This chapter discusses nutrition care and assessment. It outlines how illness can affect nutrition status by reducing food intake or causing issues like nausea or mouth inflammation. Responsibility for nutrition care involves various health professionals like physicians, nurses, registered dietitians, and dietetic technicians. Identifying patients at risk for malnutrition involves nutrition screening within 24 hours of admission. A nutrition assessment involves collecting information on medical history, medications, anthropometric measurements, biochemical analyses, and physical exam findings. The nutrition care process uses this information to develop a nutrition diagnosis, intervention, and monitoring plan. Nutritional genomics is also discussed as the study of how dietary factors can affect gene expression and potentially an individual's nutrient needs or disease risk based on their genetic variations.
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Aim of nutritional assessment
To identify nutritional problems of the community
To find the underlying cause for malnutrition
To plan and implement control of malnutrition
Maintain good nutrition of community
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NHHC chapter 13 outline
1. Chapter 13 – Nutrition Care and Assessment
Chapter Outline Instructor Resources
I. Nutrition in Health Care
Correctingnutritional problems may improveoutcomes of medical treatment and help prevent
complications
Malnutrition is common in patients hospitalized with acuteillnesses
A. How Illness Affects Nutrition Status
1. Reduced food intake/decreased appetite
2. Nausea
3. Inflammation of mouth
4. Medications can cause GI upset and anorexia
5. Interferes with digestion & absorption
6. Alters metabolism & excretion
7. Pressuresores
8. Dietary restrictions for somesurgeries or chronic illnesses
9. Drain on financial resources
10. Unable to preparefood
11. Emotional upset
B. Responsibility for Nutrition Care - Plans of care= “critical pathways”
1. Physicians - Prescribediet orders
2. Nurses
a. Screen patients
b. Participatein nutrition assessments
c. Provide direct nutrition care
d. Member of the nutrition support team
3. Registered Dietitians - Food and nutrition experts
a. Provide medical nutrition therapy
b. Assess nutrition status,diagnose nutrition problems,develop, implement, & evaluate
nutrition careplans
c. Plan & approve menus
d. Provide dietary counseling and nutrition education
e. May also manage food and cafeteria services
4. Registered Dietetic Technicians - Assist the registered dietitians
5. Other Health Care Professionals - Team members include: pharmacists;physical,
occupational,& speech therapists;nursingassistants;homehealth care aides; & social
workers
C. Identifying Risk for Malnutrition
1. Nutrition screening
a. Identifies persons at risk for nutrition problems
b. Joint Commission recommends that it be done 24 hours after admission
c. Should be completed in 10-15 minutes
2. Screening includes:
a. Admittingdiagnosis
b. Physical measurements
c. Lab reports
2. d. Information about diet and health status
3. Screening tool: SubjectiveGlobal Assessment
4. Nursingdiagnosis may identify need for nutrition intervention
D. The Nutrition CareProcess - Used by registered dietitians
1. Nutrition Assessment
a. Medical record
b. Physical exam
c. Laboratory analyses
d. Medical procedures
e. Interview with patient or caregiver
f. Consultation with other health professionals
2. Nutrition Diagnosis
a. Actual or potential
b. Problem, etiology, signs & symptoms
3. Nutrition Intervention
a. Dietary & lifestyle changes
b. Nutrition counseling or education
c. Medication changes
d. Goal stated in measurableoutcomes
4. Nutrition Monitoringand Evaluation
a. May need to modify the plan
b. Must be flexible
c. May need to include motivational techniques or additional education
II. Nutrition Assessment
A. Historical Information
1. Medical History - including family medical history
2. Medication & Supplement History
a. Prescription drugs
b. OTC medications
c. Dietary supplements
3. Personal & Social History
a. Cultural background
b. Religious beliefs
c. Financial concerns
d. Who prepares and shops for food
e. Living situation
f. Use of tobaccoor illegal drugs
4. Food & Nutrition History
a. Lifestyle habits
b. Allergies
c. Nutrition & health beliefs
B. Dietary Assessment
1. The 24-Hour Dietary Recall
a. All foods & beverages
b. Time of day eaten
c. Amounts consumed
d. Food preparation
3. e. Food models and measuringutensils
f. Multiple-pass method
g. Typical day?
