Nutritional Assessment
Chapter 11
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 11: Nutritional Assessment
Defining Nutritional Status
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Optimal nutritional status
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Undernutrition
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Overnutrition
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Nutritional requirements at different ages
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Infants and children
Adolescence
Pregnancy and lactation
Adulthood
The aging adult
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-2
Chapter 11: Nutritional Assessment
Purposes and Components
of Nutritional Assessment
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Purposes of nutritional assessment
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Nutrition screening
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Admission nutrition screening tool
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24-Hour diet recall
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Food frequency questionnaire
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Food diaries
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Direct observation
Food guide pyramid
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-3
Chapter 11: Nutritional Assessment
Subjective Data—
Health History Questions
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Eating patterns
Usual weight
Changes in appetite, taste, smell, chewing, swallowing
Recent surgery, trauma, burns, infection
Chronic illnesses
Vomiting, diarrhea, constipation
Food allergies or intolerances
Medications and/or nutritional supplements
Self-care behaviors
Alcohol or illegal drug use
Exercise and activity patterns
Family history
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-4
Chapter 11: Nutritional Assessment
Objective Data—Physical Exam
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Equipment needed
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Skinfold calipers—Lange or Harpenden
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Measurement tape
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Anthropometer
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Pen or pencil
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Nutrition assessment data form
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-5
Chapter 11: Nutritional Assessment
Objective Data—Physical Exam
(cont.)
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Anthropometric measures
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Derived weight measures
• Body weight as percent of ideal body weight
• Percent usual body weight
• Recent weight change
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-6
Chapter 11: Nutritional Assessment
Objective Data—Physical Exam
(cont.)
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Body mass index =
Weight (kg)
Height (m)2
or
Weight (lbs)
Height (in)2 x 705
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Waist-to-hip ratio =
Waist circumference
Hip circumference
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-7
Chapter 11: Nutritional Assessment
Objective Data—Physical Exam
(cont.)
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Skinfold thickness
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Technique of measurement
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Repeat three measurements and then take
average
Mid-upper arm circumference (MAC)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-8
Chapter 11: Nutritional Assessment
Objective Data—Physical Exam
(cont.)
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Derived anthropometric measures
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Mid-upper arm muscle circumference (MAMC)
MAMC = MAC – (p × TSF)
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Mid-arm muscle area (MAMA)
MAMA = (MAC – MAMA)2
4p
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Arm span or total arm length
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Frame size by elbow breadth
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-9
Chapter 11: Nutritional Assessment
Laboratory Studies
in Nutritional Assessment
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Hemoglobin
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Hematocrit
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Cholesterol
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Triglycerides
Total lymphocyte count
Skin testing
Serum proteins
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Serum albumin
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Serum transferrin
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Prealbumin
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Nitrogen balance
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Creatinine-height index
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-10
Chapter 11: Nutritional Assessment
Abnormal Findings
Classification of Malnutrition
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Obesity
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Marasmus (protein-calorie malnutrition)
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Kwashiorkor (protein malnutrition)
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Marasmus/kwashiorkor mix
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-11
Chapter 11: Nutritional Assessment
Abnormal Findings
Abnormalities Caused by
Nutritional Deficiencies
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Pellagra
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Scorbutic gums
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Follicular hyperkeratosis
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Bitot’s spots
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Kwashiorkor
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Rickets
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Magenta tongue
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HIV-associated malnutrition
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 11-12