assessment: dietary and clinical data
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Chapter 14. Assessment: Dietary and Clinical Data. Nutritional Status. A measurement of the degree to which the individual’s physiologic need for nutrients is being met Nutrient intake Nutrient requirements. Nutrition Imbalance. - PowerPoint PPT PresentationTRANSCRIPT
Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc.Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc.
Assessment: Dietary and Clinical DataAssessment: Dietary and Clinical DataAssessment: Dietary and Clinical DataAssessment: Dietary and Clinical Data
Chapter 14Chapter 14
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Nutritional StatusNutritional Status
A measurement of the degree to which A measurement of the degree to which the individual’s physiologic need for the individual’s physiologic need for nutrients is being metnutrients is being met
Nutrient intakeNutrient intake
Nutrient requirementsNutrient requirements
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Nutrition ImbalanceNutrition Imbalance
Nutrition is an important factor in the Nutrition is an important factor in the etiology and management of several etiology and management of several major causes of death and disabilitymajor causes of death and disability
Homeostasis within safe ranges of intakeHomeostasis within safe ranges of intake
Deficiencies and excessesDeficiencies and excesses
Undernutrition and overnutritionUndernutrition and overnutrition
Nutritional riskNutritional risk
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Development of Deficiency Development of Deficiency Development of Deficiency Development of Deficiency
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Nutrition ScreeningNutrition Screening
Purpose: To quickly identify individuals Purpose: To quickly identify individuals who are malnourished or at nutritional risk who are malnourished or at nutritional risk andand t to determine if a more detailed o determine if a more detailed assessment is warrantedassessment is warranted
Usually completed by DTR, nurse, Usually completed by DTR, nurse, physician, or other qualified health care physician, or other qualified health care professionalprofessional
At-risk patients referred to RDAt-risk patients referred to RD
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Characteristics of a Nutrition Characteristics of a Nutrition ScreeningScreening
Simple and easy to completeSimple and easy to complete
Routine dataRoutine data
Cost effectiveCost effective
Effective in identifying nutritional Effective in identifying nutritional problemsproblems
Reliable and validReliable and valid
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Nutrition QuestionnaireNutrition QuestionnaireNutrition QuestionnaireNutrition Questionnaire
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Nutrition Screening ToolsNutrition Screening Tools
Acute-care hospital or residential settingAcute-care hospital or residential setting
Perinatal servicePerinatal service
Pediatric practicePediatric practice
Malnutrition Universal Screening Tool Malnutrition Universal Screening Tool (MUST)(MUST)
Nutrition Screening Initiative (NSI)Nutrition Screening Initiative (NSI)
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Nutrition AssessmentNutrition Assessment
A comprehensive evaluation, completed A comprehensive evaluation, completed by a registered dietitian, for defining by a registered dietitian, for defining nutritional status using medical, social, nutritional status using medical, social, nutritional, and medication histories, nutritional, and medication histories, physical examination, anthropometric physical examination, anthropometric measurements, and laboratory datameasurements, and laboratory data
Gather adequate data to make Gather adequate data to make professional judgment about nutritional professional judgment about nutritional statusstatus
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Nutrition Assessment GoalsNutrition Assessment Goals
Identify individuals who require Identify individuals who require aggressive nutritional supportaggressive nutritional support
Restore or maintain nutritional statusRestore or maintain nutritional status
Identify appropriate MNTsIdentify appropriate MNTs
Monitor efficacy of interventionsMonitor efficacy of interventions
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Nutrition HistoriesNutrition Histories
Medical and social historiesMedical and social histories
Medication historyMedication history
Nutrition or diet historyNutrition or diet history
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Nutrient Intake AnalysisNutrient Intake Analysis
At least 72 hoursAt least 72 hours
Daily food record or food diaryDaily food record or food diary
Food frequency questionnaireFood frequency questionnaire
24-hour recall24-hour recall
Advantages and disadvantagesAdvantages and disadvantages
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Food DiaryFood Diary
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AnthropometryAnthropometry
Involves obtaining physical Involves obtaining physical measurements of an individual and measurements of an individual and relating them to standards that reflect the relating them to standards that reflect the growth and development of the growth and development of the individualindividual
Evaluate overnutrition and undernutritionEvaluate overnutrition and undernutrition
Important to use proper techniqueImportant to use proper technique
Serial measurements most valuableSerial measurements most valuable
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Interpretation of Height and WeightInterpretation of Height and Weight
Children’s growth chartsChildren’s growth charts
Length and heightLength and height
Weight: ideal weight for height, actual Weight: ideal weight for height, actual body weight, % weight lossbody weight, % weight loss
BMIBMI
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Using Height and Weight to Assess Using Height and Weight to Assess Nutritional StatusNutritional Status
• Measure, do not just ask a person’s height
• Measure weight (at admission, current, and usual).
• Determine percentage of weight change over time (weight pattern).
• Determine percentage above or below usual or ideal body weight
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Calculating BMICalculating BMI
BMI = Weight (kg) divided by (height [m]BMI = Weight (kg) divided by (height [m]22))
Appropriate BMI between 18.5 and 24.9Appropriate BMI between 18.5 and 24.9
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Body CompositionBody Composition
Subcutaneous fat (skin-fold thickness)Subcutaneous fat (skin-fold thickness)
Circumference measurementsCircumference measurements
– Waist circumferenceWaist circumference
– Midarm circumferenceMidarm circumference
– Head circumferenceHead circumference
– Calf circumferenceCalf circumference
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Skinfold Calipers Measure the Thickness of Skinfold Calipers Measure the Thickness of Subcutaneous Fat Tissue in MillimetersSubcutaneous Fat Tissue in MillimetersSkinfold Calipers Measure the Thickness of Skinfold Calipers Measure the Thickness of Subcutaneous Fat Tissue in MillimetersSubcutaneous Fat Tissue in Millimeters
Courtesy Dorice Czajika-Narins, PhD
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Other Methods of Body CompositionOther Methods of Body Composition
Underwater weighingUnderwater weighing Total body potassiumTotal body potassium Neutron activation analysisNeutron activation analysis BIABIA CTCT Ultrasound and MRIUltrasound and MRI DEXADEXA Air displacement plethysmogramAir displacement plethysmogram
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Nutrition-Focused Physical Nutrition-Focused Physical ExaminationExamination
Physical signsPhysical signs
– EquipmentEquipment
– Examination techniquesExamination techniques
– FindingsFindings
Immune functionImmune function
Handgrip dynamometryHandgrip dynamometry
Biochemical analysisBiochemical analysis
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Classifying MalnutritionClassifying Malnutrition
Body weightBody weight
Body fatBody fat
Somatic and visceral protein storesSomatic and visceral protein stores
Laboratory valuesLaboratory values
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Focal PointsFocal Points
Nutrition screening is needed to identify those Nutrition screening is needed to identify those individuals who would benefit from more in-depth individuals who would benefit from more in-depth nutrition assessment, intervention and follow-up.nutrition assessment, intervention and follow-up.
Careful and meticulous nutritional assessment is an Careful and meticulous nutritional assessment is an important tool in patient management. important tool in patient management.
Adaptations of the exact content of the screening and Adaptations of the exact content of the screening and assessment will vary according to the patient’s medical assessment will vary according to the patient’s medical diagnosis and clinical setting. diagnosis and clinical setting.
A skilled registered dietitian uses the screening and A skilled registered dietitian uses the screening and assessment process to make the best possible decisions assessment process to make the best possible decisions about the specific nutritional diagnoses, interventions, about the specific nutritional diagnoses, interventions, desired outcomes and evaluation.desired outcomes and evaluation.