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
& bodys response
to treatment

Hospitalized
patients
40-60% with
acute illness are
malnourished
Others decline in
nutrition status
within 3 weeks

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

Planning Care
The Nutrition Care The Nursing
Process
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

2007 Thomson - Wadsworth

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
2007 Thomson - Wadsworth

Food Frequency Questionnaire

2007 Thomson - Wadsworth

Anthropometric Data
Height: Adults
Length

Head
circumference
Assesses brain
development
< 3 years of age

Infants
< 24 months

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

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

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