This is Your

Presentation Title
Nursing
Knowledge ▫ The five components of a nutrition assessment:
Base
▪ Screening for malnutrition for risk factors
▪ Anthropometry
▪ BMI
▪ Labs and tests
▪ Dietary history

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Factors
influencing
nutrition ▫ Environmental factors
▫ Developmental needs
▪ Infants through school age
▪ Adolescents
▪ Young and middle adults
▪ Older adults

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Alternative
Food Patterns
▫ Based on religion, cultural background, ethics, health
beliefs, and preference
▫ Vegetarian diet consists predominantly of plant foods

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Assessment
▫ Screening a patient is a quick method of identifying
malnutrition or risk of malnutrition using sample tools:
▪ Height
▪ Weight
▪ Weight change
▪ Primary diagnosis
▪ Comorbidities
▪ Screening tools (3 used in practice)

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Assessment
▫ Assess patients for malnutrition
▪ Conditions that interfere with their ability to ingest,
digest, or absorb adequate nutrients.
▪ Congenital anomalies and surgical revisions of the GI
tract
▪ Only IV therapy
▪ Chronic diseases or increased metabolic requirements
▪ Infants and older adults are at great risk

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Assessment

▫ An ideal body weight (IBW) provides an estimate of

what a person should weigh.
▫ Body mass index (BMI) measures weight corrected
for height and serves as an alternative to traditional
height-weight relationships.

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Biochemical
Data ▫ No single test is both sensitive and specific for protein-
calorie malnutrition
▫ Biochemical data may help support the diagnosis of a
nutritional problem
▫ Laboratory
▪ Albumin: 3.5-5.0 g/dL (half life 21 days)
▪ Transferrin and total iron-binding capacity (TIBC)
▪ Hemoglobin (12-18%)
▪ Prealbumin (half life 1.9 days)

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Biochemical
Data
▫ Albumin
▪ Often used to assess protein status
▪ Serum levels may be maintained until
malnutrition is in a chronic stage
▪ Low albumin may indirectly identify patients
who may benefit from nutrition assessment and
intervention

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Biochemical
Data
▫ Prealbumin
▪ Thyroxin-binding protein
▪ More sensitive indicator of protein status
▪ More expensive to measure

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Dietary and
health history
▫ Health status; age; cultural background; religious
food patterns; socioeconomic status; personal food
preferences; psychological factors; use of alcohol or
illegal drugs; use of vitamin, mineral, or herbal
supplements; prescription or over-the-counter (OTC)
drugs; and the patient’s general nutrition knowledge

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Dietary Data ▫ Nurse should ask
▪ “Do you avoid any particular foods?”
▪ “Are you on a diet?”

Medical
psychosocial ▫ May shed light on factors that influence intake,
history nutritional requirements, or nutrition counseling

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Physical
Assessment
▫ Physical signs and symptom of malnutrition
observed in a client
▫ Physical signs and symptoms of malnutrition can
vary in intensity among population groups because
of genetic and environmental differences
▫ Physical findings occur only with overt malnutrition
▫ Dysphagia (4 screening tools)

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 ▫ Outcome: Patient will maintain patent airway and clear lung sounds.
Nursing ▫ Nursing Interventions
Diagnosis:
▪ Monitor for s/s of difficulty in swallowing
Risk for
Aspiration r/t ▪ Cough during eating; change in voice tone or quality after
impaired swallowing; abnormal movements of the mouth, tongue, or
swallowing lips; and slow, weak, imprecise, or uncoordinated speech.
▪ Abnormal gag, delayed swallowing, incomplete oral clearance
or pocketing, regurgitation, pharyngeal pooling, delayed or
absent trigger or swallow, and inability to speak consistently

