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nutritional assessment

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different ways to assess the nutritional status of a client (e.g., BMI, Mid-arm circumference, triceps skinfold)

different ways to assess the nutritional status of a client (e.g., BMI, Mid-arm circumference, triceps skinfold)

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  • 1. NUTRITIONAL ASSESSMENT Maria Carmela L. Domocmat, RN, MSN
  • 2. Purposes• Provides insight into the client’s overall physical health• Helps identify risk factors for obesity and to promote health• Help identify nutritional deficits• Hydration s an important indicator of the client’s general health status Maria Carmela L. Domocmat, RN, MSN
  • 3. SUBJECTIVE DATA Maria Carmela L. Domocmat, RN, MSN
  • 4. General nutritional status interview• Dietary habits• Average daily intake of food and fluids• types and quantities consume• where and when food is eaten• any conditions or diseases that affect intake or absorption Maria Carmela L. Domocmat, RN, MSN
  • 5. • use various nutritional assessment tools o Checklist for nutritional screening o Nutrition Screening Checklist Maria Carmela L. Domocmat, RN, MSN
  • 6. Nutrition Screening ChecklistI have an illness or condition that made me change the kind and/or Yes (2 pts)_____amount of food I eatI eat fewer than 2 meals per day Yes (2 pts)_____I eat few fruits or vegetables, or milk products Yes (2 pts)_____I have 3 or more drinks of beer, liquor, or wine almost everyday Yes (2 pts)_____I have tooth or mouth problems that make it hard for me to eat Yes (2 pts)_____I don’t always have enough money to buy the food I need Yes (2 pts)_____I eat alone most of the time Yes (2 pts)_____I take 3 or more different prescribed or over-the-counter drugs each Yes (2 pts)_____daywithout wanting to, I have lost or gained 10 pounds in the last 6 Yes (2 pts)_____monthsI am not always physically able to shop, cook, and/or feed myself Yes (2 pts)_____Instruction: Check “yes” for each condition that applies, then total the nutritional score.For total scores of 3-5 points (moderate risk) or ≥ 6 points (high risk), further evaluation isneeded (especially for elderly) Maria Carmela L. Domocmat, RN, MSN
  • 7. OBJECTIVE DATA Maria Carmela L. Domocmat, RN, MSN
  • 8. 1.Anthropometric measurements2.Body composition measurements Maria Carmela L. Domocmat, RN, MSN
  • 9. Anthropometric measurements• Height, weight, BMI• Helps to evaluate the client’s physical growth, development, and nutritional status Maria Carmela L. Domocmat, RN, MSN
  • 10. Heighto Normal findings: within range for age, ethnic and genetic heritage Maria Carmela L. Domocmat, RN, MSN
  • 11. Heighto Abnormal findings: extreme shortness is seen achondroplastic dwarfism and Turner’s syndrome extreme tallness – gigantism (excessive secretion of GH) and Marfan’s syndrome Maria Carmela L. Domocmat, RN, MSN
  • 12. Weighto determine ideal body weight (IBW) and percentage of IBW Maria Carmela L. Domocmat, RN, MSN
  • 13. Weighto Method for determining desired weight. Females assume 100 pounds for the first 5 feet (60 inches) and add 5 pounds for each inch over 60. Maria Carmela L. Domocmat, RN, MSN
  • 14. Weighto Method for determining desired weight. Males assume 106 pounds for the first 5 feet (60 inches) and add 6 pounds for each inch over 60. Maria Carmela L. Domocmat, RN, MSN
  • 15. o calculate &age of IBW:• actual weight x 100 = %IBW IBW Maria Carmela L. Domocmat, RN, MSN
  • 16. o Normal findings: body weight is within 10% of ideal range Maria Carmela L. Domocmat, RN, MSN
