NUTRITIONAL CARE PROCESS

(ADIME) PROCESS
Adequate Diet – is composed of various nutrients
which body needs for maintenance, repair, and for
growth and development.
Essential of an Adequate Diet
•Milk Group - provide most of the calcium
requirements
•Meat Group - provides generous amounts of
protein in high quality
•Bread and Cereal Group – furnishes
carbohydrates, minerals and vitamins at a relatively
at low costs.
•Vegetable-Fruit Group - important supplier of
fiber, vitamins and minerals particularly Vitamin A
and C.
Assessment of Nutritional Status

Nutritional Status or Nutriture

- is the degree to which the individual’s
psychological need for nutrients is being met
by food she or he eats.

- is the state of balance in the individual

between the nutrient intake and the nutrient
expenditure or needs
Nutritional Status Assessment

•Dietary History and Intake Data

A. 24 Hour Recall – patient or individual
completes a questionnaire or maybe an
interview asking to recall everything that he or
she ate within the last 24 hours.

B. Food Frequency Questionnaire – patient

answers the questionnaire for frequency of
food use as accurately as possible
C. Dietary History

contains additional information about the

patient’s income, physical activity, ethnic and
cultural background, influence s on eating
habits and religion, home life and meal
patterns, factors that affect appetite, allergies,
intolerances, food avoidance, dental and oral
problems in eating, gastrointestinal problems,
chronic diseases, dietary modifications and
medication.
Ethnic and Religion
1. Christianity – holy week observances may
restrict meat (Good Friday)
2. Seventh Day Adventist – no pork and
shellfish, alcohol, encourages veges diet
3. Judaism – no pork, shellfish, blood products,
mixing of milk or dairy products with meat in one
meal, Kosher diet, no cooking during Sabbath
day (Saturday)
4. Mormon – no alcohol, tobacco and caffeine
5. Islam – no pork (Haalal diet), no alcohol,
caffeine, practices Ramadam (fasting from
sunrise to sunset of the month)
6. Hinduism – all meats are prohibited
Food Avoidance

1. Phenylalanine (EAA) – low protein diet to

avoid imbalance of brain amino acids in
Phenylketonuria
2. Purine – reduce uric acid producing foods in
gouty arthritis and hyperurecemia
3. Tyramine – high protein foods that
underwent protein breakdown by aging,
fermentation and smoking
4. Gluten – a protein found in wheat, rye,
barley, and other starchy foods, except rice and
corn like in Celiac Disease
Medications

1.Monoamineoxidase Inhibitors (MAOI) –

antidepressants, AVOID tyramine containing
foods like alcoholic beverages, dairy products,
avocado, banana, meats, chocolates and
condiments causes HYPERTENSIVE CRISIS.

2. Warfarin Sodium (Coumadin) –

anticoagulant, AVOID or instruct the patient to
decrease intake of green leafy vegetables
3. Methimazole (Tapazole) – antithyroid, uses
for Hyperthyroidism, inhibits synthesis of
thyroid hormone by interfering with iodine.
Teach the client to AVOID seafood and iodine
products.

4. Estrogen Replacement Therapy (HRT) –

management of menopausal symptoms in
women. Estrogens increase risk of
cardiovascular disease and cancer so instruct
the patient to AVOID or reduce alcohol,
caffeine and smoking.
D. Food Diary or Record – this method
involves time, understanding and motivation
on the part of the patient as she or he writes
down everything he or she eats or drinks for a
certain period of time.

E. Observation of Food Intake – most and

accurate method of dietary intake
assessment, because it requires knowing the
amount and kind of food presented to the
patient and record the amount actually eaten.
General Rules for Menu Planning
•Use the whole day as a unit rather than the
individual meal.
•Use some food from each of the food groups
daily (energy giving foods, body building foods
and body regulating foods)
•Use some raw fruits or vegetables at least
once a day
•Plan to have for each meal at least one food
with staying power or high in satiety value.
•Combine or alternate bland form with those of
a more pronounced flavor.
•Combine and alternate soft and crisp foods.
•Have a variety of color, food and food
arrangement.
•When more foods are served at one meal,
decease the size of portions and use fewer rich
foods.
•Meal or menu patterns are helpful in planning
menu but consider the family’s habits and
needs. The traditional recommended patterns
for breakfast like fruit, egg or substitute, bread
or rice, hot beverage and for lunch and dinner-
meat, fish and poultry, rice, vegetable and fruit
or dessert
•It is best to have a weekly menu plan.
 Nutritional Survey – is an epidemiological
investigation of the nutritional status of the
population.

Methods of Nutritional Assessment

•DIRECT information
A.Clinical Examination
- advantages as more coverage in a short time,
inexpensive, no sophisticated equipments
-disadvantages as non-specificity of signs,
overlapping of deficiency states and bias of the
observer
-system of collecting data starts from the head
to toe (cephalocaudal)
-establishing data base

Methods of Collecting Data

•Interview
•Observation - IPPA

Sources of Data
•Primary: Patient
•Secondary: Family Members, Significant
Others, Health team members and Chart
 A.Biochemical Examination

- estimation of time desaturation, enzyme

activity or blood composition
- tests samples are blood and urine and results
generally compared to
standards
- advantages as objectivity and can detect
easily states of nutritional deficiency
- disadvantages as costly and time consuming
-factors affecting accuracy of results like
standards of collection and method of transport
and storage of samples
A.Anthropometric Measurement –
measurement of the variations of the
physical dimensions and gross composition
of the human body at different age levels and
degrees of nutrition.

•Weight for age – uses weighing scale,

assess body mass
• Height for age – uses statiometer,
anthropometric steel rods fixed accurately
and vertically to the wall
•Weight for height/length – most accurate
indicator of present state of nutrition, an
expression of leanness or wasting

•Skin fold thickness – uses reliable caliper

• Body circumferences
• Birth weight
• What is the healthy waistline?
Women - <31 inches
Men - <35 inches
•Methods that provide INDIRECT information
A.Food Consumption Studies
B.Studies on Health Condition and Vital
Statistics
C.Studies on food supply situation
D.Studies on socio-economic conditions
E.Studies on cultural and anthropological
influences
MALNUTRITION

• it is a global problem.
• a condition caused by sustained, deficient,
excessive, or imbalanced supply of calories,
and nutrients.
Forms of Malnutrition
Under nutrition - a pathological state resulting
from the consumption of an inadequate quantity
of food, over an extended period of time.
Specific deficiency - a pathological state
resulting from a relative or absolute lack of an
individual nutrient. (VAD, IDA,IDD)
Over nutrition - a pathological state resulting
from the consumption of an excessive quantity of
food, a calorie excess over an extended period
of time.
Types of Malnutrition

Acute malnutrition – related to the present

state of nutrition like weight loss, low weight
for height and normal height for age

Chronic malnutrition – related to the past

state of nutrition like nutritional dwarfism,
low weight for height and low height for age
Effects of Malnutrition
•Increases susceptibility of infections
•Inhibits mental development
•Imposes heavy social and economic burdens

Causes of Malnutrition in the Philippines

•Poverty
•Poor distribution of food supply
•Large family size
•Low level of education among household
member
Indicators for children below 10 years old
fo r A g e
W EIGHT
fo r A g e
HEIGHT
10
It offers the most acceptable parameter and the most simplest
way to determine the nutritional status of the school children.

Body Mass Index Indicator for 18 – 65 years old

Weight in KILOGRAMS
(Height in METERS)2
Public Health Nursing in the Phils.
Chapter 4, Page 93
 This alone is accurate measure of the amount of visceral fat
(CENTRAL OBESITY)
Normal Findings
Men - < 90 cm / 35 inches
Women - < 80 cm / 31.5 inches

Waist Circumference (cm) – narrowest point

Hip Circumference (cm) – widest point

Normal Findings Men -<1 Women - < 0.85

Equal to or greater than 1 (men), 0.85 (women) means android or central obesity
Public Health Nursing in the Philippines
Chapter 6, page 201 - 202
Sensitive indicator of CURRENT nutritional status

Less sensitive and generally an indicator of PAST

nutritional status (CHRONIC MALNUTRITION)

Most accurate indicator of present or current

state of nutrition
Assess body composition and fat distribution

Can be used for rapid diagnosis of PEM in children

1 – 4 years of age

<12.5 cm Undernutrition
12.5 to 13.5 cm Risk undernutrition
>13.5 to 16 cm Adequate nutrition