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 ▫ Monitor Respiratory rate, depth, and effort
Nursing
▫ Auscultate lung sounds q 4 hrs
Diagnosis:
Risk for ▫ Monitor bowel sounds q 4 hrs
Aspiration r/t ▫ Take VS q 4 hrs, esp. temp
impaired ▫ Feed slowly with small bites and allow time for chewing
swallowing and swallowing
▫ Place food on strong side of mouth
▫ Have patient sit upright when eating and keep HOB 30-45
degrees for an hour after eating
▫ Encourage patient to use chin tuck when swallowing
▫ Provide rest periods

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Medication
▫ High risk for development of drug-induced nutrient
deficiencies include the ff.:
▪ Habitually consume fewer calories and nutrients
than they need
▪ Have increased nutrient requirements including
infants, adolescents, and pregnant and lactating
women
▪ Elderly
▪ People with chronic illness
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Medication
▫ High risk for development of drug-induced nutrient
deficiencies include the ff.:
▪ People who take large number of drugs (5 or
more), whether prescription, OTC, or dietary
supplements
▪ Those who are receiving long-term drug therapy
▪ Substance abusers

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Physical Signs & Symptoms of Malnutrition

• Hair is dull, brittle, dry, or • Edema of lower

falls out easily extremities
• Swollen glands of neck • Weakened hand grasp
and cheeks • Depressed mood
• Dry, rough or spotty skin • Abnormal heart
• Poor or delayed wound rate/rhythm and BP
healing or sores • Enlarged liver or spleen
• Thin appearance with lack • Loss of balance and
of SC tissues coordination
• Muscle wasting

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Nutritional Problems
Protein-energy malnutrition

▫ This refers to a form of malnutrition where there is

inadequate protein and calorie intake
▫ Causes childhood morbidity and mortality
▫ Conditions/Diseases:
▪ Kwashiorkor
▪ Marasmus
▪ Marasmic-kwashiorkor
 Causes or Contributory Factors

• Inadequate intake of food

• Diarrhea
• Respiratory infections
• Measles
• Poor environmental hygiene
• Large family size
• Poor maternal health
• Failure of lactation
• Premature termination of breast feeding
• Use of over diluted cow’s milk
Source: BORGEN Magazine

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Kwashiorkor

▫ Kwashiorkor is the most common and widespread

nutritional disorder in developing countries.
▫ also known as “edematous malnutrition” because of
its association with edema (fluid retention)
▫ People who have kwashiorkor typically have an
extremely emaciated appearance in all body parts
except their ankles, feet, and belly, which swell with
fluid

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Marasmus

▫ It is a severe form of malnutrition that consists of the

chronic wasting away of fat, muscle, and other
tissues in the body.

▫ The lack of nutrition can range from a shortage of

certain vitamins to complete starvation.

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 A COMPARATIVE CHART
KWASHIORKOR
• It develops in children whose
diets are deficient of protein.
• It occurs in children between 6
months and 3 years of age
• Subcutaneous fat is preserved.
• Edema is present.
• Enlarged fatty liver.
• Ribs are not very prominent
• Lethargic
• Muscle wasting is mild or
absent
• Poor appetite.
• Needs adequate amounts of
proteins
MARASMUS
• It is due to deficiency of
proteins and calories
• It is common in infants under 1
year of age
• SCs fat is not preserved
• Edema is absent
• No fatty liver
• Ribs become very prominent
• Alert and irritable
• Severe muscle wasting
• Voracious feeder.
• Needs adequate amount of
protein, fats and carbohydrates
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Assessment of
PEM Gomez Classification
Wt. for age (%)= Wt of child x 100
Wt. of normal child of same age
Between 90-110% Normal nutritional status

Between 75- 89% Mild malnutrition (1st degree)

Between 60- 74% Moderate malnutrition (2nd degree)

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Prevention
▫ Oral rehydration therapy helps to prevent dehydration
caused by diarrhea
▫ Exclusive breast feeding for 6 months thereafter
supplementary foods may be introduced
▫ Immunization for infants and children
▫ Nutritional supplements
▫ Early diagnosis and treatment
▫ Promotion and correction of feeding practices
▫ Family planning and spacing of birth

