Chapter 13

Nutrition Care and Assessment

2007 Thomson - Wadsworth

Nutrition in Health Care

Health problems
Alter nutrition needs Can lead to malnutrition

Hospitalized patients
40-60% with acute illness are malnourished Others decline in nutrition status within 3 weeks

Poor nutrition status

Can influence the course of disease & bodys response to treatment

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

Physicians
Prescribe diet orders

Nurses
Screen patients Participate in nutrition assessments Provide direct nutrition care

Registered Dietetic Technician

Assist the Registered Dietitians

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

Screening
Medical diagnosis Medical record Physical measurements Lab reports Diet history

2007 Thomson - Wadsworth

Planning Care
The Nutrition Care Process
Nutrition assessment Nutrition diagnosis Nutrition intervention Nutrition monitoring & evaluation

The Nursing Process

Assessment Nursing diagnosis Outcome identification & planning Implementation Evaluation

2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth

The Nutrition Care Process

Assessment
Medical, social, & dietary histories Anthropometric data Biochemical analysis Physical exam

Intervention
Dietary changes Nutrition education Medication changes

Diagnosis
Actual or potential Problem, etiology, signs & symptoms

Monitoring & evaluation

May need to modify the plan Must be flexible

2007 Thomson - Wadsworth

Historical Information
Medical history
Age Gender Weight Prescription drugs OTC medications Dietary supplements Type of illness

Social history
Cultural heritage Financial concerns Who prepares and shops for food Living situation

Diet history
Food intake Meal patterns Physical problems

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Dietary Assessment Methods

24-hour recall
All foods & beverages Time of day eaten Amounts consumed Food preparation Typical day?

Food record
Recorded over several days Recorded as consumed Does not rely on memory

Food frequency questionnaire

Direct observation
Calorie counting Time consuming
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Food Frequency Questionnaire

2007 Thomson - Wadsworth

Anthropometric Data
Height: Adults Length
Infants < 24 months

Head circumference
Assesses brain development < 3 years of age

Weight
BMI % Usual body weight % Ideal body weight

Circumference of waist & limbs

Evaluates body fat Evaluates muscle mass

2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth

Biochemical Analysis
Provides information about
Protein-energy nutrition Vitamin & mineral status Fluid & electrolyte balance Organ functioning

Analysis of blood & urine samples

2007 Thomson - Wadsworth

Plasma Proteins
Albumin
Most abundant Slow to reflect changes in status

Prealbumin & retinol-binding protein

Also called transthyretin Responds quickly to changes in protein status Expensive test

Transferrin
Transports iron Indicates PEM & iron status Slow to detect changes in status

2007 Thomson - Wadsworth

Fluid Imbalance
Edema
Weight gain Facial puffiness Swelling limbs Abdominal distention Tight-fitting shoes

Dehydration
Thirst Dry skin or mouth Reduced skin tension Dark yellow or amber urine with low volume

Diseases of heart, kidney, liver, lungs

Fever, sweating, vomiting, diarrhea, burns

2007 Thomson - Wadsworth

Assessment of Nutrition Status

Functional Assessment
Exercise tolerance Respiratory muscle strength Immunity

Integrating assessment data

Subjective Global Assessment (SGA) Combines historical information with results of physical examination

2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth