1. Differentiate Nutritional health with nutritional assessment.

 Nutritional health requires the intake and absorption of protein, lipids, and carbohydrate

that, together, maintain the structure and meet the energy requirements of tissues, while

nutritional assessment is the systematic process of collecting and interpreting information

in order to make decisions about the nature and cause of nutrition related health issues that

affect an individual.

 Overall, nutritional health is the act of maintaining good health by intaking and absorbing

nutrients, and nutritional assessment is collecting and interpreting the nutritional intake of a

patient that is related to the health issues of an individual.

2. Outline the risk factors that influence nutritional health.

 Alcohol or substance abuse

 Cognitive dysfunction

 Decreased exercise

 Depression, poor mental health

 Functional limitations, limited mobility, transportation

 Inadequate funds

 Limited education

 Medical problems, chronic diseases

 Medications

 Poor dentition

 Restricted diet, poor eating habits

 Social isolation

3. In a table format, identify physical and laboratory parameters utilized in a nutrition

assessment.
 Physical parameters Laboratory parameters
Body weight Complete blood count
Height Lipid profile
BMI Electrolytes
Skinfold measurements Liver parameters
Control of vital parameters

Rough assessment of muscle mass and

subcutaneous fat stores

Inspection and palpation for water retention

(edema and ascites)

4. Differentiate between normal and abnormal findings in a nutritional assessment.

Body System Healthy findings Malnutrition

findings
Hair Shiny, firm in Dull, brittle, dry,

the scalp loose; falls out

Eyes Bright, clear Pale membranes;

pink spots; redness

membranes adjust slowly to

adjust easily to darkness

light
Teeth and gums No pain or Missing,

caries, gums discolored,

firm teeth bright decayed teeth;

gums bleed easily

and are swollen

and spongy
Glands No lumps Swollen at front of

neck
Tongue Red, bumpy, Sore, smooth,

rough purplish, swollen

Skin Smooth, firm, Off-color, scaly,

good color flacky, cracked,

dry rough, spotty,

“sandpaper” feel or

sores; lack of fat

under skin
Nails Firm, pink Spoon-shaped,

brittle, ridged, pale

Internal Regular heart Abnormal heart

systems rhythm, heart rate, heart rhythm,

rate, and blood or blood pressure;

pressure; no enlarged liver,

impairment of spleen abnormal

digestive digestion; burning,

function, tingling of hands,

reflexes, or feet; loss of

mental status balance,

coordination,

mental confusion,

irritability, fatigue
Muscles and Muscle tone; “wasted”

bones posture, long appearance of

bone muscles swollen

development bumps on skull or

appropriate for ends of bones;

age small bumps on

ribs; bowed legs or

 knock knees

5. Determine specific nutritional assessment techniques and tools appropriate for

unique stages in the life span.

 Nutritional Risk Screening 2002 (NRS-2002) for the inpatient setting.

 Malnutrition Universal Screening Tool (MUST) for the ambulatory setting.

 Mini Nutritional Assessment (MNA) for institutionalized geriatric patients.

 The most-used tool is the Subjective Global Assessment (SGA), which includes

information on a medical history (weight loss; dietary intake change; gastrointestinal and

functional impairment) and physical examination (loss of subcutaneous fat; muscle

wasting; ankle edema, sacral edema, and ascites).

 Anthropometric assessment- Anthropometry is the measurement of the size, weight, and

proportions of the body

 Biochemical assessment- Biochemical assessment means checking levels of nutrients in

a person’s blood, urine, or stools.

 Clinical assessment- Clinical assessment includes checking for visible signs of

nutritional deficiencies such as bilateral pitting edema, emaciation (a sign of wasting,

which is loss of muscle and fat tissue as a result of low energy intake and/or nutrient loss

from infection), hair loss, and changes in hair color.

 Dietary assessment- Assessing food and fluid intake is an essential part of nutrition

assessment. It provides information on dietary quantity and quality, changes in appetite,

food allergies and intolerance, and reasons for inadequate food intake during or after

illness.
6. Develop a Diet Pyramid integrating physical activity which can be proposed in

maintaining good health and sustaining healthy lifestyle.

CASE STUDY

Mr. Domingo Sabado is an 85-year-old widower brought to Lorma Medical Center, Out-Patient-

Department (OPD) by his niece who is concerned about his diminished dietary intake. His past

medical history is significant for mild hypertension, which is treated with a diuretic and a 2g

sodium therapeutic diet. Physical examination reveals blood pressure of 110/75 and pulse rate

of 72. Height is 5’2” and weight is 156 lb. Weight 6 months prior was 175 lb. Significant

laboratory measures: albumin 3.0 mg/dl, urinalysis sent to laboratory appeared dark and scanty

in volume. His skin appears dry with dry axillae and petechiae on trunk and arms. His eyes are

sunken. Temporal wasting is noted as well as diminished subcutaneous fat stores on limbs. The

exam of the oral cavity reveals poorly fitting dentures, spongy gums, and deep tongue furrows.
Upon talking to Mr. Sabado, the nurse learns that food does not taste the same to him anymore.

He blames this on his low-sodium diet. His niece reports that she takes her uncle grocery and

shopping each week at the CSI City Mall and has noticed that his pantry at home has many of

the items still there from the prior week. She tells the nurse that her uncle is a retired

professional Chef at Thunderbird Resort and Casino and used to love to cook until the last few

months. He has resorted to heating food in the microwave and often overcooked it. Mr. Sabado

states he overheats the food because the microwave is unpredictable. His niece is reading her

concerns from a list she has made and passes the list to her uncle for further comment. The

nurse notices he squints at the list and then says he has nothing to add.

The nurse conducts a diet recall that reveal

Breakfast: large mug black coffee, either cold cereal and whole milk or 2 pieces of toast with

butter and jelly, around 6 oz. of apple juice

Lunch: sandwich on white bread – either tuna salad, peanut butter and jelly, or sliced chicken

with mayonnaise and lettuce. Used to add tomato to sandwich.

Occasionally heats leftovers from restaurant meal with niece, usually has enough for two or

three reheated meals during week. Pasta or meat and rice type meals. No vegetables. Cookie,

cup of tea with whole milk and 2 tsp sugar.

Dinner: 6 oz ready to eat pudding meal from 7-Eleven, 4 oz milk with comment “NO liquids after

7PM or I have to get up all night.

Mr. Sabado takes no nutritional supplements of any kind. The nurse asks further

questions about the lack of fruit and vegetables and learns that it has been almost 6 months

since Mr. Sabado had fruit other than apple juice. He also has stopped eating vegetables in the

same time frame. He states that he cannot be bothered preparing either type of food, but on
further questioning admits that he is having difficulty chewing some foods and some vision

problems that make food preparation difficult or unsafe.

1. In bullets, identify the Subjective Data and Objective Data.

SUBJECTIVE DATA

 Client states that food does not taste the same to him anymore and blames his low-sodium

diet.

 Weight 6 months prior: 175 lb.

 Companion of the client (niece) reports: (a) diminished dietary intake (b) client does not

touch his pantry and would rather reheat.

 Client does not take nutritional supplements.

 Client have not eaten fruits and vegetables for almost 6 months except from apple juice.

 Diet recall of the client

- Breakfast: large mug black coffee, either cold cereal and whole milk or 2 pieces of toast

with butter and jelly, around 6 oz. of apple juice

- Lunch: sandwich on white bread – either tuna salad, peanut butter and jelly, or sliced

chicken with mayonnaise and lettuce. Used to add tomato to sandwich. Occasionally

heats leftovers from restaurant meal with niece, usually has enough for two or three

reheated meals during week. Pasta or meat and rice type meals. No vegetables. Cookie,

cup of tea with whole milk and 2 tsp sugar.

- Dinner: 6 oz ready to eat pudding meal from 7-Eleven, 4 oz milk with comment “NO

liquids after 7PM or I have to get up all night.

OBJECTIVE DATA

 Vital Signs

- blood pressure: 110/75

 - pulse rate: 72

- Height: 5'2

- Weight: 156 lb.

 Laboratory Results

- albumin: 3.0 mg/dl

- urine analysis: dark and scanty in volume

 Nurse observations

- dry skin

- trunk and arms petechiae

- sunken eyes

- presence of temporal wasting

- diminishes subcutaneous fat stores on limbs

- dentures are poorly fitting

- spongy gums

- deep tongue furrows

- client squints when reading

2. How would the data from the case scenario be clustered to identify the problem

areas?

In clustering the Data above, you should first identify the Subjective and objective Data.

Doing this will help you know what part of the patient’s body is having a complication. Next

thing to do is to know the health practices of the patient and what kind of food does he take,

this is done to know if their certain practices is contributing on a certain complication. We

can also use the different methods to cluster we have the;

A: Anthropometry
 Anthropometry allows for an assessment of the different component parts of the

human body. Body composition refers to the anatomical makeup of the body in

terms of bone, muscle, water and fat.

D Dietary

Energy requirements

An estimation of the total daily calorie intake, as well as overall quality of diet

should be assessed. Asking the patient (or their family/carer if patient unable)

about their daily dietary intake will help understand patterns of eating, portion

sizes, cooking methods and types of food and drink taken. 

E Environment

Social

Ability to shop, cook, assistance with eating and drinking, mobility, budget

restraints, limited storage facilities, meal timings, family support.

Physical

Appetite, dentures, dexterity, use of cutlery, sight, taste changes, nausea,

vomiting, heart burn, bloating, early satiety, diarrhoea, constipation, pain,

breathing difficulties, dysphagia (swallowing problems), food intolerances, special

diets, diminished thirst, taste preferences

3. How should the nurse interpret the data related to Mr. Sabado fruit and vegetables

intake?
4. What additional data would the nurse require to develop a plan of care for Mr.

Sabado.

The additional data would nurse require to develop a plan care for Mr. Sabado is refer him

to dietitian for evaluation of nutritional needs. Teach about nutritional needs and devise an

eating plan that includes high-calorie, high-protein foods and supplements and takes into

account his food preferences. Encourage frequent, small meals. Encourage him to keep a

food diary and teach strategies to reduce risks for infection. Lastly, provide information

about communal meals that is available to seniors like him.