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NUTRITIONAL ASSESSMENT    Maria Carmela L. Domocmat, RN, MSN
Purposes• Provides insight into the client’s  overall physical health• Helps identify risk factors for  obesity and to pro...
SUBJECTIVE DATA      Maria Carmela L. Domocmat, RN, MSN
General nutritional    status interview• Dietary habits• Average daily intake of food  and fluids• types and quantities co...
• use various nutritional  assessment tools o Checklist for nutritional   screening o Nutrition Screening Checklist       ...
Nutrition Screening ChecklistI have an illness or condition that made me change the kind and/or          Yes (2 pts)_____a...
OBJECTIVE DATA      Maria Carmela L. Domocmat, RN, MSN
1.Anthropometric measurements2.Body composition measurements         Maria Carmela L. Domocmat, RN, MSN
Anthropometric       measurements• Height, weight, BMI• Helps to evaluate the client’s  physical growth, development,  and...
Heighto Normal findings:   within range for age, ethnic and   genetic heritage          Maria Carmela L. Domocmat, RN, MSN
Heighto Abnormal findings:   extreme shortness is seen   achondroplastic dwarfism and   Turner’s syndrome   extreme tallne...
Weighto determine ideal body weight  (IBW) and percentage of IBW         Maria Carmela L. Domocmat, RN, MSN
Weighto Method for determining desired  weight.   Females assume 100 pounds for the   first 5 feet (60 inches) and add 5  ...
Weighto Method for determining desired  weight.   Males assume 106 pounds for the   first 5 feet (60 inches) and add 6   p...
o calculate &age of IBW:• actual weight x 100 = %IBW         IBW        Maria Carmela L. Domocmat, RN, MSN
o Normal findings:   body weight is within 10% of ideal   range          Maria Carmela L. Domocmat, RN, MSN
o Abnormal findings:   current weight that is 10-20%   below IBW – indicates a lean   client and possibly mild   malnutrit...
o Abnormal findings:   weight exceeding 10% of IBW range-   considered overweight   20% - obesity          Maria Carmela L...
BMI      Maria Carmela L. Domocmat, RN, MSN
BMIo Calculated based on ht and wt  regardless of gendero A practical measure for  estimating total body fato Calculated a...
o But not diagnostic of client’s  health status   Does not differentiate bet fat or   muscle tissue          Maria Carmela...
Inaccurately high or low findingscan result for individuals who areparticularly muscular or elderlywho tend to lose muscle...
• May not accurately reflect body fat  in adults, who are shorter than 5  feet          Maria Carmela L. Domocmat, RN, MSN
• Further assessments using  measurements that determine body fat  composition shld be performed – to  determine health st...
o formula:   • kg/m2 = BMIo Normal findings:   18.5 – 24.9          Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
o Abnormal findings:    ‹18.5 = underwt    25-29.9 = overwt; increases risk    for health problems    30 or greater = obes...
BODY COMPOSITIONMEASUREMENTS      Maria Carmela L. Domocmat, RN, MSN
Body composition       measurementso Useful in determining location  of body fat         Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Fat DistributionMaria Carmela L. Domocmat, RN, MSN
Fat Distribution• Pear-shaped body has a lower risk for disease  than does apple-shaped body.• this is measured by Waist-t...
Body composition       measurementso Waist circumference   Most common measurement used to   determine extent of abd visce...
Waist circumferenceVisceral fat• excess fat within the abd cavity• assoc with higher health risks than  subq fat• may be a...
Waist circumferenceNormal findings:• F: less than 35 inches• M: less than 40 inches        Maria Carmela L. Domocmat, RN, ...
Waist circumferenceAbnormal findings:• Increased measurement may indicate  increased risk for disorders such  as DM, HTN, ...
Waist circumference• May not be accurate in adults  who are shorter than 5 feet         Maria Carmela L. Domocmat, RN, MSN
Body composition       measurementso Waist-to-hip ratio measurement    used to help determine obesity.    The distribution...
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Waist-to-hip ratio     measurementEx:• 30-inch waist and 40-inch hips  would have a ratio of .75• 41-inch waist and 39-inc...
Waist-to-hip ratio     measurementNormal findings:• Male: ratio ‹1.0• Female: ratio of ‹0.8        Maria Carmela L. Domocm...
Waist-to-hip ratio        measurementAbnormal findings:•   Male: ratio ›1.0•   Female: ratio ›0.8•   increased risk of dis...
Body composition       measurementso Mid-arm circumference o Helps to assess skeletal muscle   mass          Maria Carmela...
Mid-arm circumferenceprocedure• extend hand dangle nondominant arm  freely next to the body• locate arm’s midpoint (halfwa...
Mid-arm circumferencerecord both the MAC ad SR#• Ex: 25 cm, 88% of standard.        Maria Carmela L. Domocmat, RN, MSN
MAC standard referenceAdult    standard 90% SR-                       60% SR-MAC (cm) reference moderately                ...
Body composition       measurementso Triceps skin-fold thickness o Helps to evaluate subq fat stores o measure, in millime...
Skinfold calipers• areas: arm; suprailiac region of  abd; or subscapular area          Maria Carmela L. Domocmat, RN, MSN
Skinfold calipers• Male: measure at mid-chest,  abdominal (1 inch to the side  of the belly button), & top of  mid-thigh• ...
Maria Carmela L. Domocmat, RN, MSN
Triceps skin-fold       thicknessArm = grasp skinfold and subqfat bet thumb and forefinger,midway bet acromion process and...
Maria Carmela L. Domocmat, RN, MSN
TSF standard referenceAdult    standard 90% SR-                      60% SR-TSF (mm) referenc moderatel                   ...
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Triceps skin-fold        thickness• Abnormal finding: greater than  120% = obesity         Maria Carmela L. Domocmat, RN, ...
Body composition       measurementso Mid-arm muscle circumference o Evaluate muscle reserve stores o Fla: MAMC = MAC (cm) ...
Mid-arm muscle        circumferenceAdult   standar        90% SR-                 60% SR-MAC     d              moderate  ...
Mid-arm muscle     circumferenceto calculate % = 20.29/23.2 =87%record MAC and TSF and SR #• ex: MAMC = 25 - [0.314 x 15] ...
• Note: when evaluating anthropometric  data, base conclusions on a data  cluster, not on individual findings          Mar...
HYDRATION      Maria Carmela L. Domocmat, RN, MSN
Hydrationo Measure I &Oo Weight clientso Check skin turgoro Check for pitting edemao Observe skin for moistureo Assess ven...
Hydrationo Inspect tongue’s condition  gently palpate eyeballo Observe eye position and  surrounding colorationo Auscultat...
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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)

