This document provides guidance on conducting a nutritional assessment and developing a nutrition care plan. It outlines tools for assessment including dietary history, physical exam measures like weight and skin folds, and dietary guides. The nutritional assessment involves collecting a health history, diet evaluation through recalls and checks, and physical exam findings to identify nutritional deficiencies, overnutrition or other issues. Common dietary guides are also outlined such as food groups, plates, and pyramids to aid in planning therapeutic diets.

1. NUTRITION –
FOCUSED NURSING
CARE PLAN
NUTRITIONAL
ASSESSMENT

2. • Wt. Gain
1 lb/ wk (1/2 kg) = add 500
kcal./ day
lose- less 500 cal
2 lbs/ wk ( 1 kg ) = add 1000
kcal./ day
lose- less 1000 cal.

3. • Consume 10 kcal/ lb of BW –
for wt. maintenance
• Most adults – 12 kcal/ lb
• Active adults – 15 kcal/ lb

4. • A. NUTRITIONAL ASSESSMENT
• TOOLS: interview; medical charts
• simple assessment – determining if the
person is overweight or underweight or
has had a change in wt. that may be
indicative of a change in health status.
• lab. Values – hemoglobin; Albumin –
protein status
• Cholesterol & other blood fats such as
triglycerides, BG
• physical signs of nutritional status
• psychological issues – contributing to
physical health concerns
• comprehensive nutritional assessment
– conducted to det. goals & determine
inteventions to correct actual or
potential imbalances

5. • 1. HISTORY
• Dietary history
• used in conjunction w/ physical parameters
of health
• current & past health history
• - EX: Chewing & swallowing problems 2° ill-fitting
dentures or missing teeth or from mechanical
problems ( obstruction, inflammation, edema )
• - neurological problem (dysphagia, parkinson’s
disease, stroke, traumatic brain injury )
• - anorexia or loss of appetite
• - cognitive impairments
• - paralysis or physical disabilities that may
impair the ability to feed oneself
• - excessive nutrient intake – bulimia nervosa/
obesity
• - GI disorders – lactose intolerance; cystic
fibrosis; pancreatic disorders; inflammatory
bowel disease; liver disorders
• - altered metabolism – pregnancy; fever; sepsis;

6. • a. DIET EVALUATION
• a.1. DIET HISTORY
• - through interview
• - food preferences &
intolerances
• - taste, appetite, recent wt.
changes
• - desired wt. & usual wt.
• - estimation of typical
kilocalorie & nutrient
intake

7. • TOOLS:
• DIETARY GUIDES
• - are tools devised to aid in
planning, procuring,
preparing, serving &
consuming meals for both
normal & therapeutic diets
of individuals or groups.

8. • TOOLS COMMONLY USED:
1. Three food groups or your guide to
good nutrition (YGGN)
• a. Energy-giving foods – GO
• b. Body-building foods – GROW
• c. body-regulating foods – GLOW
• - based on the body’s physiologic
functions
2. Plate model
• - illustrates the types of food needed
for a healthy diet & the proportions
that should be eaten every day.
• - is simple & designed so that
appropriate food selection can be
made visually without having to
weigh or measure foods

9. • - helps one to eat more fruits & vegetables,
less fat & cholesterol, and helps to control
the amount of carbohydrate ingested at each
meal
• - uses a 9-inch diameter plate which is
divided into 3 portions.
• 1st
quarter – lunch & dinner
• - filled w/ 1/2 –inch deep starchy foods
( corn, pasta, & rice )
• 2nd
quarter – filled w/ serving of meat or meat
alternative.
• - best choices are lean meats, fish, poultry
or legumes, prepared w/o oils or fats
• Remaining half – filled w/ non-starchy
vegetables – tomatoes, green leafy veg.,
carrots, etc.
• Side dishes – serving fruit ( 1 cup fresh or 1
cup canned or 4 ounces juice )
• 1 cup serving of low fat milk or yogurt

10. 4. Food pyramid
• is the hierarchy of food groups
in a person’s diet that helps to
put the dietary guidelines into
action.
• - requires consumption of a
variety of foods w/ the right
amount of servings to get
the nutrients needed by the
body, & to maintain or
improve weight.
• - it specifies the
recommended amounts

11. 5. The recommended energy
& nutrient Intakes ( RENI )
• - defined as levels of intakes of
energy & nutrients which, on the
basis of current scientific
knowledge, are considered adequate
for the maintenance of health & well-
being of nearly all healthy persons in
the population
• - it emphasizes that the
standards are in terms of
nutrients, & not foods or
diets.

