historyAgeGenderWeightPrescription drugsOTC medicationsDietary

supplementsType of illness

• Social historyCultural heritageFinancial concernsWho prepares and

shops for foodLiving situation

• Diet historyFood intakeMeal patternsPhysical problems

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Dietary Assessment Methods

• 24-hour recallAll foods & beveragesTime of day eatenAmounts consumedFood preparationTypical day?

• Food frequency questionnaire

• Food recordRecorded over

several daysRecorded as

consumedDoes not rely on

memory

• Direct observationCalorie countingTime consuming

© 2007 Thomson - Wadsworth

Food Frequency Questionnaire

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Anthropometric Data

• Height: Adults• Length

Infants< 24 months

• WeightBMI% Usual body

weight% Ideal body

weight

• Head circumferenceAssesses brain

development< 3 years of age

• Circumference of waist & limbsEvaluates body fatEvaluates muscle

mass

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

Biochemical Analysis

• Provides information aboutProtein-energy nutritionVitamin & mineral statusFluid & electrolyte balanceOrgan functioning

• Analysis of blood & urine samples

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Plasma Proteins

• AlbuminMost abundantSlow to reflect

changes in status

• TransferrinTransports iron Indicates PEM &

iron statusSlow to detect

changes in status

• Prealbumin & retinol-binding proteinAlso called

transthyretinResponds quickly

to changes in protein status

Expensive test

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Fluid Imbalance

• EdemaWeight gainFacial puffinessSwelling limbsAbdominal

distentionTight-fitting shoes

• Diseases of heart, kidney, liver, lungs

• Dehydration ThirstDry skin or mouthReduced skin tensionDark yellow or amber

urine with low volume

• Fever, sweating, vomiting, diarrhea, burns

© 2007 Thomson - Wadsworth

Assessment of Nutrition Status

• Functional AssessmentExercise toleranceRespiratory

muscle strength Immunity

• Integrating assessment dataSubjective Global

Assessment (SGA)Combines

historical information with results of physical examination

© 2007 Thomson - Wadsworth