nutritional assessment

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 promote health
• Help identify nutritional deficits
• Hydration s an important indicator
of the client’s general health
status


SUBJECTIVE DATA


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


• use various nutritional
assessment tools
o Checklist for nutritional
screening
o Nutrition Screening Checklist


Nutrition Screening Checklist
I have an illness or condition that made me change the kind and/or Yes (2 pts)_____
amount of food I eat
I 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)_____
day
without wanting to, I have lost or gained 10 pounds in the last 6 Yes (2 pts)_____
months
I 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 is
needed (especially for elderly)

OBJECTIVE DATA


1.Anthropometric measurements
2.Body composition measurements


Anthropometric
measurements
• Height, weight, BMI
• Helps to evaluate the client’s
physical growth, development,
and nutritional status


Height
o Normal findings:
within range for age, ethnic and
genetic heritage


Height
o Abnormal findings:
extreme shortness is seen
achondroplastic dwarfism and
Turner’s syndrome
extreme tallness – gigantism
(excessive secretion of GH) and
Marfan’s syndrome


Weight
o determine ideal body weight
(IBW) and percentage of IBW


Weight
o 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.


Weight
o 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.


o calculate &age of IBW:
• actual weight x 100 = %IBW
IBW


o Normal findings:
body weight is within 10% of ideal
range


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


weight exceeding 10% of IBW range-
considered overweight
20% - obesity


BMI


BMI
o Calculated based on ht and wt
regardless of gender
o A practical measure for
estimating total body fat
o Calculated as wt in kg and
divided by the square in ht in
meters
o Simple, quick, inexpensive

o But not diagnostic of client’s
health status
Does not differentiate bet fat or
muscle tissue


Inaccurately high or low findings
can result for individuals who are
particularly muscular or elderly
who tend to lose muscle mass
Inaccurate if client is retaining
fluid (e.g., edema, ascites,
pregnant)


• May not accurately reflect body fat
in adults, who are shorter than 5
feet


• Further assessments using
measurements that determine body fat
composition shld be performed – to
determine health status and assoc
risk factors


o formula:
• kg/m2 = BMI
o Normal findings:
18.5 – 24.9


‹18.5 = underwt
25-29.9 = overwt; increases risk
for health problems
30 or greater = obese; igher risk
for diabetes and cardiovascular
dse
•


BODY COMPOSITION
MEASUREMENTS


Body composition
measurements
o Useful in determining location
of body fat


Fat Distribution


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


Body composition
measurements
o Waist circumference
Most common measurement used to
determine extent of abd visceral
fat in relation to body fat


Waist circumference

Visceral 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


Waist circumference

Normal findings:
• F: less than 35 inches
• M: less than 40 inches


Waist circumference

Abnormal findings:
• Increased measurement may indicate
increased risk for disorders such
as DM, HTN, Hyperlipidemia,
cardiovascular dse


Waist circumference

• May not be accurate in adults
who are shorter than 5 feet


Body composition
measurements
o Waist-to-hip ratio measurement
used to help determine obesity.
The distribution of fat is
evaluated by dividing waist size
by hip size.


Waist-to-hip ratio
measurement
Ex:
• 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.


Waist-to-hip ratio
measurement
Normal findings:
• Male: ratio ‹1.0
• Female: ratio of ‹0.8


Waist-to-hip ratio
measurement
Abnormal 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.


Body composition
measurements
o Mid-arm circumference
o Helps to assess skeletal muscle
mass


Mid-arm circumference

procedure
• 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


Mid-arm circumference

record both the MAC ad SR#
• Ex: 25 cm, 88% of standard.


MAC standard reference
Adult standard 90% SR- 60% SR-
MAC (cm) reference moderately severely
(SR) malnourish malnourish
ed ed

M 29.3 26.3 17.6
F 28.5 25.7 17.1


Body composition
measurements
o Triceps skin-fold thickness
o Helps to evaluate subq fat stores
o measure, in millimeters, the
amount of skin and body fat.


Skinfold calipers
• areas: arm; suprailiac region of
abd; or subscapular area


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 you're a woman.

Triceps skin-fold
thickness
Arm = grasp skinfold and subq
fat bet thumb and forefinger,
midway bet acromion process and
tip of elbow
pull skin away from muscle
apply calipers
repeat 3 times record in mm


TSF standard reference
Adult standard 90% SR- 60% SR-
TSF (mm) referenc moderatel severely
e (SR) y malnouris
malnouris hed
hed
M 12.5 11.3 7.5
F 16.5 14.9 9.9


Triceps skin-fold
thickness
• Abnormal finding: greater than
120% = obesity


Body composition
measurements
o Mid-arm muscle circumference
o Evaluate muscle reserve stores
o Fla: MAMC = MAC (cm) – [0.314 x
TSF (mm)]


Mid-arm muscle
circumference
Adult standar 90% SR- 60% SR-
MAC d moderate severely
(cm) referen ly malnouri
ce (SR) malnouri shed
shed
M 25.3 22.8 15.2
F 23.2 20.9 13.9


Mid-arm muscle
circumference
to calculate % = 20.29/23.2 =
87%
record MAC and TSF and SR #
• ex: MAMC = 25 - [0.314 x 15] =
20.29; 87% of standard


• Note: when evaluating anthropometric
data, base conclusions on a data
cluster, not on individual findings


HYDRATION


Hydration

o Measure I &O
o Weight clients
o Check skin turgor
o Check for pitting edema
o Observe skin for moisture
o Assess venous filing
o Observe neck veins


Hydration
o Inspect tongue’s condition
gently palpate eyeball
o Observe eye position and
surrounding coloration
o Auscultate lung sounds
o Take BP on different positions


nutritional assessment

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