12. 6. New nutritional guides for
Filipinos
• -are general but simple statements
intended to provide the general
public w/ recommendations about
proper diet & wholesome dietary
practice to promote good health for
themselves & their families.
• - they do not provide
quantitative
recommendations; instead
they provide qualitative
recommendations
considered essential for

13. 7. NUTRITIONAL GUIDELINES
FOR FILIPINOS (2000)
1. Eat a variety of foods
every day
• No single food provides all
the nutrients the body
needs.
2. Breastfeed infants
exclusively from birth to 4
– 6 months, and give
appropriate foods while
continuing breastfeeding.

14. 4. Consume fish, lean meat,
poultry, or dried beans.
Provide good quality protein & dietary
energy, as well as iron & zinc.
5. Eat more vegetables,
fruits, and root crops.
6. Eat foods cooked in edible/
cooking oil in daily meals.
7. Consume milk, milk
products & other calcium-
rich foods, such as small
fish & dark green, leafy
vegetables every day.

15. 8. Use iodized salt, but avoid
excessive intake of salty
foods.
9. Eat clean & safe foods.
10. For a healthy lifestyle
and good nutrition, exercise
regularly, do not smoke,
and avoid drinking alcoholic
beverages.

16. 8. The food composition
tables ( FCT )
- a dietary tool which
contains a list of foods w/
numerical values
corresponding to the
amount of energy,
nutrients, fibers & ash per
100grams of any particular
food in the list.

17. 9. The food exchange list
( FEL )
• - a list of common foods
grouped in terms of
equivalent amounts of CHO,
CHON, FATS & CALORIEs.
• - consists of 8 groupings
namely – vegetable exchanges,
fruit exchanges, milk
exchanges, rice
exchanges,meat & fish
exchanges, fat exchanges,
alcoholic beverages, and sugar

18. a.2. 24-HOUR food RECALL
- quick & easy of evaluationg
intake
- person must be able to
recount all the types &
amounts of foods &
beverages consumed during
a 24-hour period

19. • a.3. FOOD FREQUENCY
checklists
- a checklist of particular foods that
helps determine what’s consumed &
how often
- may list the foods in one column, &
the person marks off how often they
are eaten
- how often the food is consumed (per
day/ per week, or per m0nthe)
- if the food is eaten frequently,
seldom, never
- typically does not include the serving
size, & it may only include specific
foods or nutrients suspected of being

20. • a.4. CALORIE COUNT
• The ENERGY (CALORIE)
value of food is the amount
of energy produced in the
body as a result of food
metabolism.
•
• Calorie – the most common
term to express energy
• a unit measure of heat
a.5. FOOD DIARY

21. 2. PHYSICAL
EXAMINATION/
findings – clinical
assessment

22. • The physical examination (PE)
of an individual for signs and
symptoms suggestive of
nutritional health and/or
clinical pathology
• conducted by the physician or
trained clinical staff on
anatomic changes

23. a. ANTHROPOMETRY
- the science that deals
with body
measurements, such as
size, weight, &
proportions
- useful in screening
individuals who may
have varying degrees of
protein-energy

24. a.1. WEIGHT
-this measurement needs to be
undertaken at the very 1st
encounter w/ a patient &
must be regularly monitored
- usual BW should be noted
- taken on the same scale at
the same time of day
( typically before breakfast &
after voiding ), in the same
amount of clothing, w/o shoes
- wt loss is best expressed in
term of percentage of wt.

