Faculty of Nursing

Nutrition Across the Human Life Span

Course Code: 170111220

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 Chapter Six

Nutrition Assessment
By the end of this chapter you will be able to:
1. Recognize the role of nurses in nutritional screening process
2. Understand the steps of Nutrition Care Process
3. Know how to Assess the nutritional status of your client

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Nutrition in Nursing:
• Nutrition has been an integral component of nursing care since Florence
Nightingale noted nutrition as the second most important area of nursing.
• Nurses have a variety of nutrition care responsibilities:
1) Recognize at-risk patients: screen(‫ فحص‬،‫ )تحري‬every patient for malnutrition
2) Implement nutrition intervention:
a. Ensure that screening occurs within time frame
b. Ensure that dietitian-prescribed intervention occur on time
c. Maximize food & supplement intake:
• Avoid disconnecting enteral(‫ )التغذي<<ة المعوي<<ة‬or parenteral nutrition(‫التغذي<<ة‬
‫ )الوريدية‬for the patient
• Help the patient to select appropriate food
• Encourage patients who feel full quickly to eat nutrient-dense foods like
meat & milk over juice or soup
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3) Monitor the implementation of nutrition plan arranged by Dietitian.
i. Observe intake of food & supplements
ii. Document appetite & take action when the client does not eat
iii. Monitor weight
iv. Request a nutritional consult
v. Monitor progression of nothing by mouth (NPO) status and restrictive
diets
4) Communicate with the patient and Dietitian:
 Consult with dietitian about nutrition concerns
 Communicate changes in the patient’s condition that may indicate
malnutrition
5) Educate the patient about:
The importance of obtaining adequate nutrition
Counsel the client about drug-nutrient interaction
Advice the client to avoid foods that are not tolerated

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Nutrition Screening:
- Is a quick look at a few variables to judge a client’s relative risk for nutritional
problems.
- It is designed to detect actual or potential malnutrition based on a few selected
criteria that are readily available.
- Nutrition screening can be specific for a particular population like pregnant
women or particular disorder like cardiac disease.
- Patients identified as high or moderate risk are referred to a dietitian for further
nutrition assessment, diagnosis and intervention.
- Nutrition screening should be conducted within 24 hours after admission to a
hospital or other health-care facility.
- Because the standard applies 24 hours a day, 7 days a week, staff nurses are
usually responsible for completing the screen as part of the admission process.

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Mini Nutritional Assessment-Short Form (MNA-SF):
Is an example of a widely used validated tool for screening older adults
 It is designed to identify Protein-Calorie malnutrition in people 65 years and
older.
 It consists of six questions with a maximum possible score of 14.
Its screening score is:
a. A score from 12-14 indicates normal nutritional status
b. A score from 8-11 indicates at risk for malnutrition
c. A score of 7 or less indicates malnutrition
 A score less than 12 needs further assessment by a dietician
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 Nutrition Care Process

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A. Nutrition Assessment:
 It is an ongoing, dynamic process that involves initial data collection and continual
reassessment and analysis of the client’s status compared to accepted standards,
recommendations, and/or goals.
 Patients found to be at a moderate or high risk for malnutrition through screening are
referred to a dietitian for a nutrition assessment
 General characteristics for the diagnosis of adult malnutrition include:
i. Weigh loss over time
ii. Inadequate food and nutrition intake compared to requirements
iii. Loss of muscle mass
iv. Loss of fat mass
v. Local or generalized fluid accumulation
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Nutrition assessment data to identify malnutrition:
a) Medical History and Clinical Diagnosis:
- Chief complaints & past medical history: may suggest clues(‫ )دلي<ل‬about nutrition
status & nutrient requirements.

- Medical conditions often associated with malnutrition include: AIDS, cancer,

alcoholism, diabetes..etc..
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- Patients with gastrointestinal symptoms or disorders are among those who are
most prone(‫ )عرض<ة‬to malnutrition, particularly when symptoms such as nausea,
vomiting, diarrhea, and anorexia last for more than 2 weeks.
b) Physical Exams (Findings):
• Physical findings (signs) that may diagnose malnutrition include:
1. Loss of muscle or subcutaneous fat
2. Fluid accumulation
3. Dry skin
4. Swollen glands around the neck
• Most physical symptoms cannot be considered diagnostic because evaluation
of “normal” versus “abnormal” findings is subjective, and the signs of
malnutrition may be nonspecific.
• Physical findings occur only with overt (severe) malnutrition, not subclinical
(asymptomatic) malnutrition.
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c) Anthropometric Data:

I. Body Mass Index (BMI):

 An index of weight in relation to height that is calculated mathematically by
dividing weight in kilograms by the square of height in meters.
 It is used to estimate relative risk of health problems related to weight
 Interpreting BMI
• < 18.5 underweight
• 18.5–24.9 healthy weight
• 25–29.9 overweight
• 30–34.9 obesity class 1
• 35–39.9 obesity class 2
• 40 obesity class 3

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II. Weight Change:
 Unintentional (‫)غ<<<ير مقص<<<ود‬weight loss is a well-validated indicator of
malnutrition .
 The significance of weight change is evaluated after the percentage of usual
body weight lost in a given period of time is calculated .
 Usually, weight changes are more reflective of chronic, not acute, changes in
nutritional status.

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d) Laboratory Data:

- Currently there is no universally agreed upon biochemical indicators to

diagnose malnutrition because these indicators may be related to
malnutrition or related to illness.
- Example: serum albumin may be used to screen or diagnose malnutrition ,
but the major cause of low serum albumin or other proteins is inflammation
not malnutrition.

e) Food (Dietary) Intake:

Information about food and nutrient intake can be obtained through patient
or caregiver interview, food record or observation.
These intakes compared to estimated needs to assess adequacy.
A decrease in intake compared to the patient’s normal intake may indicate
nutritional risk.
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B. Nutrition Diagnosis:
Diagnosis is made after assessment data are interpreted .
Diagnosis :
i. Provides written documentation of the client’s status .
ii. Serves as a framework for the plan of care that follows
 The diagnosis relate directly to nutrition when the pattern of nutrition and
metabolism is the problem .

 Nutrition diagnosis is organized in three domains:

i. Intake: Excessive or Inadequate intake compared to requirements (actual or
estimated)
ii. Clinical: Medical or physical conditions that are outside normal
iii. Behavioral/Environmental: Relate to knowledge, attitudes, beliefs,
physical environment, access to food, or food safety

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PES Statement: a statement that describes each problem, the root causes, and
the assessment that provide evidence for the nutrition diagnosis.
It refers to nutrition diagnosis term (Problem) related to (Etiology) as evidenced
by (Signs/Symptoms)

P (Problem):
• Describes alterations in the client’s nutritional status
E (Etiology):
- Cause/Contributing Risk Factors
- Linked to the nutrition diagnosis term by the words “related to.”
S (Signs/Symptoms):
Data or indicators used to determine the client's nutrition diagnosis.
 Linked to the etiology by the words “as evidenced by.”

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Example PES Statements:
1. Excessive Fat Intake related to limited access to healthful options – frequent
consumption of high-fat, fast-food meals as evidenced by serum cholesterol
level of 230 mg/dL and patient report of 10 meals per week of hamburgers and
fries

2. Excessive Energy Intake related to unchanged dietary intake and restricted

mobility while fracture heals as evidenced by 2.5 kg weight gain during last 3
weeks due to patient report of consumption of 500 kcal/day more than estimated
needs

3. Swallowing Difficulty related to post stroke complications as evidenced by

results of swallowing tests and reports of choking during mealtimes

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