Nutritional Assessment By Dr. Hanan Said Ali

Learning Objectives. Define nutritional assessment Learning Objectives * Define nutritional assessment. * Take nursing history. * Perform Physical examination. * Calculate percentage of weight loss. * Take dietary history. * Perform anthropometric measurements. * Interpret laboratory data. *Identify selected nursing diagnosis

What Is The Nutritional Assessment What Is The Nutritional Assessment ? A nutrition assessment is an in-depth evaluation of both objective and subjective data related to an individual's food and nutrient intake, lifestyle, and medical history.

***The assessment leads to a plan of care, or intervention, designed to help the individual either maintain the assessed status or attain a healthier status.

Nutritional Assessment centres around six major areas: 1- Nursing history. 2- Physical examination. 3-Calculating percentage of weight loss. 4- Dietary history. 5- Anthropometric measurements. 6- Laboratory data.

1- How To Gather Nursing History 1- How To Gather Nursing History ? Nurses obtain considerable nutrition-related data in the routine admission nursing history: * Age, sex, and activity level. * Difficulty eating (e.g., impaired chewing or swallowing) * Condition of the mouth, and presence of dentures. * change in appetite. * Change in weight.

* Physical disabilities that affect purchasing , preparing, and eating food. * Cultural and religious beliefs that affect food choice. * Living arrangement(e.g., living alone)and economic status. * General health status and medical condition. * Medication history.

2- How to Conduct Physical Examination Related To Nutritional Status 2- How to Conduct Physical Examination Related To Nutritional Status ? Assessment focuses on rapidly proliferating tissues such as skin, hair, nails, eyes, and mucosa . Signs Associated With Malnutrition General appearance Apathetic, listless, looks tired, easily fatigued. Weight Over weight or underweight. Skin Dry, flaky (fragile) ; pale or pigmented ; presence of petechiae or bruises , oedema.

Nails Brittle, pale, ridged, or spoon shaped(iron) Nails Brittle, pale, ridged, or spoon shaped(iron). Eyes Pale, or red conjunctiva, dryness , night blindness (vitamin A deficiency). Lips Swollen , red, cracks at side of mouth, vertical fissures(B vitamins); Tongue Swollen, beefy red colored(B vitamins) decrease or increase in size.

Gums Swollen, inflamed; bleed easily (Vit. C defic Gums Swollen, inflamed; bleed easily (Vit.C defic.) Muscles Undeveloped flaccid, wasted Gastrointestinal system Anorexia, indigestion, diarrhea, constipation, enlarged liver, protruding abdomen. Nervous system Decreased reflexes sensory loss, burning and tingling of hands and feet(B vitamin), mental confusion or irritability.

3-How To Calculate Percentage Of Weight Loss 3-How To Calculate Percentage Of Weight Loss ? Accurate assessment of the client’s height, current body weight,(CBW) , and usual body weight (UBW) is essential.

Calculating percent of deviation usual body weight current weight % usual body weight =____________ × 100 usual body weight * Mild malnutrition 85-90 % * Moderate malnutrition 75-84 % * Sever malnutrition less than 74 %

Calculating percent of weight loss usual weight – current weight % weight loss= _______________________ ×100 usual weight Significant wt. loss Sever weight loss 5% over 1 mo. >5 % over 1 mo. 7.5 % over 3 mo. > 7.5 % over 3 mo 10 % over 6 mo. > 10 % over 6 mo

4- What Is The Methods For Collecting Dietary History 4- What Is The Methods For Collecting Dietary History ? Four possible methods for collecting dietary data: A- 24 – hours food recall The nurse ask the client to recall all the food and beverages the client consumes during 24 – hour. B- Food frequency record * Is a checklist that indicates how often general food groups or specific foods are eaten. * Frequency may be categorized as time/ day, time/ week, times/ month, or frequently ,seldom , never

* When specific foods or nutrients are suspected of being deficient or excessive , the nurse may use a selective food frequently that focuses e.g., on fat, fruit, vegetable, and fiber intake. C- A Food diary Is a detailed record of measured amounts (portion size) of all food and fluids a clients consumes during a specified period usually 3 to 7 days

D- A diet history Interview by the dietitian It include characteristics of foods usually eaten as well as the frequency and amount of food consumed * It also include: 1- A & B & C 2- Medical and psychosocial factors. 3- Food habits. 4- choice

Data are analyzed by computer and translated into caloric and nutrient intake. Result compared with the standard.

