Nutrition in Nursing
Chapter 1
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutritional Screening
• Nutritional screen
– Quick look at a few variables to judge a
client’s relative risk for nutritional problems
– No accepted universal tool
– JCAHO mandates that screen must be done
within 24 hours of admission to the hospital
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutritional Screening (cont’d)
• Comprehensive nutritional assessment
– Moderate to high risk at screening referred to
dietitian for assessment
– Nutritional care process: 4 steps
o Assessment
o Nutritional diagnosis
o Implementation
o Monitoring and evaluation
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutritional Screening (cont’d)
• Comprehensive nutritional assessment (cont’d)
– Different from nursing care plan
o Dietitians can get most of information from
nursing admission assessment
o Dietitians interview patients and/or families to
obtain a nutrition history
– Helps to differentiate:
o Nutrition problems caused by inadequate intake
from those caused by illness or its treatments
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutritional Screening (cont’d)
• Comprehensive nutritional assessment (cont’d)
– Dietitians
o Calculate estimated calorie and protein
requirements based on the assessment data
o Determine nutritional diagnoses that define
the nutritional problem, etiology, and signs
and symptoms
o May also determine the appropriate
malnutrition diagnosis
o
Formulate nutrition interventions
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition
• Assessment
– Data classified as ABCD:
o Anthropometric
o Biochemical
o Clinical
o Dietary data
– Client’s medical-psychosocial history is also
evaluated for its impact on nutritional status
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Anthropometric data
– Physical measurements of the body
– Body mass index
o “Healthy” or “normal” BMI is defined as 18.5
to 24.9
o Above or below related to health risks
– “Ideal” body weight
– Edema or dehydration skews accurate weight
measurements
– Recent weight change
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Biochemical data
– No single test is both sensitive and
specific for protein-calorie malnutrition
– Biochemical data may help support the
diagnosis of a nutritional problem
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Albumin
– Often used to assess protein status
– Serum levels may be maintained until malnutrition is
in a chronic stage
– Low albumin may indirectly identify patients who may
benefit from nutrition assessment and intervention
• Prealbumin
– Thyroxin-binding protein
– More sensitive indicator of protein status
– More expensive to measure
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Clinical data
– Physical signs and symptoms of malnutrition
observed in the client
– Most signs cannot be considered diagnostic
– Physical signs and symptoms of malnutrition
can vary in intensity among population groups
because of genetic and environmental
differences
– Physical findings occur only with overt
malnutrition
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Dietary data
– Nurse should ask, “Do you avoid any particular
foods?”
– Nurse should not ask, “Are you on a diet?”
• Medical psychosocial history
– May shed light on factors that influence intake,
nutritional requirements, or nutrition counseling
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Medication
– Both prescription and over-the-counter drugs have
the potential to affect and be affected by nutritional
status
– At greatest risk for development of drug-induced
nutrient deficiencies include those who:
o Habitually consume fewer calories and nutrients
than they need
o Have increased nutrient requirements including
infants, adolescents, and pregnant and lactating
women
o Are elderly
o Have chronic illnesses
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• At greatest risk for development of drug-induced
nutrient deficiencies include those who (cont’d):
– Take large numbers of drugs (five or more),
whether prescription drugs, over-the-counter
medications, or dietary supplements
– Are receiving long-term drug therapy
– Self-medicate
– Are substance abusers
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Nursing diagnosis
– Provide written documentation of the client’s
status
– Serve as a framework for the plan of care that
follows
• Planning: client outcomes
– Outcomes, or goals, should be measurable,
attainable, specific, and client centered
– Focus on the client, not the health care provider
– Keep in mind that the goal for all clients is to
consume adequate calories and protein using
foods they like and tolerate as appropriate
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Nursing interventions
– Nutrition therapy
o Diet is a four-letter word with negative
connotations
o Usually general suggestions to increase/
decrease, limit/avoid, reduce/encourage, or
modify/maintain aspects of the diet because
exact nutrient requirements are determined
on an individual basis
o Nutrition theory does not always apply to
practice
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Integrating Nutrition (cont’d)
• Nursing interventions (cont’d)
– Client teaching
o Clients in clinical settings may be more
receptive to nutritional advice
o Hospitalized patients are also prone to
confusion about nutrition messages
• Monitoring and evaluation
– Monitoring precedes evaluation
– Evaluation assesses whether client outcomes
were achieved
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Signs & Symptoms of
Malnutrition
• Hair is dull, brittle, dry,
or falls out easily
• Swollen glands of neck
and cheeks
• Dry, rough, or spotty
skin
• Poor or delayed wound
healing or sores
• Thin appearance with
lack of subcutaneous fat
• Muscle wasting
• Edema of lower
extremities
• Weakened hand grasp
• Depressed mood
• Abnormal heart
rate/rhythm and BP
• Enlarged liver or spleen
• Loss of balance and
coordination
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses With
Nutritional Relevance
• Altered nutrition: more than body requirements
• Altered nutrition: less than body requirements
• Altered nutrition: risk for more than body
requirements
• Constipation
• Diarrhea
• Fluid volume excess
• Fluid volume deficit
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses With
Nutritional Relevance (cont’d)
•
•
•
•
•
•
•
•
•
Risk for aspiration
Altered oral mucous membrane
Altered dentition
Impaired skin integrity
Noncompliance
Impaired swallowing
Knowledge deficit
Pain
Nausea
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins