NUTRITION ASSESSMENT

EVELIN MALINTI, MSN

 Nutritional Assessment
• Purposes
– Provides insight into the client’s overall physical health
– Helps identify risk factors for obesity and to promote health
– Help identify nutritional deficits
– Hydration s an important indicator of the client’s general health
status
 Assessment
• Nutritional History
– 24-hour recall
– Difficulty eating
– Changes in appetite
– Diet history & preferences
– Changes in weight
– General health & medical history
 Assessment
• Physical Examination
– Head to toe
– Hydration (Intake & output)
– Anthropometric
measurements
– Body composition
measurements
 Anthropometric Measurements
• Height, weight, BMI
• Helps to evaluate the client’s physical growth, development,
and nutritional status
 Anthropometric…
• Height
– Normal findings: within range
for age, ethnic and genetic
heritage
– Abnormal findings:
• extreme shortness is seen
achondroplastic dwarfism and
Turner’s syndrome
• extreme tallness – gigantism
(excessive secretion of GH) and
Marfan’s syndrome
 Anthropometric…
Weight
• determine ideal body weight (IBW) and percentage of IBW
– Method for determining desired weight.
• Females assume 100 pounds for the first 5 feet (60 inches) and add 5 pounds
for each inch over 60.
• Males assume 106 pounds for the first 5 feet (60 inches) and add 6 pounds for
each inch over 60.
• Normal findings: body weight is within 10% of
ideal range
• Abnormal findings: current weight that is 10-
20% below IBW – indicates a lean client and
possibly mild malnutrition
– if 20-30% - indicates moderate malnutrition
– more than 30% - severe malnutrition
– weight exceeding 10% of IBW range considered
overweight
– 20% - obesity
 Anthropometric
• BMI
– Calculated based on ht and wt regardless of gender
– A practical measure for estimating total body fat
– Calculated as wt in kg and divided by the square in ht in meters
– Simple, quick, inexpensive
 BMI cont..
• But not diagnostic of client’s health status
• Does not differentiate bet fat or muscle tissue
• Inaccurately high or low findings can result for individuals who are
particularly muscular or elderly who tend to lose muscle mass
• Inaccurate if client is retaining fluid (e.g., edema, ascites, pregnant)
• May not accurately reflect body fat in adults, who are shorter than 5 feet
• Further assessments using measurements that determine body fat
composition should be performed – to determine health status and
associated risk factors
BMI
• Formula
 Body Composition Measurement
• Useful in determining location of body fat
 Fat Distribution
• Pear-shaped body has a lower risk for disease than does
apple-shaped body. This is measured by Waist-to-hip ratio
measurement
• Waist circumference
– Most common measurement used to determine extent of abd
visceral fat in relation to body fat
• Waist-to-hip ratio
measurement
– used to help determine
obesity.
– The distribution of fat is
evaluated by dividing waist
size by hip size
– Normal findings:
• Male: ratio ‹1.0
• ·Female: ratio of ‹0.8
• Measuring the mid-upper-arm
circumference
• Helps to assess skeletal muscle
mass
• procedure
– extend hand dangle nondominant arm freely
next to the body
– locate arm’s midpoint (halfway bet top of
acromion process and olecranon process)
• measure in cm
• to calculate % = MAC/SR
 MAC Standard reference

Adult MAC Standard 90% SR – 60% SR –

(cm) Reference moderately severely
malnourished Malnourished
M 29.3 26.3 17.6

F 28.5 25.7 17.1

 Skin Fold Measurement
• Triceps skin-fold
thickness
• Helps to evaluate
subcutaneus fat stores
• measure, in
millimeters, the
amount of skin and
body fat.
• Arm = grasp skinfold and subcutaneus fat bet
thumb and forefinger, midway bet acromion
process and tip of elbow
• Pull skin away from muscle
• Apply calipers
• Repeat 3 times record in mm
• TSF standard reference
• Male = 12.5
• Female= 16.5
• 90% SR= moderate
malnourished
• 60% SR = severe
malnourished
• >120%= Obesity
 Weight Management
• Overweight is an energy imbalance in which more food is
consumed than needed.

• An underweight person expends more calories than are consumed.

 High Risk For Nutrition problems
• AIDS
• Cancer
• Problems: GI, metabolism, obesity, renal, liver, pancreas and
gall bladder
• Post operative client
• Immobilisation
 Diagnostic and Laboratory Data
• Protein indices
– Serum albumin
– Pre-albumin
– Serum transferrin
• Hemoglobin level
• Lymphocytes count
• Nitrogen Balance
• Urine Creatinine excretion
 Nursing Diagnoses
• Imbalanced Nutrition: Less Than Body Requirements
• Imbalanced Nutrition: More Than Body Requirements or Risk
for More Than Body Requirements
 Other Nursing Diagnoses
• Activity Intolerance related to insufficient energy from
protein depletion
• Acute Pain related to lactose intolerance
• Ineffective Health Maintenance related to excessive
intake of nutrients
• Impaired Oral Mucous Membrane: related to dehydration
• Constipation related to inadequate dietary intake and
fiber
• Impaired Swallowing related to decreased strength of
muscles involved in mastication
 Other Nursing Diagnosis
• Chronic Low Self-Esteem: related to obesity
• Risk for Impaired Skin Integrity: related to inadequate intake of
proteins, vitamins, and minerals
• Ineffective Health Maintenance: related to inadequate financial
resources to purchase nutritious foods
• Risk for Infection: related to nutrient replacement therapy
• Deficient Knowledge: related to information of normal nutrition
 Implementation
• Monitoring Weight and Intake
• Diet Therapy
– Nothing by Mouth (NPO)
– Clear-Liquid diet
– Full-Liquid diet
– Soft diet
– Diet as tolerated
 Implementation
• Diet Therapy
– Low-residue
– High-fiber
– Liberal bland
– Fat-controlled
– Sodium-restricted
– Lactose intolerance
 Implementation
• Assistance with Feeding
• Providing Nutrition Support
• Nutrition Support Teams
 Implementation
• Providing Enteral Nutrition: is an alternative
method to give adequate nutrition used when
the client is unable to ingest foods or the GI tract
is impaired.
– Feeding tubes (e.g nasogastric tube)
– Insertion of enteral feeding tubes
– Enteral formulas
Enteral Feeding Routes
 Implementation
• Administration of Enteral Feedings
– Can be intermittent or continuous
– Safety considerations
– Potential complications
– Removal of a nasogastric tube
 Implementation
• Administering Medication through a Feeding Tube
– Types of feeding tubes
– Checking for tube placement
– Checking the patency of tube
– Clearing the tubing of formula
– Flushing the port
– Measuring intake and output
 Implementation
• Providing Total Parenteral Nutrition (TPN)
– Intravenous infusion of a solution directly into a
vein to meet the client’s daily nutritional
requirements
– Used to treat malnourished clients or clients who
have the potential for becoming malnourished
and who are not candidates for enteral support.
 Implementation
• Components of Parenteral Nutrition
– Carbohydrates found primarily in form of dextrose
– Amino acids
– Lipids (fat emulsions)
 Implementation
• Complementary Therapy
– Nutrition is integrated as part of the therapeutic regimen of
numerous types of complementary therapies.
– Diet and nutrition are used by many alternative modalities for the
prevention and treatment of chronic diseases.
 Evaluation
• Current data is used to measure achievement of goals and
outcomes.

• The plan of care is modified to maximize the client’s response to

therapy.