DNT 200 NUTRITION FOR HEALTH SCIENCES NUTRITION INTERVENTION

NUTRITION INTERVENTION

NUTRITION INTERVENTION Nutrition Assessment Defining nutrition status Assessor gathers information from many sources Historical data Anthropometric measurements Biochemical analysis (laboratory tests) Physical examinations Nutritional assessments define a person’s nutritional status

NUTRITION INTERVENTION Nutrition Assessment Historical data Health history -- identifies health-related factors that affect nutrition status Use records completed by attending physicians, nurses, or other health care providers Ask the patient Include socioeconomic history Profoundly affects nutrition status Identifies personal, financial, and environmental influences on food intake Community customs can help the assessor evaluate nutrition status

NUTRITION INTERVENTION Nutrition Assessment Historical data Drug history -- used to note food-drug interactions Diet history Include Portion sizes How food is prepared Beverage consumption including alcohol

NUTRITION INTERVENTION Nutrition Assessment Methods 24-hour Recall Provides data for one day only Usefulness is limited -- does not provide enough accurate information to allow generalizations to be made about an individual’s usual food intake Advantage -- easy to obtain

NUTRITION INTERVENTION 24-Hour Recall Form

NUTRITION INTERVENTION Nutrition Assessment Methods (con’t) Usual Intake Uses form similar to 24-hour recall Ask “What is the first thing you usually eat or drink during the day?” If data varies widely, the client may have difficulty in answering the questions resulting in useless data for estimating nutrient intake

NUTRITION INTERVENTION Nutrition Assessment Methods (con’t) Food Frequency Checklist Purpose -- to determine how often an individual eats a specific type of food per day, per week, or per month If used with a usual intake or 24-hour recall, permits cross checking of information to improve accuracy

NUTRITION INTERVENTION Food Frequency Checklist Form

NUTRITION INTERVENTION Nutrition Assessment Methods (con’t) Food Records (Food Diary) Requires time, effort, and a cooperative patient Record keeper assumes an active role -- may, for the first time, become aware of personal food habits and begin to assume responsibility for them Are particularly valuable for overweight people trying to loose weight Major disadvantages - Poor compliance in recording data - Conscious or unconscious changes in eating habits may occur while the person is keeping the record

NUTRITION INTERVENTION Nutrition Assessment Analysis of food intake data Informally -- requires a general knowledge of nutrients in the different food groups Food composition table Does not include data on the amount of nutrients actually absorbed May be uncertainty about portion sizes Provides only a starting point and should be combined with other sources to confirm or eliminate the possibility of suspected nutritional problems

NUTRITION INTERVENTION Nutrition Assessment Anthropometric measurements Are physical measurements that provide an indirect assessment of body composition and development Purpose Evaluate the progress of growth in pregnant women, infants, children, and adolescents Determine under-nutrition and obesity in all age groups

NUTRITION INTERVENTION Nutrition Assessment Types Abdominal girth -- reflects abdominal fluid retention Height-weight Reflects over-nutrition and under-nutrition; growth in children Can be difficult to evaluate Fluid retention can mask significant weight loss Bedridden patient may be difficult to weigh Body mass index -- Especially useful in estimating risk to health associated with over-nutrition

NUTRITION INTERVENTION Nutrition Assessment Types (con’t) Percent IBW, UBW, recent weight change -- reflects over-nutrition and under-nutrition Head circumference -- reflects brain growth and development in infants and children under 2

NUTRITION INTERVENTION Nutrition Assessment Types (con’t) Fat-fold -- reflects subcutaneous fat and total body fat Mid-arm muscle circumference -- reflects muscle mass (protein status)

NUTRITION INTERVENTION Nutrition Assessment Should be taken periodically and compared with standards and previous measurements Requires minimal equipment but needs proper instruction and practice to ensure reliability

NUTRITION INTERVENTION Nutrition Assessment Biochemical analysis Are laboratory tests Most based on blood or urine samples Interpretation requires skill No test reflects nutrition status alone

NUTRITION INTERVENTION Nutrition Assessment Biochemical analysis (con’t) Assessment of protein-energy malnutrition Most commonly used tests Serum albumin Accounts for over 50% of total serum proteins When protein status degenerates, serum albumin concentrations tend to decline slowly -- represent prolonged protein depletion Correlate well with survival of the hospitalized population Increase slowly with appropriate nutritional support -- measurement as an early response to nutritional therapy is of limited value Normal value = 3.5 grams/dL or greater

NUTRITION INTERVENTION Nutrition Assessment Biochemical analysis (con’t) Total lymphocyte count Lymphocytes (white blood cells) are important participants in the immune response Their numbers are reduced as depletion occurs Standard is 2,500 per cubic milliliter -- values below 1,500 are considered depleted

NUTRITION INTERVENTION Nutrition Assessment Biochemical analysis (con’t) Serum transferrin Is a protein that transports iron -- its concentrations reflect both protein and iron status Is relatively slow to respond to changes in protein intake Standard is 200 or greater mg per dL