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nutritional assessment

  1. 1. NUTRITIONAL ASSESSMENT Maria Carmela L. Domocmat, RN, MSN
  2. 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. 3. SUBJECTIVE DATA Maria Carmela L. Domocmat, RN, MSN
  4. 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. 5. • use various nutritional assessment tools o Checklist for nutritional screening o Nutrition Screening Checklist Maria Carmela L. Domocmat, RN, MSN
  6. 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. 7. OBJECTIVE DATA Maria Carmela L. Domocmat, RN, MSN
  8. 8. 1.Anthropometric measurements2.Body composition measurements Maria Carmela L. Domocmat, RN, MSN
  9. 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. 10. Heighto Normal findings: within range for age, ethnic and genetic heritage Maria Carmela L. Domocmat, RN, MSN
  11. 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. 12. Weighto determine ideal body weight (IBW) and percentage of IBW Maria Carmela L. Domocmat, RN, MSN
  13. 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. 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. 15. o calculate &age of IBW:• actual weight x 100 = %IBW IBW Maria Carmela L. Domocmat, RN, MSN
  16. 16. o Normal findings: body weight is within 10% of ideal range Maria Carmela L. Domocmat, RN, MSN
  17. 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. 18. o Abnormal findings: weight exceeding 10% of IBW range- considered overweight 20% - obesity Maria Carmela L. Domocmat, RN, MSN
  19. 19. BMI Maria Carmela L. Domocmat, RN, MSN
  20. 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. 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. 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. 23. • May not accurately reflect body fat in adults, who are shorter than 5 feet Maria Carmela L. Domocmat, RN, MSN
  24. 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. 25. o formula: • kg/m2 = BMIo Normal findings: 18.5 – 24.9 Maria Carmela L. Domocmat, RN, MSN
  26. 26. Maria Carmela L. Domocmat, RN, MSN
  27. 27. Maria Carmela L. Domocmat, RN, MSN
  28. 28. Maria Carmela L. Domocmat, RN, MSN
  29. 29. Maria Carmela L. Domocmat, RN, MSN
  30. 30. Maria Carmela L. Domocmat, RN, MSN
  31. 31. Maria Carmela L. Domocmat, RN, MSN
  32. 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. 33. BODY COMPOSITIONMEASUREMENTS Maria Carmela L. Domocmat, RN, MSN
  34. 34. Body composition measurementso Useful in determining location of body fat Maria Carmela L. Domocmat, RN, MSN
  35. 35. Maria Carmela L. Domocmat, RN, MSN
  36. 36. Fat DistributionMaria Carmela L. Domocmat, RN, MSN
  37. 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. 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. 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. 40. Waist circumferenceNormal findings:• F: less than 35 inches• M: less than 40 inches Maria Carmela L. Domocmat, RN, MSN
  41. 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. 42. Waist circumference• May not be accurate in adults who are shorter than 5 feet Maria Carmela L. Domocmat, RN, MSN
  43. 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. 44. Maria Carmela L. Domocmat, RN, MSN
  45. 45. Maria Carmela L. Domocmat, RN, MSN
  46. 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. 47. Waist-to-hip ratio measurementNormal findings:• Male: ratio ‹1.0• Female: ratio of ‹0.8 Maria Carmela L. Domocmat, RN, MSN
  48. 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. 49. Body composition measurementso Mid-arm circumference o Helps to assess skeletal muscle mass Maria Carmela L. Domocmat, RN, MSN
  50. 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. 51. Mid-arm circumferencerecord both the MAC ad SR#• Ex: 25 cm, 88% of standard. Maria Carmela L. Domocmat, RN, MSN
  52. 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. 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. 54. Skinfold calipers• areas: arm; suprailiac region of abd; or subscapular area Maria Carmela L. Domocmat, RN, MSN
  55. 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. 56. Maria Carmela L. Domocmat, RN, MSN
  57. 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. 58. Maria Carmela L. Domocmat, RN, MSN
  59. 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. 60. Maria Carmela L. Domocmat, RN, MSN
  61. 61. Maria Carmela L. Domocmat, RN, MSN
  62. 62. Triceps skin-fold thickness• Abnormal finding: greater than 120% = obesity Maria Carmela L. Domocmat, RN, MSN
  63. 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. 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. 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. 66. • Note: when evaluating anthropometric data, base conclusions on a data cluster, not on individual findings Maria Carmela L. Domocmat, RN, MSN
  67. 67. HYDRATION Maria Carmela L. Domocmat, RN, MSN
  68. 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. 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

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