25. • Cut off point for Low Birth
Weight (LBW) = 2500 g (2.5
kg)

26. • INFANTS:
1. 1st
6 MONTHS:
DBW (gram) = Birthwt (g) +
(Age in mos x 600)
2. 7 – 12 MONTHS:
DBW(g) = Birthwt (g) +
(Age in mos x 500)

27. • Infant’s weight doubles at
5-6 months
• Triples at 12 months
• Quadruples at 24 months

28. • CHILDREN:
DBW = (Age in yrs x 2) +
8
Note: At least +2 kg every
year
 ADULT – ( dietary calculations)

29. • Indicates wasting
if < 85% of standard
1.McLaren & Read
2.Body Mass Index (BMI)

30. % = Actual weight x 100
Ideal weight

31. Interpretations:
Overweight ≥ 110%
Normal 90 – 109%
Mildly UW 85 –
89%
Moderately UW 75 – 84%
Severely UW < 75%

32. a.2. HEIGHT
- Indicates stunting
- Compare actual height
with standard height for
various ages
- Using WHO tables
- Stunted if < 90% of
standard height

33. - should be measured w/
the individual standing
as straight as possible,
w/o shoes, against the
wall using a fixed
measuring stick

34. • For infants:
- Height at birth is about 50
cm (48 to 52 cm)
- + 24 cm at age 1 year
- + 12 cm at age 2 years
- + 8 cm at age 3 years
- + 6 cm/year from 4-8
years

35. 1. HEAD-CHEST RATIO
- Measures head & chest
circumference
- 0 – 5 or 6 mos => 1
- 6 months = 1
- 7 – 12 months = <1
a.3. BODY
CIRCUMFERENCES

36. 2. MID-ARM CIRCUMFERENCE
(MAC)
- indicates the level of the
body’s protein stores which
are found mainly in the
muscles
- Non-dominant arm is flexed
at a 90-degree angle and
the circumference is
measured w/ a
nonstretchable measuring
tape after the midpoint of
the upper arm is

37. 4. WAIST
CIRCUMFERENCE
- Values above standards
indicate central body fat
adiposity
5. WAIST HIP RATIO = Waist(in/cm)
Hips (in/cm)

38. • Getting waist
measurement: the narrowest
• Getting hip measurement:
the broadest
Females: <0.85 inches
Males: <1.0 inches

39. • Determines fatness or
leanness
• Compare with standards’
• Triceps, biceps,
subscapular, abdomen,
upper thigh
a.4. SKIN FOLDS

40. 1. TRICEPS SKIN FOLD (TSF)
- an index of the body’s fat
or energy stores
Low skin fold measurement
--- may indicate
malnutrition
Used for both men & women
Measure the skinfold
thickness --- in the
posterior side of the
nondominant upper arm at
the midpoint

41. b. CLINICAL FEATURES
OF
b.1. MALNUTRITION

42. - or poor nutritional status – a
state in which a prolonged lack
of one or more nutrients retards
physical development orv
causes the appearance of
specific clinical conditions
(anemia, goiter, rickets, etc. –
micronutrient deficiencies)
- this may occur because the diet
is poor or because of a
digestion & metabolism
problem.

43. Protein Energy Malnutrition (PEM)
lead to acute thinness (wasting)
or a long term reduction in child
growth(stunting).
• Kwashiorkor Protein
deficiency
occurs after weaning, when milk
high in protein is replaced by a
starchy staple food that provide
insufficient protein

44. Kwashiorkor

45. - swollen and discolored skin on
the arms and legs
- thin and pale hair,
- diarrhea,
- profound apathy, and
loss of appetite.
- tissues and organs waste away,

46. Marasmus Protein
calorie deficiency
As overall deficiency in food
Small size for chronological age
Mental apathy
Dry flaky skin
Frequent infections
Anorexia & diarrhea
Red swollen lips

48. • MARASMUS &
KWASHIORKOR
• b.2. OBESITY
• OVERWEIGHT – refers to an
excess of body weight 10%
greater than the standard
• OBESITY – excess of body
wt. 20% or more than the

49. Overweight
Excess of body weight 10%
greater than the standard
Obesity
Excess in 20% or more of the
standard.
Extreme obesity = 30%

50. “global epidemic”
Increased intake of kilocalorie
High intake of sugar-based beverages
Decreased consumption of fiber based
food
Fast pace of eating

51. • What are the known causes
and theories of OBESITY?
- it occurs when caloric
intake exceeds expenditure
over an extended period
- reduced physical activity

52. • b.3. CERTAIN VITAMIN
DEFICIENCIES
 Refer to your handouts on vitamins & assignment.

