Chapter 7
Nutritional Assessment
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Describe the recommended dietary
allowances for adequate nutritional
intake for all age groups.
Identify nutritional differences for
different age groups.
Perform a nutritional history and
physical assessment.
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Perform anthropometric
measurements.
Describe the most common
pathophysiologies for abnormal
findings.
Describe laboratory analyses needed
and their clinical significance to the
nutritional assessment.
Copyright 2002, Delmar, A division of Thomson Learning
Dietary Guidelines
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Recommended dietary allowances
(RDA)
Food guide pyramid
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Six food groups
Fats, oils, and sweets: use sparingly
Milk, yogurt and cheese: 2–3 servings/day
Meat, poultry, fish, eggs: 2–3 servings/day
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Dietary Guidelines
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Vegetables: 3–5 servings per day
Fruits: 2–4 servings per day
Breads, cereal, rice, pasta: 6–11
servings per day
Copyright 2002, Delmar, A division of Thomson Learning
Nutrition Through
the Life Cycle
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Children
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Daily needs change based on age
group
Infants
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Rapid growth and development
Preferred to breast feed for first 12
months
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Nutrition Through
the Life Cycle
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Assess reflexes—sucking, rooting,
swallowing
Assess physical development
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Infant Feeding
Guidelines
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Introduce foods one at a time
Begin with foods that are least
allergenic
Avoid egg whites and citrus
fruits until 12 months old
Avoid honey in infants under 12
months
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Assessment
of Infants
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Breastfed? How often? How long?
Bottle-fed? How often? How much?
Formula preparation? Storage?
How does the infant respond to
eating?
Constipation? Diarrhea?
Is the infant ever put in bed with a
bottle?
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for Toddlers
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Physical growth slows
Increased independence
Small portions
Offer one new food at a time
Serving size 1–2 tbsp for each year
of age
Routine mealtimes
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for Preschoolers
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Independence
May become a picky eater
Offer food choices
Serve small servings
Finger foods
Routine mealtimes
Involve in food preparation
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for
School-Age Children
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Erratic growth and eating patterns
Strong food preferences
Balanced diet
Limit highly sweetened snacks and
foods
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Assessment
of Young Children
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Concerns with child’s eating?
Child’s food preferences?
Involvement in sports? Physical
activity?
Child’s meal schedule?
Balanced diet?
Food allergies?
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for Adolescents
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Period of rapid growth and change
Fluxuating nutritional needs
Concerns with body image
Risks for eating disorders
Adjustments to caloric needs based
on physical activity level
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Assessment
of Adolescents
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Participation in physical activity?
Adhere to a specific diet or meal plan?
Skip meals?
Satisfaction with current weight?
Consumption of snacks?
Have you ever induced vomiting, used
laxatives, diuretics, or diet pills to
control weight?
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for Young and MiddleAged Adults
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Growth and caloric needs stabilize
Eating habits may be influenced by
activity levels, life stressors
Nutritional risks for development of
disease
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Obesity
Osteoporosis
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
Nutritional Guidelines
for Young and MiddleAged Adults
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Type 2 Diabetes Mellitus
Atheroschlerosis
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Assessment
of Young and MiddleAged Adults
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Caloric intake?
Adherence to specific diet?
Satisfaction with current weight?
Physical activity?
Consumption of snacks?
Typical meal patterns?
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for Pregnant and
Lactating Women
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Role of proper nutrition in
development of healthy infant
Target weight gain for pregnancy
Iron supplements
Prenatal vitamins
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for Pregnant and
Lactating Women
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Folic acid
Additional caloric intake for
pregnancy and lactation
Adhere to food guide pyramid
Fluid consumption
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Assessment
of Pregnant Women
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Prepregnancy weight?
Ideal body weight (IBW)?
Use of supplemental vitamins?
Consumption of caffeine, artificial
sweeteners, alcohol?
Presence of constipation, nausea,
vomiting, or heartburn?
Presence of food cravings?
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for the Older Adult
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Decreased caloric requirements
Adhere to food guide pyramid,
except consume decreased portion
size
Encourage to eat in a sitting position
Encourage adequate fluid intake and
high fiber diet
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Guidelines
for the Older Adult
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Nutritional risk factors
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Difficulty chewing or swallowing
Decreased appetite
Decreased ability to feed self
Decreased taste and smell
Decreased esophageal emptying time
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional Assessment
of Older Adults
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Presence of physical limitations that
affect eating?
Difficulty chewing or swallowing?
Presence of dental problems?
Difficulty obtaining or preparing
foods?
Do you eat alone?
Copyright 2002, Delmar, A division of Thomson Learning
Cultural Differences in
Nutrition
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Cultural beliefs related to the
consumption of food
Religious beliefs related to the
consumption of food
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Food restrictions
Periods of fasting
Copyright 2002, Delmar, A division of Thomson Learning
Components of
a Nutritional
Assessment
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Nutritional history
Physical assessment
Anthropometric measurements
Laboratory data
Diagnostic data
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional History
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General diet information
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Changes in past 12 months
Ability to obtain and prepare foods
Food preferences
Adherence to particular diet
Consumption of fast foods
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Nutritional History
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Food intake history
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24-hour recall
Food diary
Calorie count
Evaluation of adequacy of diet
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Food guide pyramid
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Physical Assessment
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Head to toe
Assess for subjective and
objective signs and symptoms of
poor nutritional status
Copyright 2002, Delmar, A division of Thomson Learning
Signs and Symptoms of
Poor Nutritional Status
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Subjective data
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Fatigue
Weight changes
Changes in appetite
Weakness
Changes in bowel habits
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Signs and Symptoms of
Poor Nutritional Status
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Objective data
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Weight changes
Dry, rough, scaly skin
Dry, cracked lips
Swollen, bleeding gums
Edema
Decreased muscle tone
Copyright 2002, Delmar, A division of Thomson Learning
Anthropometric
Measures
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Height
Weight
Ideal body weight, percent IBW
Percent weight change
Triceps skinfold
BMI
Mid-arm circumference
Waist/hip ratio
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Laboratory Data
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Hematocrit and hemoglobin
Cholesterol and triglyceride levels
Transferrin, TIBC, iron
Total lymphocyte count
Albumin and prealbumin
Glucose
Creatinine and nitrogen
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Diagnostic Data
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Radiographic studies
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