PHYSICAL ASSESSMENT

ANTHROPOMETRIC MEASUREMENT
1. Height and Weight
2. BMI
3. Body Composition
4. Mid-arm Circumference
5. Fat-fold or Skin-fold Thickness
 OTHER SOURCES OF DATA

Malnutrition Universal Screening Tool (‘MUST’)

‘MUST’ is a 5 step nationally recognized and validated screening tool to identify ADULTS
who are malnourished or at risk of malnutrition. It is the most commonly used screening
tool in the UK and is suitable for use in hospitals, community and other care settings.

This tool can be completed electronically using the on line 'MUST' calculator or manually
as outlined below:
SUBJECTIVE GLOBAL ASSESSMENT (SGA)

The Subjective Global Assessment (SGA) is a type of clinical tool doctors use to determine a person's overall state of health. It is most often used when assessing
nutritional status in patients with kidney problems like end-stage renal disease or chronic renal insufficiency. The method is also useful when evaluating patients at
risk for malnutrition.
MINI NUTRITIONAL ASSESSMENT (MNA)

The Mini-Nutritional Assessment Short-Form (MNA®-

SF) is a screening tool used to identify older adults (>
65 years) who are malnourished or at risk of
malnutrition. ... An in-depth assessment and physical
exam should be performed when patients are
identified to be malnourished or at nutritional risk.
GERIATRIC NUTRITIONAL RISK INDEX (GNRI)

The geriatric nutritional risk index (GNRI) is a widely

used, simple, and well-established tool to assess
nutritional risk.
NUTRITION DIAGNOSIS
AND PLAN OF CARE
NUTRITION PROBLEMS
 Protein-Energy-Malnutrition
Protein–energy malnutrition (PEM) is a form
of malnutrition that is defined as a range of
pathological conditions arising from coincident
lack of dietary protein and/or energy (calories)
in varying proportions. The condition has mild,
moderate, and severe degrees.
 Different Forms of PEM:

1. Marasmus
2. Kwashiorkor
3. Marasmic-Kwashiorkor
Marasmus
Marasmus is a severe form of
protein-energy malnutrition that
results when a person does not
consume enough protein and
calories. Without these vital
nutrients, energy levels become
dangerously low and vital
functions begin to stop.
 Kwashiorkor
Kwashiorkor, also known as
“edematous malnutrition”
because of its association with
edema (fluid retention), is a
nutritional disorder most often
seen in regions experiencing
famine. It is a form of
malnutrition caused by a lack
of protein in the diet
Marasmic Kwashiorkor
Marasmic kwashiorkor is caused by
acute or chronic protein deficiency
and chronic energy deficit and is
characterized by edema, wasting,
stunting, and mild hepatomegaly. The
distinction between kwashiorkor and
marasmus is frequently blurred, and
many children present with features
of both conditions.
Xerophthalmia
Xerophthalmia is a
progressive eye disease
caused by vitamin A
deficiency. Lack of
vitamin A can dry out
your tear ducts and eyes.
Anemia
Anemia is a condition in
which the amount of
red blood cells in the
body is decreased
below normal for your
child's age.
 Goiter
A goiter (GOI-tur) is an
abnormal enlargement of
your thyroid gland. Your
thyroid is a butterfly-shaped
gland located at the base of
your neck just below your
Adam's apple.
Vitamin B2 Deficiency or Riboflavin Deficiency

Riboflavin deficiency can

result from inadequate
dietary intake or by
endocrine abnormalities.
Riboflavin deficiency also
correlates with other vitamin
B complexes.
 NUTRITION
INTERVENTION
 FOOD ADMINISTRATION

1. Oral Nutrition
2. Enteral Nutrition
5. Parenteral Nutrition
 Enteral Nutrition

Enteral nutrition generally refers to any

method of feeding that uses the
gastrointestinal (GI) tract to deliver part or
all of a person's caloric requirements.
 Parenteral Nutrition

Parenteral nutrition refers to the delivery

of calories and nutrients into a vein.
 MONITORING
NUTRITIONAL STATUS
Age-Related Changes
That Affect Nutrition
Perceptual Changes

Elderly people have a higher risk of

malnutrition -- not getting enough calories,
protein, vitamins and minerals
Gastrointestinal Changes
There are a number of changes that occur
in the stomach which negatively affect
digestion and reduce the absorption of
nutrients.
Reduced Metabolism

As people age, they often lose muscle mass

due to reduced activity levels, illnesses and
hormonal changes.
Less Saliva and Dentition
Problems
Common among the elderly. Saliva
contains a variety of enzymes that trigger
the initial chemical breakdown of nutrients
such as starch and fat.
Adapting to Dietary Changes

Changing your diet can be tough, so don't

hesitate to ask a professional for help.
Selected Therapeutic Diet
REGULAR DIET
A regular diet is a
healthy meal plan
that includes a variety
of healthy foods from
all the food groups.
LIQUID DIET
A liquid diet consists only of
liquids instead of solid food. This
includes homemade or store-
bought juices and smoothies,
homemade protein shakes,
premade protein shakes and
store-bought liquid meal
replacements.
CLEAR LIQUID DIET
A clear liquid diet
consists of clear liquids
— such as water, broth
and plain gelatin — that
are easily digested and
leave no undigested
residue in your intestinal
tract.
FULL LIQUID DIET
A full liquid diet is made
up only of fluids and
foods that are normally
liquid and foods that turn
to liquid when they are at
room temperature, like
ice cream.
SOFT DIET
A soft diet is made up of
foods that are soft and
easy to chew and
swallow. These foods
may be chopped,
ground, mashed,
pureed, and moist.
LOW RESIDUE DIET
It limits high-fiber foods,
like whole-grain breads
and cereals, nuts, seeds,
raw or dried fruits, and
vegetables. "Residue" is
undigested food, including
fiber, that makes up stool.
DIABETIC DIET
A diabetic diet is a
healthy-eating plan that's
naturally rich in nutrients
and low in fat and
calories.
LOW-CALORIE DIET
A low-calorie diet is one
that restricts your intake
to 1,200 to 1,600 calories
per day for men, and
1,000 to 1,200 calories
per day for women.
HIGH-CALORIE DIET
Butter, honey, and brown sugar, added to
foods to make them taste better.
Oils, sauces, and gravies.
Peanut butter.
Whole milk, yogurt, mayonnaise, and sour
cream.
Granola cereal with fruit and granola bars.
Muffins, pancakes, waffles, and other breads.
Milkshakes, puddings, and custard.
LOW CHOLESTEROL DIET

You should limit both

total fat and saturated
fat. ...
LOW-FAT DIET

A low-fat diet is an
eating plan that is low
in total fat, unhealthy
fat, and cholesterol.
LOW SODIUM OR LOW SALT DIET

Helps keep high blood

pressure and swelling
(also called edema)
under control.
HIGH PROTEIN DIET
High-protein diets
typically include large
quantities of protein
and only a small
amount of
carbohydrate.
LOW PROTEIN DIET

A low-protein diet is a
diet in which people
reduce their intake of
protein.