Chapter 13
Nutrition Care
and
Assessment
© 2007 Thomson - Wadsworth
Nutrition in Health Care
• Health problems
 Alter nutrition
needs
 Can lead to
malnutrition
• Poor nutrition
status
 Can influence the
course of disease
& body’s response
to treatment
• Hospitalized
patients
 40-60% with
acute illness are
malnourished
 Others decline in
nutrition status
within 3 weeks
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How Illness Affects
Nutrition Status
• Reduced food intake
 Nausea
 Inflammation of
mouth
 Medications can cause
GI upset
• Interferes with
digestion &
absorption
• Alters metabolism &
excretion
• Dietary restrictions
for some surgeries
or chronic illnesses
• Drain on financial
resources
• Unable to prepare
food
• Emotional upset
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Responsibility for
Nutrition Care
• Registered Dietitians
 Provide medical
nutrition therapy
 Assess, diagnose,
develop,implement &
evaluate nutrition care
plans
 Plan & approve menus
 Provide education
• Registered Dietetic
Technician
 Assist the Registered
Dietitians
• Physicians
 Prescribe diet orders
• Nurses
 Screen patients
 Participate in nutrition
assessments
 Provide direct nutrition
care
• Other team members
such as pharmacists &
speech therapists
consult
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Identifying Risk for
Malnutrition
• Nutrition screening
 Identifies persons at
risk for nutrition
problems
 Must be done 24
hours after
admission
 Should be
completed in 5-15
minutes
• Screening
 Medical diagnosis
 Medical record
 Physical
measurements
 Lab reports
 Diet history
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Planning Care
• The Nutrition
Care Process
• The Nursing
Process
 Nutrition
assessment
 Nutrition diagnosis
 Nutrition
intervention
 Nutrition
monitoring &
evaluation
 Assessment
 Nursing diagnosis
 Outcome
identification &
planning
 Implementation
 Evaluation
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
The Nutrition Care Process
• Assessment
• Intervention
 Medical, social, &
dietary histories
 Anthropometric data
 Biochemical analysis
 Physical exam
• Diagnosis
 Actual or potential
 Problem, etiology,
signs & symptoms
 Dietary changes
 Nutrition education
 Medication changes
• Monitoring &
evaluation
 May need to
modify the plan
 Must be flexible
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Historical Information
• Medical history
 Age
 Gender
 Weight
 Prescription drugs
 OTC medications
 Dietary
supplements
 Type of illness
• Social history
 Cultural heritage
 Financial concerns
 Who prepares and
shops for food
 Living situation
• Diet history
 Food intake
 Meal patterns
 Physical problems
© 2007 Thomson - Wadsworth
Dietary Assessment
Methods
• 24-hour recall
• Food record
 All foods & beverages
 Time of day eaten
 Amounts consumed
 Food preparation
 Typical day?
• Food frequency
questionnaire
 Recorded over
several days
 Recorded as
consumed
 Does not rely on
memory
• Direct observation
 Calorie counting
 Time consuming
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Food Frequency Questionnaire
© 2007 Thomson - Wadsworth
Anthropometric Data
• Height: Adults
• Length
 Infants
 < 24 months
• Head
circumference
 Assesses brain
development
 < 3 years of age
• Weight
 BMI
 % Usual body
weight
 % Ideal body
weight
• Circumference of
waist & limbs
 Evaluates body fat
 Evaluates muscle
mass
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Biochemical Analysis
• Provides information about
Protein-energy nutrition
Vitamin & mineral status
Fluid & electrolyte balance
Organ functioning
• Analysis of blood & urine
samples
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Plasma Proteins
• Albumin
 Most abundant
 Slow to reflect
changes in status
• Transferrin
 Transports iron
 Indicates PEM &
iron status
 Slow to detect
changes in status
• Prealbumin &
retinol-binding
protein
 Also called
transthyretin
 Responds quickly
to changes in
protein status
 Expensive test
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Fluid Imbalance
• Edema
• Dehydration
 Weight gain
 Facial puffiness
 Swelling limbs
 Abdominal
distention
 Tight-fitting shoes
• Diseases of heart,
kidney, liver, lungs
 Thirst
 Dry skin or mouth
 Reduced skin tension
 Dark yellow or
amber urine with low
volume
• Fever, sweating,
vomiting, diarrhea,
burns
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Assessment of
Nutrition Status
• Functional
Assessment
• Integrating
assessment data
 Exercise tolerance
 Respiratory
muscle strength
 Immunity
 Subjective Global
Assessment (SGA)
 Combines
historical
information with
results of physical
examination
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth