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Nutritional Assessment
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Over-nutrition(Obesity and over weight)
Associated problems Heart disease Cancer Hypertension Diabetes Joint disease Surgical complications Venous thrombosis
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Under-nutrition(malnourished)
Problems associated Poor wound healing Sepsis Abcess formation Other infections such as pneumonia
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Why is the assessment of nutritional risk important?
Potential to reduce the severity of the disease Potential for shortened recovery time
Ultimately leads to better patient outcomes and reduced health care costs
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Elements of Nutritional Screening & Assessment
Health History Medical History Diet History
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Health History
Weight gain or loss, history of N/V/D, or change in appetite
Menstrual history Family history - heart disease, etc. Lifestyle habits - smoking, exercise, eating
out, fast food, etc.
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Medical History
Drugs that may affect appetite Drug interactions that may affect nutrient
absorption, metabolism, or excretion Supplement use, especially excessive
supplementation in the elderly
Inform clients of harmful effects of some supplements in megadoses:
A & D accumulate in the body B & C may increase risk of kidney stones
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Diet History
Usual food and fluid intake Type and amount eaten
Eating patterns and habits # and timing of meals and snacks setting of meals eaten at home frequency of meals eaten out Snacks
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Diet History
Food preferences and restrictionsreligious or culturalfood allergies or intolerances
Problems with eatingChewing or swallowingPhysical limitations-i.e., unable to cut or mash
foods Food buying and preparation
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Types of Diet History
Diet Recall Food Record Recall Food Frequency
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Diet Recall
Ask client to recall everything eaten on the previous day or on a typical day
Advantages Easy to administer Easy for client to participate
Disadvantages Only assesses one day’s intake Doesn’t reflect differences-seasons or holidays Relies on memory
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Food Record Recall
Ask client to record intake over at least 3 days:
Advantages Takes only a small amt of time for interviewer More representative of clients diet Helps them review dietary habits
Disadvantages Need to be literate Time consuming for client Eat better during collection period
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Food Frequency
Ask client via a questionnaire how often certain foods have been eaten in past 6-months Advantages
Interviewer not requiredQuick to completeProvides a view of dietary habits over a period of time
DisadvantagesCan’t assess # and timing of mealsMay not reflect cultural dietary habitsMay have difficulty completing forms
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Food Guide Pyramid
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Healthy Diet
The Dietary Guidelines from USDA describe a healthy diet as one that
Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products;
Includes lean meats, poultry, fish, beans, eggs, and nuts; and
Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
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Anthropometric Measurements
Height and Weight BMI Body Composition Body Proportion
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Anthropometric Measures
Measure size, weight, and proportions of human body
Clinically significant weight changes >5% BW over 1 month >7.5% BW over 3 months >10% BW over 6 months
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Height and Weight
Weight and height most common measurements Height-flat, vertical measuring surface, no shoes,
stand erect Weight-minimal clothing, no shoes, empty bags
including colostomies, same time each day, coordinate with diuretic dosing.
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Body Mass Index
Assessment of optimal weight for height
< 18.5 Underweight 18.5 - 24.9 Normal 25.0 – 29.9 Overweight 30 – 39.9 Obesity > 40 Extreme Obesity
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Body Composition
Proportion of fat versus muscle mass Skinfold calipers to measure skinfold
thickness Calipers used most often
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Body Proportion – Waist to Hip Ratio
Where fat is accumulated on body?Apple shape - abdominal accumulation
Android obesity Increased risk for obesity-related diseases and early
mortalityPear shape - hip accumulation
Gynoid obesity
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Laboratory Measurements
Serum albumin Decreased protein, poor wound healing, immune
system compromised
Nitrogen balance Index of Protein nutritional status
TLC (total lymphocyte count) Assess immune system, malnutrition causes
decrease TLC, also AIDS
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Laboratory Measurements
Hgb & Hct Associated with anemia
Hgb A1C- compliance with Diabetes Fasting blood glucose
Screening for diabetics or glucose intolerance, Glucose levels increase when pancreas is not secreting
enough insulin or when insulin resistance is present in peripheral tissues
Cholesterol & Triglycerides Elevated lipid levels, and heart disease risk High LDL, low HDL
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Laboratory Measurements
Creatinine-Height Index (CHI) Estimates amount of skeletal muscle mass
Skin Testing Immunity function
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Dietary Deficiencies for Specific Client Populations
Healthy adults & children Low fiber, fruits & vegies
Vegetarians Need supplemental Vit B12-only found in
animal products
Athletes, active children & adults Need complex carbohydrates (muscle energy) Need iron-rich foods to correct anemia
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Dietary Deficiencies for Specific Client Populations
Pregnant and breast feeding women Last 2 trimesters-caloric needs increase by
300cal/day Breast feeding requires 500 additional cal/day
Elderly men & women Drying of mouth, decreased sense of taste &
smell, decreased thirst, may diminish appetite Obese clients
63% of US population is overweight 25% of children are obese
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Nutrition and Illness
Eating disorders 8 mil people have either anorexia or bulimia
HTN, diabetes, heart disease 43 mil people, more common in African
Americans Cancer
Increased caloric requirements Decreased appetite