5- What Are The Anthropometric Measurement Of Nutritional Assessment 5- What Are The Anthropometric Measurement Of Nutritional Assessment ? 1- Skinfold measurement Triceps skinfold ( TSF) it measure SC tissue (Grasp the skin on the back of the upper arm along the axis of the humerus). Measurement Male 12 mm Female 20 mm

2- The mid – arm circumference(MAC) It measure of fat, muscle, and skeleton. Arm hanging freely and the forearm flexed measure at the midpoint of the arm. Measurement Male 32 cm Female 28cm

3- The mid- arm muscle circumference (MAMC) Is an estimate of lean body mass, or skeletal muscle reserve. MAC (cm) – 3.143 TSF (mm) MAMC cm = _______________________ 10 Measurement Male 54 cm2 Female 30 cm2

6- What Are The Laboratory Tests To Be Done 6- What Are The Laboratory Tests To Be Done ? 1- Albumin This test helps in determining if a patient has liver disease, kidney disease, or if insufficient protein is being absorbed by the body. 2- Prealbumin Thyroxin – binding albumin Prealbumin is a simple blood test, as easy to perform as a glucose test. Prealbumin has a normal range of 15-35 mg/dL .

*Prealbumin is a quick, easy nutrition screening tool that can help meet this requirement. *Physicians see results in 2 days, as opposed to 21 days with Albumin as the nutritional marker. * Prealbumin should be measured 2-3 times per week * used to monitor the effectiveness of nutritional therapy

3- 24- urinary urea nitrogen. to measures of protein metabolism 3- 24- urinary urea nitrogen * to measures of protein metabolism. 4- Urinary creatinine * It reflect a person's total muscle mass The greater the muscle mass, the greater the excretion of creatinine. 4- Haemoglobin level * Low haemoglobin level may be evidence of iron deficiency anaemia.

Selected Nursing Diagnosis Wellness Diagnosis: Health- Seeking Behavior related to desire and request to learn more about attaining ideal body weight. Readiness for Enhanced Fluid Balance related to a desire for information pertaining to a need for increased fluids.

Selected Nursing Diagnosis Cont. Risk Diagnosis Risk for Deficient Fluid Volume related to impending dehydration secondary to nausea and vomiting. Risk for Imbalanced Fluid volume related to lack of adequate home cooling system and high environmental temperatures . Risk for Imbalanced Nutrition: More Than Body Requirement related to increasing sedentary lifestyle and decreasing metabolic demands

Selected Nursing Diagnosis Cont. Actual Diagnosis Disturbed Body Image related to recent increase in weight. Hopelessness related to inability to lose weight and remain on prescribed diet. Impaired Swallowing related to muscle weakness and chewing difficulties secondary to a recent stroke

Selected Nursing Diagnosis Cont. Actual Diagnosis Cont. Deficient Fluid Volume related to nausea and vomiting secondary to chemotherapy. Excess Fluid Volume related to edema in ankles secondary to congestive heart failure. Imbalanced Nutrition: More Than Body Requirements related to excessive caloric intake and sedentary life.

Selected Nursing Diagnosis Cont. Actual Diagnosis Cont. Imbalanced Nutrition: Less Than Body Requirements related to inadequate caloric/ nutrient intake secondary to lack of access and ability to prepare or obtain nutritious food to meet caloric and nutritive requirements.

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