1. © 2007 Thomson - Wadsworth Chapter 13 Nutrition Care and Assessment

2. © 2007 Thomson - Wadsworth Nutrition in Health Care Health problems Alter nutrition needs Can lead to malnutrition Poor nutrition status Can influence the course of disease & body’s response to treatment Hospitalized patients 40-60% with acute illness are malnourished Others decline in nutrition status within 3 weeks

3. © 2007 Thomson - Wadsworth How Illness Affects Nutrition Status Reduced food intake Nausea Inflammation of mouth Medications can cause GI upset Interferes with digestion & absorption Alters metabolism & excretion Dietary restrictions for some surgeries or chronic illnesses Drain on financial resources Unable to prepare food Emotional upset

4. © 2007 Thomson - Wadsworth Responsibility for Nutrition Care Registered Dietitians Provide medical nutrition therapy Assess, diagnose, develop,implement & evaluate nutrition care plans Plan & approve menus Provide education Registered Dietetic Technician Assist the Registered Dietitians Physicians Prescribe diet orders Nurses Screen patients Participate in nutrition assessments Provide direct nutrition care Other team members such as pharmacists & speech therapists consult

5. © 2007 Thomson - Wadsworth Identifying Risk for Malnutrition Nutrition screening Identifies persons at risk for nutrition problems Must be done 24 hours after admission Should be completed in 5-15 minutes Screening Medical diagnosis Medical record Physical measurements Lab reports Diet history

6. © 2007 Thomson - Wadsworth Planning Care The Nutrition Care Process Nutrition assessment Nutrition diagnosis Nutrition intervention Nutrition monitoring & evaluation The Nursing Process Assessment Nursing diagnosis Outcome identification & planning Implementation Evaluation

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8. The Nutrition Care Process Assessment Medical, social, & dietary histories Anthropometric data Biochemical analysis Physical exam Diagnosis Actual or potential Problem, etiology, signs & symptoms Intervention Dietary changes Nutrition education Medication changes Monitoring & evaluation May need to modify the plan Must be flexible

9. © 2007 Thomson - Wadsworth Historical Information Medical history Age Gender Weight Prescription drugs OTC medications Dietary supplements Type of illness Social history Cultural heritage Financial concerns Who prepares and shops for food Living situation Diet history Food intake Meal patterns Physical problems

10. © 2007 Thomson - Wadsworth Dietary Assessment Methods 24-hour recall All foods & beverages Time of day eaten Amounts consumed Food preparation Typical day? Food frequency questionnaire Food record Recorded over several days Recorded as consumed Does not rely on memory Direct observation Calorie counting Time consuming

11. © 2007 Thomson - Wadsworth Food Frequency Questionnaire

12. © 2007 Thomson - Wadsworth Anthropometric Data Height: Adults Length Infants < 24 months Weight BMI % Usual body weight % Ideal body weight Head circumference Assesses brain development < 3 years of age Circumference of waist & limbs Evaluates body fat Evaluates muscle mass

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18. Biochemical Analysis Provides information about Protein-energy nutrition Vitamin & mineral status Fluid & electrolyte balance Organ functioning Analysis of blood & urine samples

19. © 2007 Thomson - Wadsworth Plasma Proteins Albumin Most abundant Slow to reflect changes in status Transferrin Transports iron Indicates PEM & iron status Slow to detect changes in status Prealbumin & retinol-binding protein Also called transthyretin Responds quickly to changes in protein status Expensive test

20. © 2007 Thomson - Wadsworth Fluid Imbalance Edema Weight gain Facial puffiness Swelling limbs Abdominal distention Tight-fitting shoes Diseases of heart, kidney, liver, lungs Dehydration Thirst Dry skin or mouth Reduced skin tension Dark yellow or amber urine with low volume Fever, sweating, vomiting, diarrhea, burns

21. © 2007 Thomson - Wadsworth Assessment of Nutrition Status Functional Assessment Exercise tolerance Respiratory muscle strength Immunity Integrating assessment data Subjective Global Assessment (SGA) Combines historical information with results of physical examination

22. © 2007 Thomson - Wadsworth