Nutrition in Nursing Chapter 1

Nutritional Screening Quick look at a few variables to judge a client’s relative risk for nutritional problems No accepted universal tool JCAHO mandates that screen must be done within 24 hours of admission to the hospital

Nutritional Screening (cont’d) Comprehensive nutritional assessment Moderate to high risk at screening referred to dietitian for assessment Nutritional care process: 4 steps Assessment Nutritional diagnosis Implementation Monitoring and evaluation

Nutritional Screening (cont’d) Comprehensive nutritional assessment (cont’d) Different from nursing care plan Dietitians can get most of information from nursing admission assessment Dietitians interview patients and/or families to obtain a nutrition history Helps to differentiate: Nutrition problems caused by inadequate intake from those caused by illness or its treatments

Nutritional Screening (cont’d) Comprehensive nutritional assessment (cont’d) Dietitians Calculate estimated calorie and protein requirements based on the assessment data Determine nutritional diagnoses that define the nutritional problem, etiology, and signs and symptoms May also determine the appropriate malnutrition diagnosis Formulate nutrition interventions

Question Nutritional screening helps to differentiate problems caused by inadequate intake from those that are caused by: a. Malnutrition b. Illness or its treatment c. Accident or injury d. Chronic diseases

Answer b. Illness or its treatment Rationale: A nutrition history can help differentiate nutrition problems caused by inadequate intake from those caused by illness or its treatments.

Integrating Nutrition Assessment Data classified as ABCD: Anthropometric Biochemical Clinical Dietary data Client’s medical-psychosocial history is also evaluated for its impact on nutritional status

Integrating Nutrition (cont’d) Anthropometric data Physical measurements of the body Body mass index “Healthy” or “normal” BMI is defined as 18.5 to 24.9 Above or below related to health risks “Ideal” body weight Edema or dehydration skews accurate weight measurements Recent weight change

Integrating Nutrition (cont’d) Biochemical data No single test is both sensitive and specific for protein-calorie malnutrition Biochemical data may help support the diagnosis of a nutritional problem

Integrating Nutrition (cont’d) Albumin Often used to assess protein status Serum levels may be maintained until malnutrition is in a chronic stage Low albumin may indirectly identify patients who may benefit from nutrition assessment and intervention Prealbumin Thyroxin-binding protein More sensitive indicator of protein status More expensive to measure

Integrating Nutrition (cont’d) Clinical data Physical signs and symptoms of malnutrition observed in the client Most signs cannot be considered diagnostic Physical signs and symptoms of malnutrition can vary in intensity among population groups because of genetic and environmental differences Physical findings occur only with overt malnutrition

Integrating Nutrition (cont’d) Dietary data Nurse should ask, “Do you avoid any particular foods?” Nurse should not ask, “Are you on a diet?” Medical psychosocial history May shed light on factors that influence intake, nutritional requirements, or nutrition counseling

Integrating Nutrition (cont’d) Medication Both prescription and over-the-counter drugs have the potential to affect and be affected by nutritional status At greatest risk for development of drug-induced nutrient deficiencies include those who: Habitually consume fewer calories and nutrients than they need Have increased nutrient requirements including infants, adolescents, and pregnant and lactating women Are elderly Have chronic illnesses

Integrating Nutrition (cont’d) At greatest risk for development of drug-induced nutrient deficiencies include those who (cont’d): Take large numbers of drugs (five or more), whether prescription drugs, over-the-counter medications, or dietary supplements Are receiving long-term drug therapy Self-medicate Are substance abusers

Integrating Nutrition (cont’d) Nursing diagnosis Provide written documentation of the client’s status Serve as a framework for the plan of care that follows Planning: client outcomes Outcomes, or goals, should be measurable, attainable, specific, and client centered Focus on the client, not the health care provider Keep in mind that the goal for all clients is to consume adequate calories and protein using foods they like and tolerate as appropriate

Integrating Nutrition (cont’d) Nursing interventions Nutrition therapy Diet is a four-letter word with negative connotations Usually general suggestions to increase/ decrease, limit/avoid, reduce/encourage, or modify/maintain aspects of the diet because exact nutrient requirements are determined on an individual basis Nutrition theory does not always apply to practice

Integrating Nutrition (cont’d) Nursing interventions (cont’d) Client teaching Clients in clinical settings may be more receptive to nutritional advice Hospitalized patients are also prone to confusion about nutrition messages Monitoring and evaluation Monitoring precedes evaluation Evaluation assesses whether client outcomes were achieved

Thyroid-binding protein is also called prealbumin. Question Is the following statement true or false? Thyroid-binding protein is also called prealbumin.

Answer False. Rationale: Prealbumin, also known as thyroxin-binding protein, is a more sensitive indicator of protein status than albumin but not entirely specific for malnutrition; it is affected by metabolic stress and other medical conditions.

Physical Signs & Symptoms of Malnutrition Hair is dull, brittle, dry, or falls out easily Swollen glands of neck and cheeks Dry, rough, or spotty skin Poor or delayed wound healing or sores Thin appearance with lack of subcutaneous fat Muscle wasting Edema of lower extremities Weakened hand grasp Depressed mood Abnormal heart rate/rhythm and BP Enlarged liver or spleen Loss of balance and coordination

Nursing Diagnoses With Nutritional Relevance Altered nutrition: more than body requirements Altered nutrition: less than body requirements Altered nutrition: risk for more than body requirements Constipation Diarrhea Fluid volume excess Fluid volume deficit

Nursing Diagnoses With Nutritional Relevance (cont’d) Risk for aspiration Altered oral mucous membrane Altered dentition Impaired skin integrity Noncompliance Impaired swallowing Knowledge deficit Pain Nausea

Question Mrs. Kirk, age 75, was admitted to the long-term– care facility because she was found by her children too weak to care for herself. What assessment data would influence the nurse to suspect possible malnutrition? a. Brittle, dry hair and loss of reflexes b. Weakened hand grasp and lack of subcutaneous fat c. Depressed mood and loss of sensation in extremities d. Abnormal BP and thin, wrinkled skin

Answer b. Weakened hand grasp and lack of subcutaneous fat Rationale: See Box 1.4: Physical signs and symptoms suggestive of malnutrition.