  • 17. o Abnormal findings: current weight that is 10-20% below IBW – indicates a lean client and possibly mild malnutrition • if 20-30% - indicates moderate malnutrition • more than 30% - severe malnutrition Maria Carmela L. Domocmat, RN, MSN
  • 18. o Abnormal findings: weight exceeding 10% of IBW range- considered overweight 20% - obesity Maria Carmela L. Domocmat, RN, MSN
  • 19. BMI Maria Carmela L. Domocmat, RN, MSN
  • 20. BMIo Calculated based on ht and wt regardless of gendero A practical measure for estimating total body fato Calculated as wt in kg and divided by the square in ht in meterso Simple, quick, inexpensive Maria Carmela L. Domocmat, RN, MSN
  • 21. o But not diagnostic of client’s health status Does not differentiate bet fat or muscle tissue Maria Carmela L. Domocmat, RN, MSN
  • 22. Inaccurately high or low findingscan result for individuals who areparticularly muscular or elderlywho tend to lose muscle massInaccurate if client is retainingfluid (e.g., edema, ascites,pregnant) Maria Carmela L. Domocmat, RN, MSN
  • 23. • May not accurately reflect body fat in adults, who are shorter than 5 feet Maria Carmela L. Domocmat, RN, MSN
  • 24. • Further assessments using measurements that determine body fat composition shld be performed – to determine health status and assoc risk factors Maria Carmela L. Domocmat, RN, MSN
  • 25. o formula: • kg/m2 = BMIo Normal findings: 18.5 – 24.9 Maria Carmela L. Domocmat, RN, MSN
  • 26. Maria Carmela L. Domocmat, RN, MSN
  • 27. Maria Carmela L. Domocmat, RN, MSN
  • 28. Maria Carmela L. Domocmat, RN, MSN
  • 29. Maria Carmela L. Domocmat, RN, MSN
  • 30. Maria Carmela L. Domocmat, RN, MSN
  • 31. Maria Carmela L. Domocmat, RN, MSN
  • 32. o Abnormal findings: ‹18.5 = underwt 25-29.9 = overwt; increases risk for health problems 30 or greater = obese; igher risk for diabetes and cardiovascular dse• Maria Carmela L. Domocmat, RN, MSN
  • 33. BODY COMPOSITIONMEASUREMENTS Maria Carmela L. Domocmat, RN, MSN
  • 34. Body composition measurementso Useful in determining location of body fat Maria Carmela L. Domocmat, RN, MSN
  • 35. Maria Carmela L. Domocmat, RN, MSN
  • 36. Fat DistributionMaria Carmela L. Domocmat, RN, MSN
  • 37. Fat Distribution• Pear-shaped body has a lower risk for disease than does apple-shaped body.• this is measured by Waist-to-hip ratio measurement Maria Carmela L. Domocmat, RN, MSN
  • 38. Body composition measurementso Waist circumference Most common measurement used to determine extent of abd visceral fat in relation to body fat Maria Carmela L. Domocmat, RN, MSN
  • 39. Waist circumferenceVisceral fat• excess fat within the abd cavity• assoc with higher health risks than subq fat• may be an independent predictor of health risks even when BMI is not markedly increased Maria Carmela L. Domocmat, RN, MSN
  • 40. Waist circumferenceNormal findings:• F: less than 35 inches• M: less than 40 inches Maria Carmela L. Domocmat, RN, MSN
  • 41. Waist circumferenceAbnormal findings:• Increased measurement may indicate increased risk for disorders such as DM, HTN, Hyperlipidemia, cardiovascular dse Maria Carmela L. Domocmat, RN, MSN
  • 42. Waist circumference• May not be accurate in adults who are shorter than 5 feet Maria Carmela L. Domocmat, RN, MSN
  • 43. Body composition measurementso Waist-to-hip ratio measurement used to help determine obesity. The distribution of fat is evaluated by dividing waist size by hip size. Maria Carmela L. Domocmat, RN, MSN
  • 44. Maria Carmela L. Domocmat, RN, MSN
  • 45. Maria Carmela L. Domocmat, RN, MSN
  • 46. Waist-to-hip ratio measurementEx:• 30-inch waist and 40-inch hips would have a ratio of .75• 41-inch waist and 39-inch hips would have a ratio of 1.05. Maria Carmela L. Domocmat, RN, MSN