53. 3. DIETARY
CALCULATIONS

54. a.1. ACTUAL & IDEAL BODY
WEIGHT & HEIGHT
- wt. is the measure people
use to judge their “fitness”

55. • IBW range can be 10% higher
or lower depending on body
size
% of IBW – obtained
Formula = pt’s true wt X 100
IBW
• 110% - 120% - Overweight
• 90 – 110% - Normal
• 80 – 90% - mildly underweight
• 70 – 79% - moderately
underweight

56. • ADULTS
1.HAMWI METHOD
Males: For the 1st
5 ft, allow
106 lbs; ±6 lbs every inch
above or below 5 ft
Females: For the 1st
5 ft,
allow 100 lbs; ±5 lbs every
inch above or below 5 ft

57. NDAP FORMULA
Males: For the 1st
5 ft,
allow 112 lbs; ±4 lbs every
inch above or below 5 ft
Females: For the 1st
5 ft,
allow 106 lbs; ±4 lbs every
inch above or below 5 ft

58. 3. TANHAUSSER’S
METHOD OR BROCCA
INDEX
DBW (kg) = Height (cm) –
100
* For Filipinos, deduct 10% of
the difference

59. 4. DERIVED FORMULA
BASED ON BMI
Desirable BMI for Men: 22
Desirable BMI for Women:
20.8 or 21
DBW (kg) = Desirable BMI
x height (m2)

60. • HEALTHY WEIGHT - defined by
3 criteria:
1. A weight that is within the
suggested range for height
2. A fat distribution pattern that
is associated w/ a low risk of
illness & premature death.
3. A medical history that reflects
an absence of risk factors
associated w/ obesity, such as

61. % IBW = current/actual weight x
100
ideal weight
Normal: 90 – 109%
Overweight: 110 – 119%
Obese: 120% or more

62. % Usual body wt = current weight
x100
Usual body wt
Interpretations:
% usual body weight Nutrition status
85 – 95 Mildly UW
75 – 84 Moderately UW
< 75 Severely UW

63. • a.2. BODY MASS INDEX
- measures weight in relation
to height
- measure of adiposity or
overfat, not simply
overweight
- should not be applied to
children, adolescents, adults
over 65 y/o, pregnant &
lactating women, & highly
muscular individuals.

64. • - formula:
• BMI = weight (kg)
Height(m²)
• >18.5 – underwt.
• 18.5 – 24.9 – normal
• 25.0 – 29.9 – overwt.
• 30.0 – 34.0 – obese – class 1
• 35 – 39.9 – class 2
• 40 or greater – morbid

65. Infant – 6 y/o

66. 1 month = 30 days
1 year = 12 mos
a. Write the date of weighing
this way
Ex. Date of weighing is Dec
6,2008
Year Month Day
2008 12 06

67. b. Write the birth date of
the child in the same
way
Ex. Birthdate is March 2,
2006
Year Month Day
2006 03 02

68. c. Subtract the birthdate
from the date of
weighing
2008-12-06
minus 2006-03-02
2-09-04
*The child is 2 years, 9
months and 4 days

69. d. Multiply “years by 12”.
Add this to number of
months. Disregard the
“days” column
2-9-4 : 2 years x 12
= 24 months + 9 months
= 33 months

70. % = Actual weight x 100
Ideal weight
Interpretations:
Normal 91 – 110%
Mildly UW 76 – 90%
Moderate UW 61 – 75%
Severely UW 60% or less

71. • 4. LABORATORY EXAMINATIONS
–biochemical
- Routine blood and urine
laboratory tests
- composition of blood to compare
w/ normal ranges for
hemoglobin, albumin,
transferrin, total plasma
protein, nitrogen content in 24-
hour urinary output

72. • ADVANTAGES:
1.It can detect early sub-clinical
status of nutrient deficiency.
2.It identify specific nutrient
deficiency.
3.It is independent of the
emotional & subjective factors

73. • DISADVANTAGES:
1.It is expensive & time-
consuming
2.Standard could vary with
wide range.
3.There may be problem in
interpreting results.

