Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Assessment: Dietary and Clinical Data Chapter 14

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutritional Status nA measurement of the degree to which the individual’s physiologic need for nutrients is being met nNutrient intake nNutrient requirements

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrition Imbalance nNutrition is an important factor in the etiology and management of several major causes of death and disability nHomeostasis within safe ranges of intake nDeficiencies and excesses nUndernutrition and overnutrition nNutritional risk

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Development of Deficiency

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrition Screening nPurpose: To quickly identify individuals who are malnourished or at nutritional risk and to determine if a more detailed assessment is warranted nUsually completed by DTR, nurse, physician, or other qualified health care professional nAt-risk patients referred to RD

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Characteristics of a Nutrition Screening nSimple and easy to complete nRoutine data nCost effective nEffective in identifying nutritional problems nReliable and valid

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrition Questionnaire

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrition Screening Tools nAcute-care hospital or residential setting nPerinatal service nPediatric practice nMalnutrition Universal Screening Tool (MUST) nNutrition Screening Initiative (NSI)

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrition Assessment nA comprehensive evaluation, completed by a registered dietitian, for defining nutritional status using medical, social, nutritional, and medication histories, physical examination, anthropometric measurements, and laboratory data nGather adequate data to make professional judgment about nutritional status

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrition Assessment Goals nIdentify individuals who require aggressive nutritional support nRestore or maintain nutritional status nIdentify appropriate MNTs nMonitor efficacy of interventions

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrition Histories nMedical and social histories nMedication history nNutrition or diet history

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrient Intake Analysis nAt least 72 hours nDaily food record or food diary nFood frequency questionnaire n24-hour recall nAdvantages and disadvantages

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Food Diary

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Anthropometry nInvolves obtaining physical measurements of an individual and relating them to standards that reflect the growth and development of the individual nEvaluate overnutrition and undernutrition nImportant to use proper technique nSerial measurements most valuable

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Interpretation of Height and Weight nChildren’s growth charts nLength and height nWeight: ideal weight for height, actual body weight, % weight loss nBMI

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Using Height and Weight to Assess Nutritional Status Measure, do not just ask a person’s height Measure weight (at admission, current, and usual). Determine percentage of weight change over time (weight pattern). Determine percentage above or below usual or ideal body weight

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Calculating BMI nBMI = Weight (kg) divided by (height [m] 2 ) nAppropriate BMI between 18.5 and 24.9

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Body Composition nSubcutaneous fat (skin-fold thickness) nCircumference measurements –Waist circumference –Midarm circumference –Head circumference –Calf circumference

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Skinfold Calipers Measure the Thickness of Subcutaneous Fat Tissue in Millimeters Courtesy Dorice Czajika-Narins, PhD

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Other Methods of Body Composition nUnderwater weighing nTotal body potassium nNeutron activation analysis nBIA nCT nUltrasound and MRI nDEXA nAir displacement plethysmogram

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Nutrition-Focused Physical Examination nPhysical signs –Equipment –Examination techniques –Findings nImmune function nHandgrip dynamometry nBiochemical analysis

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Classifying Malnutrition nBody weight nBody fat nSomatic and visceral protein stores nLaboratory values

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc. Focal Points nNutrition screening is needed to identify those individuals who would benefit from more in-depth nutrition assessment, intervention and follow-up. nCareful and meticulous nutritional assessment is an important tool in patient management. nAdaptations of the exact content of the screening and assessment will vary according to the patient’s medical diagnosis and clinical setting. nA skilled registered dietitian uses the screening and assessment process to make the best possible decisions about the specific nutritional diagnoses, interventions, desired outcomes and evaluation.