  • 47. Waist-to-hip ratio measurementNormal findings:• Male: ratio ‹1.0• Female: ratio of ‹0.8 Maria Carmela L. Domocmat, RN, MSN
  • 48. Waist-to-hip ratio measurementAbnormal findings:• Male: ratio ›1.0• Female: ratio ›0.8• increased risk of diseases• The higher the ratio, the higher the risk of heart disease and other obesity-related disorders. Maria Carmela L. Domocmat, RN, MSN
  • 49. Body composition measurementso Mid-arm circumference o Helps to assess skeletal muscle mass Maria Carmela L. Domocmat, RN, MSN
  • 50. Mid-arm circumferenceprocedure• extend hand dangle nondominant arm freely next to the body• locate arm’s midpoint (halfway bet top of acromion process and olecranon process)• measure in cm• to calculate % = MAC/SR Maria Carmela L. Domocmat, RN, MSN
  • 51. Mid-arm circumferencerecord both the MAC ad SR#• Ex: 25 cm, 88% of standard. Maria Carmela L. Domocmat, RN, MSN
  • 52. MAC standard referenceAdult standard 90% SR- 60% SR-MAC (cm) reference moderately severely (SR) malnourish malnourish ed edM 29.3 26.3 17.6F 28.5 25.7 17.1 Maria Carmela L. Domocmat, RN, MSN
  • 53. Body composition measurementso Triceps skin-fold thickness o Helps to evaluate subq fat stores o measure, in millimeters, the amount of skin and body fat. Maria Carmela L. Domocmat, RN, MSN
  • 54. Skinfold calipers• areas: arm; suprailiac region of abd; or subscapular area Maria Carmela L. Domocmat, RN, MSN
  • 55. Skinfold calipers• Male: measure at mid-chest, abdominal (1 inch to the side of the belly button), & top of mid-thigh• Female: measure at the mid- triceps, suprailiac (outside abdominal, about 2 inches forward of your love handles), & mid-thigh if youre a woman. Maria Carmela L. Domocmat, RN, MSN
  • 56. Maria Carmela L. Domocmat, RN, MSN
  • 57. Triceps skin-fold thicknessArm = grasp skinfold and subqfat bet thumb and forefinger,midway bet acromion process andtip of elbowpull skin away from muscleapply calipersrepeat 3 times record in mm Maria Carmela L. Domocmat, RN, MSN
  • 58. Maria Carmela L. Domocmat, RN, MSN
  • 59. TSF standard referenceAdult standard 90% SR- 60% SR-TSF (mm) referenc moderatel severely e (SR) y malnouris malnouris hed hedM 12.5 11.3 7.5F 16.5 14.9 9.9 Maria Carmela L. Domocmat, RN, MSN
  • 60. Maria Carmela L. Domocmat, RN, MSN
  • 61. Maria Carmela L. Domocmat, RN, MSN
  • 62. Triceps skin-fold thickness• Abnormal finding: greater than 120% = obesity Maria Carmela L. Domocmat, RN, MSN
  • 63. Body composition measurementso Mid-arm muscle circumference o Evaluate muscle reserve stores o Fla: MAMC = MAC (cm) – [0.314 x TSF (mm)] Maria Carmela L. Domocmat, RN, MSN
  • 64. Mid-arm muscle circumferenceAdult standar 90% SR- 60% SR-MAC d moderate severely(cm) referen ly malnouri ce (SR) malnouri shed shedM 25.3 22.8 15.2F 23.2 20.9 13.9 Maria Carmela L. Domocmat, RN, MSN
  • 65. Mid-arm muscle circumferenceto calculate % = 20.29/23.2 =87%record MAC and TSF and SR #• ex: MAMC = 25 - [0.314 x 15] = 20.29; 87% of standard Maria Carmela L. Domocmat, RN, MSN
  • 66. • Note: when evaluating anthropometric data, base conclusions on a data cluster, not on individual findings Maria Carmela L. Domocmat, RN, MSN
  • 67. HYDRATION Maria Carmela L. Domocmat, RN, MSN
  • 68. Hydrationo Measure I &Oo Weight clientso Check skin turgoro Check for pitting edemao Observe skin for moistureo Assess venous filingo Observe neck veins Maria Carmela L. Domocmat, RN, MSN
  • 69. Hydrationo Inspect tongue’s condition gently palpate eyeballo Observe eye position and surrounding colorationo Auscultate lung soundso Take BP on different positions Maria Carmela L. Domocmat, RN, MSN