74. 5. NUTRITIONAL ASSESSMENT OF
SPECIFIC DISEASES

75. • B. NURSING DIAGNOSIS
• C. PLANNING
- this stage of the nursing process
brings together all the findings of
the assessment phase
Identifying priority health concerns,
long- term health goals, & STO
• Specified health outcomes is
important for facilitating
behavioral change

76. • D. IMPLEMENTATION/
intervention
- putting plan into action
- based on the information
gathered in the
comprehensive nutritional
assessment
- may require restrictions in
diet, such as --- reduction in
calories; fat; saturated fat;
cholesterol, sodium, or other

77. • 1. DIETARY CALCULATIONS
OF CALORIE/ DAY INTAKE
- GRAMS EACH FOOD
• ESTIMATING ENERGY/
CALORIE NEEDS
• - to create a tailored
nutrition prescription, one
must determine the patient’s
energy/ calorie requirements

78. • 2. FEEDING GUIDELINES
• E. EVALUATION
• - the final step
• - must be documented – based on skills
& information gained & by the
outcomes of laboratory blood tests or
other measures
• - EX: achieving 5% wt. loss
• - helps the health care professional if
further intervention is needed
• - monitoring the growth in children
• - wt. changes in adults

80. A- AIM FOR FITNESS
- Aim for healthy weight.
- Be physically active for each
day.
B- BUILD A HEALTHY BASE
- Let the pyramid guide your
food choices.
- Choose a variety of fruits and
vegetables daily
- Keep food safe to eat.

81. C- CHOOSE SENSIBLY
- Choose a diet that is low in
saturated fat & cholesterol
and moderate in total fat.
- Choose beverages and
foods that limit your intake
of sugars.
- If you drink alcoholic
beverages, do so in

83. A – nthropometric
B – iochemical
C – linical
D – ietary measurements

84. -provides the pathway or process to
achieve this balance. The NCHF
emphasizes a sharp distinction between
disease prevention and health promotion.
Disease prevention focuses on protecting
as many people as possible from the
harmful consequences of a threat to
health (e.g., through immunizations).
- Health promotion consists of the
development of lifestyle habits which
healthy individuals and communities can
adopt to maintain and enhance the state
of well-being. The ultimate goal is the
optimization of health. Health promotion
addresses individual responsibility while

86. Examples of Promotion of Health
1.Physical fitness
2.Smoking control
3.Mind-body health
4.Spiritual health
5.Medical self-care
6.Environmental health
7.Nutrition
8.Stress management
9.Social health
10.Weight management
11.Work safety
12.Prenatal care

87. THE THREE FUNCTIONS OF NUTRIENTS
Provide EnergyProvide Energy Promote growthPromote growth
andand
developmentdevelopment
Regulate bodyRegulate body
functionsfunctions
CarbohydratesCarbohydrates ProteinsProteins ProteinsProteins
ProteinsProteins LipidsLipids LipidsLipids
Lipids (fats andLipids (fats and
oils)oils)
VitaminsVitamins VitaminsVitamins
MineralsMinerals MineralsMinerals
WaterWater WaterWater

88. SPECIAL DIET
- are used in the treatment of persons
with certain mental disorders to:
- identify and correct disordered eating
patterns
- prevent or correct nutritional
deficiencies or excesses
- prevent interactions between foods or
nutrients and medications

89. SPECIAL DIET are designed to help individuals
make changes in their usual eating habits or
food selection. Some special diets involve
changes in the overall diet, such as diets for
people needing to gain or lose weight or eat
more healthfully. Other special diets are
designed to help a person limit or avoid certain
foods or dietary components that could
interfere with the activity of a medication. Still
other special diets are designed to counter
nutritional effects of certain medications.