h. Does not address fluctuation in food intake & season
2. Food Frequency Questionnaire
a. Surveys foods and beverages regularly consumed
b. Qualitativeor semi-quantitative
3. Food Record
a. Recorded over several days
b. Recorded as consumed
c. Does not rely on memory
d. Time consuming
e. Must be highly motivated
f. Recording may influence intake
4. Direct Observation
a. Calorie counting
b. Time consuming
C. Anthropometric Data = measures of body size
1. Height (or Length)
a. Height: Adults
b. Length: Infants < 24 months = recumbent measure
c. How to Measure Length and Height
2. Body Weight
a. BMI
b. % usual body weight
c. % ideal body weight
d. How to Measure Weight
e. How to Estimateand Evaluate %UBW and %IBW
3. Head Circumference
a. Assesses brain development
b. < 3 years of age
4. Circumferences of Waist and Limbs
a. Waist circumferencecorrelates with intra-abdominal body fat
b. Arm, thigh, or calf circumference can help evaluates muscle mass
5. Anthropometric Assessment in Infants and Children - Growth patterns tracked using
height or length, weight, head circumference plotted on growth charts
6. Anthropometric Assessment in Adults - Changes in body weight over time; %UBW &
%IBW
D. Biochemical Analyses
1. Introduction
a. Provides information about
1. Protein-energy nutrition
2. Vitamin & mineral status
3. Fluid & electrolytebalance
4. Organ functioning
b. Analysis of blood & urinesamples
2. Serum Proteins
3. Albumin
4. a. Most abundant
b. Slow to reflect changes in status
4. Transferrin
a. Transports iron
b. Indicates PEM & iron status
c. Slow to detect changes in status
5. Prealbumin and Retinol-Binding Protein
a. Also called transthyretin
b. Responds quickly tochanges in protein status
c. Expensive test
E. Physical Examination
1. Clinical Signs of Malnutrition - hair,skin, GI tract (mouth, tongue)
2. Hydration Status
a. Edema
1. Often accompanies disorders of heart,kidney, liver, and lungs
2. Weight gain
3. Facial puffiness
4. Swelling limbs
5. Abdominal distention
6. Tight-fittingshoes
b. Dehydration
1. Can result from vomiting, diarrhea, fever, sweating,excessive urination,blood
loss, skin injuries,or burns
2. Symptoms
a. Thirst
b. Dry skin or mouth
c. Reduced skin tension
d. Dark yellow or amber urine with low volume
3. Functional Assessment
a. Skin responses to antigens
b. Muscle weakness/wasting
c. Exercise tolerance
III. Nutrition in Practice - Nutritional Genomics
Nutritional genomics: Study of dietary effects on gene expression
Genome: the complete set of genetic information in our cells
Dietary factors may affect people whohave particular genevariations
Genes can determine susceptibility todisease
A. What is a genome? - It is where genetic information is encoded
B. How did research in nutritional genomics begin?
1. The Human Genome Project, which was completed in April 2003
2. Genetic differences may cause inherited disorders
C. How do nutrients alter gene expression? - A combination of dietary factors and hormones
influence the types of transcription factors.
D. How much genetic variation is thereamong people? - Except for identical twins,no two
individuals aregenetically identical,but variation is as littleas 0.1%.
E. What aresome examples of single-gene disorders?
1. PKU
5. 2. Cystic fibrosis
3. Hemochromatosis
4. Most are readily managed with simpledietary changes
F. How are multigene disorders different from single-gene disorders?
1. Are sensitiveto a number of environmental influences
2. Tend to develop over many years
3. Heart disease
4. Blood cholesterol
G. Can genomic research be used to explore the differences in nutrient needs among people? -
Yes; it may provide a means for fine-tuning nutrient recommendations.
H. Will knowledge about thehuman genome substantially changethemanner in which health
care is provided? - Perhaps, but disease riskwill still be more dependent on lifestylechoices.
I. What ethical concerns are raised by havingextensive knowledge about an individual’s
genome?
1. Confidentiality
2. May not be in the best interest of children
