Chapter 11 Nutritional Assessment Nutritional status The balance between nutrient intake and nutrient requirements Optimal nutritional status Undernutrition Overnutrition Infants and children Time from birth to 4 months of age is most rapid period of growth in life cycle Although infants lose weight during first few days of life birthweight usually regained by 7th to 10th day Thereafter infants double their birth weight by 4 months and triple it by 1 year of age Breastfeeding recommended for full term infants for first year of life because breast milk ideally formulated to promote normal infant growth and development and natural immunity Slide 11 3 11 3 Adolescence Adolescence characterized by rapid physical growth and endocrine and hormonal changes Increased requirements cannot be met by three meals per day therefore nutritious snacks play an important role in achieving adequate nutrient intake In general boys grow taller and have less body fat than girls Slide 11 4 11 4 Structure and Function Cultural Competence Foods and eating customs are culturally diverse and each person has unique cultural heritage that may affect nutritional status Immigrants commonly maintain traditional eating customs long after language and manner of dress of adopted country become routine Slide 11 5 11 5 Structure and Function Cultural Competence cont Kosher is term that refers to dietary laws of observant Jews Not mixing milk and meat products prohibition of eating pig meats and crustaceans are examples of many rules within system Halal is term that refers to Islamic dietary laws here too prohibition of pig meat is one of many dietary laws Slide 11 6 11 6 Purpose of Nutritional Assessment Identify individuals who are malnourished or at risk Assist in design of a nutritional plan of care To prevent minimize the development of malnutrition Establish baseline data to evaluate nutrition Four Categories of the Nutritional Assessment Dietary information Clinical data Lab results Anthropometric Measurements New Food Pyramid 2005 U S Dept of Agriculture Other Food Pyramids Mediterranean Diet Pyramid Healthy Eating Pyramid Harvard School of Public Health History Subjective Data 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 Nutritional Assessment includes Physical examination inspection Skin hair eyes oral cavity nails and MS and neuro systems Anthropometric measures Assessment tools Health promotion teaching Lab values Assessment Tools Pg 179 and 180 in Jarvis Objective Data Inspection General appearance Clinical signs of malnutrition Skin Hair Eyes Lips Tongue Gums Nails Musculoskeletal Neurologic Anthropometric Measurements Weight and height Any changes Anthropometric Measures Growth Development and Body Composition Weight measures Body weight as a of ideal body weight Percent usual body weight Recent weight change Waist to hip ratio Body Mass Index BMI Interpretation 18 5 Underweight 18 5 24 9 Normal weight 25 0 29 9 Overweight 30 0 39 9 Obesity 40 Extreme obesity Mid Upper Arm Circumference Arm Span and Frame Size Mid Upper Arm Circumference Arm span Frame Size Collect Diet Info 24 hour recall most popular Food frequency questionnaire Food diary Direct observations Common Laboratory Studies r t Nutritional Status Hemoglobin Iron deficiency anemia Males 14 18 g dl Females 12 16 g dl Hematocrit Iron deficiency anemia Males 37 49 Females 36 46 Cholesterol 120 200 mg dl is normal HDL LDL Triglycerides 40 200 mg dl normal for adults 2065 Total lymphocyte count 1500 1800 cells mm is normal Glucose HbA1c Vitamin D Serum Proteins Serum albumin Serum transferrin Prealbumin Nitrogen balance Creatinine Height Index Skin testing Abnormal findings Marasmus Protein calorie malnutrition Kwashiokor protein malnutrition Marasmus Kwashiokor mixSevere Starvation Abnormal Findings cont d Obesity Abnormalities d t Nutritional Deficiencies Pellagra Scorbutic gums Follicular hyperkeratosis Bitot s spots Kwashiorkor Rickets Magenta tongue HIV associated malnutrition Metabolic Syndrome Definition Combination of medical disorders that increase one s risk for CV disease and diabetes S S Fasting hyperglycemia High BP Central obesity Decreased HDL elevated triglycerides Treatment Healthy lifestyle and possible Rx therapy Nursing Diagnoses Imbalanced Nutrition Less than Body Requirements Imbalanced Nutrition More than Body Requirements
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