This document provides an overview of a nurse's role in nutritional assessment. It discusses monitoring clients with acute and chronic nutritional needs, incorporating family eating habits, and teaching community nutrition. A multidisciplinary approach involving nurses, dieticians, and other providers is emphasized. Methods for nutritional assessment addressed include food intake assessments, physical exams, anthropometric tools, and clinical lab values. Risk factors for inadequate nutrition and their potential impacts are also outlined.

1. Nutritional Assessment A Presentation

2. Nurse’s Role in Nutritional Assessment Monitoring and intervention to clients needing acute and chronic nutritional care Incorporate family nutritional habits into nutritional care Active role in community teaching regarding nutrition

3. Collaborative multidisciplinary approach A varied approach to nutritional assessment will provide the best outcomes for the client: physical assessment by nurses/other providers, comprehensive nutritional assessments by registered dieticians/nurses, and follow-up by nurses/dieticians

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5. Methods of Nursing Nutritional Assessments Food Intake Assessment Physical Assessment Anthropometric Tools Clinical Values

6. Methods to Evaluated Food Intake Comparision with the MyPyramid Model: Asks client what he or she eats Compares this reported food intake with MyPyramid Model Food Frequency: requests client to fill out a questionnaire asking about Usual food intake during specified times, such as “What do you usually eat for breakfast?” 24 Hour Recall: asks client what he or she has eaten during the previous 24 hours. Food records: asks client to record his or her food intake for a specified Length of time (1 day, 3 days, 7 days) Diet History: comprehensive interview to obtain thorough Information about food intake, medications, allergies, nutrition knowledge, Cultural preferences, weight history, elimination patterns, alcohol and Tobacco usage, financial ability, functional ability to chew and swallow, and Special dietary needs.

7. Nutrition Information about You What does your nutrition label say about You? Image courtesy of Creative Commons (Copyright (C) 2009, All Rights Reserved. This work is licensed under a Creative Commons Attribution-Generic 2.0 United States License

8. Physical Assessment Head to Toe Assessment Focuses on General Appearance and signs and symptoms of Nutritional Imbalance

9. Signs and symptoms of Inadequate Nutrition Hair: dry, dull, or brittle Skin: Dry patches Wounds: poor wound healing or sores Fat and Muscles: lack of subcutaneous fat and/or muscle wasting Vital signs: abnormal cardiovascular measurements General: general weakness and/or impaired condition

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11. Anthropometric Tools Weight assessment: same time of day typically daily or weekly (view this video clip to see correct weight demonstration: http://www.youtube.com/watch?v=B_YBgEElm_A) Height measurement: measured in cm or in

12. Anthropometric Tools Body Mass Index (BMI): BMI = weight (kg) /height(m2) Body Fat Composition Methods: skin fold measurements (usually back of the arm), waist to hip ratio, densitometry (underwater weighing)

13. Clinical Values to Assess Nutritional Status Fluid Intake and Ouput: otherwise known as I & O; Average adult intake is 2200 to 2700 mL per 24 hours; Average output should be 2200 to 2700 mL Per 24 hours; average hourly output = 30 mL/hr Protein Levels: measured by serum (blood) albumin levels; Normal albumin = 3.5 to 5.5 g/dL Pre-Albumin (thyroxin-binding protein): more sensitive measure for Critically ill clients; reflects acute changes; Normal level = 23 to 43 mg/dL

14. Risk Factors for Inadequate Nutrition Biophysical Factors Psychological Factors Socioeconomic Factors

15. Impact of Risk Factors Risk factors can affect nutritional status Ask yourself, “What impact would a particular risk factor have on that person’s nutritional status?”

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