NUTRITION INTERVENTION Nutrition Assessment Biochemical analysis (con’t) Prealbumin and Retinol-binding protein Measures response to nutrition therapy Respond quickly to changes in protein intake

NUTRITION INTERVENTION Nutrition Assessment Biochemical analysis (con’t) Classifying protein-energy status Acute malnutrition (kwashiorkor-type) (protein malnutrition) Normal or above standard anthropometrics Below normal indices of blood and organ proteins Individual may be overweight -- therefore is easily overlooked Chronic malnutrition (marasmus-type) Below standard anthropometrics Normal or above indices of blood and organ proteins Mixed PEM

NUTRITION INTERVENTION Nutrition Assessment Biochemical analysis (con’t) Assessments can also reveal Energy over-nutrition Vitamin and mineral deficiencies and toxicity's Poor dietary practices

NUTRITION INTERVENTION Nutrition Assessment Biochemical analysis (con’t) Assessment of nutritional anemias A low hemoglobin or hematocrit level most frequently signals the presence of anemia Laboratory tests can pinpoint the cause of anemia and distinguish between nutritional anemia and non-nutritional causes to include blood loss, infections, sickle cell anemia, and chronic liver disease

NUTRITION INTERVENTION Nutrition Assessment

NUTRITION INTERVENTION Nutrition Assessment Physical examination Most signs are non specific -- can reflect any of several nutrient deficiencies Hair -- if dull, brittle, dry, loose or falls out may reflect PEM Eyes -- pale eye membranes, spots, redness, adjusts slowly to darkness may reflect vitamin A, B-vitamins, zinc, and iron status Teeth -- missing discolored, decayed, bleeding swollen and spongy gums may reflect mineral and vitamin C status

NUTRITION INTERVENTION Nutrition Assessment Physical examination (con’t) Face -- off color, scaly, flaky, cracked skin may reflect PEM, vitamin A and iron status Glands -- swollen at front of neck may reflect PEM and iodine status Tongue -- sore, smooth, purplish and swollen may reflect B vitamin status Skin -- dry rough, spotty, “sandpaper” feel, sores, lack of fat under skin may reflect PEM, essential fatty acid deficiency, vitamin A, B vitamin and vitamin C status

NUTRITION INTERVENTION Nutrition Assessment Physical examination (con’t) Nails -- spoon-shaped, brittle, ridged, pale may reflect iron status Internal systems -- abnormal heart rate, heart rhythm or blood pressure, enlarged liver or spleen, abnormal digestion, burning or tingling of hands, feet, loss of balance or coordination, mental confusion, irritability, fatigue may reflect PEM and mineral status Muscles and bones -- “wasted’ appearance of muscles, swollen bumps on skull or ends of bones, small bumps on ribs, bowed legs or knock-knees may reflect PEM, mineral and vitamin D status

NUTRITION INTERVENTION Nutrition Screening Uses preliminary nutrition assessment techniques to identify people who are malnourished or are at risk for malnutrition Components Review individual’s diet, drug, and health history -- does it reveal risk factors for poor nutritional status? Weigh each person on admission and regular intervals Check laboratory reports --do they suggest malnutrition? Look at the person -- are there obvious signs of malnutrition Check meals -- see if food is being eaten Communicate problems and follow-up to see that problems are being managed

NUTRITION INTERVENTION The nutrition care process Is an organized approach to problem solving consisting of five steps Assess nutrition status Analyze assessment data to determine nutrient requirements Develop plans of action (including client education) to meet nutrient needs Implement the nutrition care plan Evaluate the effectiveness of the nutrition care plan through ongoing assessment and make appropriate changes as needed *****

NUTRITION INTERVENTION Nutrition care plans Study the information gleaned from analyzing the nutritional assessment data Does the diet history show inadequacies? Is the body weight appropriate? Are the lab values out of line? Generate a problem list (this is the formal basis of the nutrition care plan) Include current and past conditions that impair nutrition status ****

NUTRITION INTERVENTION Nutrition care plans (con’t) Include areas which may present future problems For each nutrition problem, specify the strategies needed to tackle it Should provide detailed plans for reaching specific goals Should be tailored to deal with each nutrition problem’s cause ***

NUTRITION INTERVENTION Nutrition care plan implementation Provide appropriate diet and education Maintain daily contact with client and other providers Care plan may change as medical status changes Evaluating nutrition care plans Are the strategies meeting the needs of the client? Have events occurred in the client’s life that have changed the nutrition status or altered the client’s needs? **

NUTRITION INTERVENTION Professional Communication Networks Professionals communicate through the medical record The medical record compiles History Diagnosis Therapy Prognosis Progress notes Describe new information gleaned from the client, laboratory tests or other objective measurements Provide a written assessment of the data and describe the actions to be taken based on that assessment *

NUTRITION INTERVENTION Professional Communication Networks Examples of important nutrition-related information found in the medical record Evaluation of the client’s current diet Nutrition assessment data Recommended nutrition therapy Client’s acceptance and tolerance of the diet Problems with the client’s food intake Documentation of diet counseling Any planned follow-up or referral to another person or agency Client’s response to nutrition care Client’s response to diet counseling