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Vitamin A
deficiency
▫ Vit. A deficiency (VAD) or hypovitaminosis A is a
lack of vit. A in blood and tissues.
▫ Nyctalopia (night blindness) is the first sign of VAD
▫ Xerophthalmia (dry eyes) – refers to all ocular
manifestations of vitamin A deficiency

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Clinical
Features
▫ Reduced vision in the night or dim light
▫ Dry eyes
▫ Corneal inflammation
▫ Susceptibility towards respiratory and urinary
infections
▫ Growth can be halted in children
▫ Skin: rough and/or dry

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Prevention
and control
▫ Administering large doses of vitamin A orally on a
periodic basis
▫ Regular and adequate intake of vitamin A
▫ Fortification of certain food with vitamin A like
sugar, salt, tea and skimmed milk

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Vitamin D
deficiency ▫ Signs:
▪ Muscle weakness
▪ Malformation of bones
▪ Osteomalacia (weakening of the bones)
▪ Osteoporosis (thinning of the bones)
▪ Rickets
▪ Insomnia
▪ Cognitive impairment
▪ Myopia (nearsightedness)

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Vitamin D
deficiency ▫ Causes:
▪ Metabolic abnormalities with absorption or
metabolism of vitamin D
▪ Sedentary indoor lifestyle
▪ Regular use of sunblock
▪ Low stomach acid
▪ Liver or gallbladder dysfunction

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Vitamin B12
deficiency ▫ Signs and symptoms:
▪ Weakness, tiredness, or lightheadedness
▪ Heart palpitations and shortness of breath
▪ Pale skin
▪ A smooth tongue
▪ Nerve problems like numbness or tingling, muscle
weakness, and problems walking
▪ Vision loss
▪ Mental problems like depression, memory loss, or
behavioral changes
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Vitamin B12
deficiency ▫ Treatment:
▪ Serious B12 deficiency: weekly shots of vitamin B12 or
daily high-dose B12 pills
▪ Mild deficiency: standard multivitamin
▪ Strict vegetarian and vegan: fortified bread, cereals, or
other grains

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Iodine ▫ IDD leads to a much wider spectrum of disorders commencing with
Deficiency the intrauterine life and extending through childhood to adult life
Disorders with serious health and social implications
(IDD) ▫ D/O:
▪ Goiter
▪ Hypothyroidism
▪ Delayed motor milestones
▪ Mental deficiency or retardation
▪ Hearing or speech defects
▪ Neuromuscular weakness
▪ Endemic cretinism

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Clinical
Features ▫ Amenorrhea
▫ Rapid, dramatic weight loss at least 15% under
normal body weight
▫ May engage in frequent, strenuous or compulsive
exercise
▫ Perception of self as overweight despite being told
by others they are too thin
▫ Intolerance to cold. Body temperature may lower in
an effort to conserve energy
▫ hypotension
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OVERNUTRITION

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Skeletal Fluorosis

▫ Associated with life time daily intake

of 3-6mg/L or more
▫ Heavy deposition of fluoride in
skeleton
▫ Crippling occurs to disability Source: NDTV.com
Dental Fluorosis

▫ It occurs when excess fluoride

is ingested during the years of
tooth calcification (first 7
years) Source: researchgate.net

▫ Characterized by molting of
dental enamel

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Prevention

▫ Changing of water sources

▫ Chemical defluorination
▫ Preventing use of fluoridated toothpaste
▫ Fluoride supplements are not prescribed for children
consuming fluoridated water

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Obesity

▫ An epidemic disease, which consists of body weight

that is in excess of that appropriate for a person’s
height and age leading to an increased risk to health
related problems

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Nursing
Management
▫ Nursing diagnosis:
▪ Imbalanced nutrition less than body requirement
▪ Muscle weakness or Fatigue
▪ Activity intolerance
▪ Impaired fluid and electrolyte balance
▪ Impaired skin integrity
▪ Risk for infection
▪ Risk for injury

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Thank you for listening!

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