chapter 13 nutrition and care assessment

Nutrition Care and

Assessment

1313

Copyright © 2017 Cengage Learning. All Rights Reserved.

© Cengage Learning 2017

Nutrition in Health Care

• Correcting nutritional problems– May improve outcomes of medical treatments

and help to prevent complications• Poor nutrition status

– Weakens immune function– Compromises a person’s healing ability

• How illness affects nutrition status– How does illness affect nutrition status?



Ways in Which Illness Can Affect Nutrition Status



Nutrition in Health Care: How Illness Affects Nutrition Status (cont’d.)

• Illnesses and their treatments may reduce appetite and food intake

• Pressure sores raise protein and energy needs

• Dietary changes for acute illness– Temporary; can be tailored to individual’s

preferences and lifestyle



Nutrition in Health Care: How Illness Affects Nutrition Status (cont’d.)

• Dietary changes for chronic illness– May require long-term adjustments in diet and

lifestyle• Challenges to nutritional status

– Lack of strength and energy– Damaged emotional health– Health care costs that drain financial

resources



Nutrition in Health Care (cont’d.)

• Responsibility for nutrition care– What are clinical (critical) pathways?– Physicians: responsible for meeting all of a

patient’s medical needs; write diet orders– Nurses

• Screen patients for nutrition problems• Participate in nutrition and dietary assessments• Provide direct nutrition care• Members of nutrition support teams




• Responsibility for nutrition care– Registered dietitians

• Provide medical nutrition therapy• What are specific examples of their involvement?

– Registered dietetic technicians• Work in partnership with registered dietitians• What are their other roles?

– Other health care professionals




• Identifying risk for malnutrition– Nutrition screening

• Identifies patients who are malnourished or at risk for malnutrition

• Screening tools include Subjective Global Assessment (see Table 13-2)

– Nursing diagnoses• Clinical judgments about actual or potential health

problems that provide the basis for selecting appropriate nursing interventions




• The nutrition care process– Systematic approach to medical nutrition

therapy implemented by registered dietitians– Nutrition assessment: collection and analysis

of health-related data– Nutrition diagnosis: what is included in a

diagnosis?– Nutrition intervention: appropriate plan– Nutrition monitoring and evaluation: determine

effectivenessCopyright © 2017 Cengage Learning. All Rights Reserved.


The Nutrition Care Process



Nutrition Assessment

• Historical information– Sources

• Medical record• Interviewing the patient or caregiver

– Medical history– Medication and supplement history– Personal and social history– Food and nutrition history



Nutrition Assessment (cont’d.)

• Dietary assessment– Table 13-6 compares common methods for

obtaining food intake data– 24-hour dietary recall

• Guided interview• Covers foods and beverages consumed during the

previous day• What is involved in the multiple-pass method?



Nutrition Assessment:Dietary Assessment (cont’d.)

• Food frequency questionnaire (Figure 13-4)– Foods and beverages regularly consumed

during a specific time period– May collect qualitative only or

semiquantitative information– What are limitations of this tool?



Nutrition Assessment:Dietary Assessment (cont’d.)

• Food record– Written account of foods and beverages

consumed during a specified time period, usually several consecutive days

• Direct observation– Food intakes directly observed and analyzed– Nurses conduct patients’ kcalorie counts




• Anthropometric data– Related to physical measurements of the

human body– Can reveal nutritional problems: overnutrition

or protein-energy malnutrition (PEM)– Height (or length)

• Box 13-3 describes standard techniques• Estimation techniques: knee height, full arm span



Nutrition Assessment:Anthropometric Data (cont’d.)

• Body weight– Weight changes may reflect changes in body

water due to illness– Involuntary weight loss can be a sign of PEM– Box 13-4 provides tips for accuracy




• Head circumference– Assess brain growth and malnutrition in

children up to 3 years old– Used to track brain development in premature

and small-for-gestational-age infants• Circumferences of waist and limbs

– Waist: body fat evaluation– Limbs: muscle mass determination




• Anthropometric assessment in infants and children– Used to evaluate growth– Periodic measurements of height (length),

weight, and head circumference taken– Plotted on growth charts– Growth patterns <5th percentile– BMI-for-age <5th or >85th percentiles




• Anthropometric assessment in adults– Used to evaluate the nutritional risks

associated with illness– Rate of involuntary weight loss– Percentage of usual body weight (%UBW)

• (current weight ÷ usual weight) × 100– Percentage of ideal body weight

• (current weight ÷ ideal weight) × 100




• Anthropometric assessment in adults– In addition to body weight, why are skinfold

and limb circumference measurements important in a nutrition assessment?




• Biochemical analyses– Information about PEM, vitamin and mineral

status, fluid and electrolyte balances, and organ function

– Typically blood and urine samples– Repeated measures

• Indicate improving or worsening condition– Table 13-9 lists routine laboratory tests




• Biochemical analyses– Serum proteins

• Used to assess protein-energy status– Albumin

• Used to gauge severity of illness– Transferrin

• What is the correlation between iron status and transferrin levels?




• Biochemical analyses– Transthyretin (prealbumin) and retinol-binding

protein• Decrease rapidly during PEM • Respond quickly to improved protein intakes

– C-reactive protein• Rises rapidly in response to inflammation or

infection• Often elevated in critical illness




• Physical examination– Interpreting physical signs of malnutrition

• Requires skill and clinical judgment– Clinical signs of malnutrition (Table 13-10)

• Where do signs of malnutrition most commonly appear on the body?

– Hydration status• Fluid retention (edema)• Dehydration




• Physical examination– Functional assessment

• Nutrient deficiencies sometimes impair physiological functions

• Tests or procedures may be conducted to aid evaluation

• Examples: skin’s response to antigens; hand-grip strength; and exercise tolerance



Nutrition in Practice:Nutritional Genomics

• The human genome• Genetics research techniques• Epigenetics: how nutrients alter gene

expression– Transcription factors, methylation

• Polymorphisms: single- vs. multigene• Impact of genomics research on clinical

practice


chapter 13 nutrition and care assessment

Education