1. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Nutritional Assessment Chapter 11

2. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Nutritional Assessment  Nutritional status refers to the degree of balance between nutrient intake and nutrient requirements  This balance is affected by many factors, including physiologic, psychosocial, developmental, cultural, and economic factors Slide 11-2

3. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Defining Nutritional Status  Optimal nutritional status  Achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness Persons having optimal nutritional status are more active, have fewer physical illnesses, and live longer than persons who are malnourished Persons having optimal nutritional status are more active, have fewer physical illnesses, and live longer than persons who are malnourished Slide 11-3

4. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Defining Nutritional Status(cont.) Structure and Function: Defining Nutritional Status (cont.)  Undernutrition  Occurs when nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands Vulnerable groups, infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults, are at risk for: Vulnerable groups, infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults, are at risk for:  Impaired growth and development  Lowered resistance to infection and disease  Delayed wound healing  Longer hospital stays  Higher health care costs Slide 11-4

5. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Defining Nutritional Status(cont.) Structure and Function: Defining Nutritional Status (cont.)  Overnutrition  Caused by consumption of nutrients, especially calories, sodium, and fat in excess of body needs Major nutritional problem today, overnutrition can lead to obesity and is risk factor for: Major nutritional problem today, overnutrition can lead to obesity and is risk factor for:  Heart disease and hypertension  Type II diabetes  Stroke  Gallbladder disease  Sleep apnea  Certain cancers  Osteoarthritis Slide 11-5

6. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Defining Nutritional Status(cont.) Structure and Function: Defining Nutritional Status (cont.)  Overnutrition (cont.) Estimated 17% of children and adolescents, ages 2 to 19 Estimated 17% of children and adolescents, ages 2 to 19 66% of adults in U.S. are either overweight or obese 66% of adults in U.S. are either overweight or obese For children, overweight defined as body mass index (BMI) equal to or greater than 95th percentile based on age- and gender-specific BMI charts For children, overweight defined as body mass index (BMI) equal to or greater than 95th percentile based on age- and gender-specific BMI charts For adults For adults  Overweight defined as BMI of 25 or greater  Obesity defined as BMI of 30 Being overweight during childhood and adolescence associated with increased risk for becoming overweight during adulthood Being overweight during childhood and adolescence associated with increased risk for becoming overweight during adulthood Slide 11-6

7. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Developmental Competence  Infants and children  Time from birth to 4 months of age is most rapid period of growth in life cycle Although infants lose weight during first few days of life, birthweight usually regained by 7th to 10th day Although infants lose weight during first few days of life, birthweight usually regained by 7th to 10th day Thereafter, infants double their birth weight by 4 months and triple it by 1 year of age Thereafter, infants double their birth weight by 4 months and triple it by 1 year of age Breastfeeding recommended for full-term infants for first year of life because breast milk ideally formulated to promote normal infant growth and development and natural immunity Breastfeeding recommended for full-term infants for first year of life because breast milk ideally formulated to promote normal infant growth and development and natural immunity Slide 11-7

8. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Developmental Competence (cont.)  Infants and children (cont.) Although relatively few, contraindications to breastfeeding exist Although relatively few, contraindications to breastfeeding exist Infants increase their length by 50% during first year and double it by 4 years Infants increase their length by 50% during first year and double it by 4 years By age 2 years, brain has reached 50% of its adult size By age 2 years, brain has reached 50% of its adult size  By age 4, 75%  By age 8, 100% For this reason, infants and children younger than 2 should not drink skim or low-fat milk or be placed on low- fat diets For this reason, infants and children younger than 2 should not drink skim or low-fat milk or be placed on low- fat diets Fat, calories, and essential fatty acids are required for proper growth and central nervous system development Fat, calories, and essential fatty acids are required for proper growth and central nervous system development Slide 11-8

9. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Developmental Competence (cont.)  Adolescence  Adolescence characterized by rapid physical growth and endocrine and hormonal changes Caloric and protein requirements increase to meet this demand, and because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase Caloric and protein requirements increase to meet this demand, and because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase Increased requirements cannot be met by three meals per day; therefore, nutritious snacks play an important role in achieving adequate nutrient intake Increased requirements cannot be met by three meals per day; therefore, nutritious snacks play an important role in achieving adequate nutrient intake In general, boys grow taller and have less body fat than girls In general, boys grow taller and have less body fat than girls Slide 11-9

10. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Developmental Competence (cont.)  Adolescence (cont.)  Percent of body fat increases in females to about 25% and decreases in males (replaced by muscle mass) to about 12%  Typically, girls double their body weight between ages of 8 and 14  Boys double their body weight between the ages of 10 and 17 years Slide 11-10

11. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Developmental Competence (cont.)  Pregnancy and lactation  To support synthesis of maternal and fetal tissues Sufficient calories, protein, vitamins, and minerals must be consumed Sufficient calories, protein, vitamins, and minerals must be consumed National Academy of Sciences (NAS) recommends weight gain of National Academy of Sciences (NAS) recommends weight gain of  25 to 35 lb for women of normal weight  28 to 40 lb for underweight women  15 to 25 lb for overweight women Slide 11-11

12. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Developmental Competence (cont.)  Adulthood  During adulthood, growth and nutrient needs stabilize Most adults in relatively good health Most adults in relatively good health However, lifestyle factors such as cigarette smoking, stress, lack of exercise, excessive alcohol intake, and diets high in saturated fat, cholesterol, salt, and sugar and low in fiber can be factors in development of hypertension, obesity, atherosclerosis, cancer, osteoporosis, and diabetes mellitus However, lifestyle factors such as cigarette smoking, stress, lack of exercise, excessive alcohol intake, and diets high in saturated fat, cholesterol, salt, and sugar and low in fiber can be factors in development of hypertension, obesity, atherosclerosis, cancer, osteoporosis, and diabetes mellitus Adult years, therefore, are important time for education to preserve health and to prevent or delay onset of chronic disease Adult years, therefore, are important time for education to preserve health and to prevent or delay onset of chronic disease Slide 11-12

13. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Developmental Competence (cont.)  Aging adult  As people age, a number of changes occur that make them prone to undernutrition or overnutrition Major risk factors for malnutrition in older adults include poor physical or mental health, social isolation, alcoholism, limited functional ability, poverty, and polypharmacy Major risk factors for malnutrition in older adults include poor physical or mental health, social isolation, alcoholism, limited functional ability, poverty, and polypharmacy Normal physiological changes in aging adults that directly affect nutritional status include poor dentition, decreased visual acuity, decreased saliva production, slowed gastrointestinal motility, decreased gastrointestinal absorption, and diminished olfactory and taste sensitivity Normal physiological changes in aging adults that directly affect nutritional status include poor dentition, decreased visual acuity, decreased saliva production, slowed gastrointestinal motility, decreased gastrointestinal absorption, and diminished olfactory and taste sensitivity Slide 11-13

14. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Developmental Competence (cont.)  Aging adult  Important nutritional features of older years Decrease in energy requirements due to loss of lean body mass and increase in fat mass Decrease in energy requirements due to loss of lean body mass and increase in fat mass Socioeconomic conditions frequently have a significant effect on nutritional status Socioeconomic conditions frequently have a significant effect on nutritional status Decline of extended families and increased mobility of families reduce available support systems Decline of extended families and increased mobility of families reduce available support systems Facilities for meal preparation, transportation to grocery stores, physical limitations, income, and social isolation interfere with acquisition of balanced diet Facilities for meal preparation, transportation to grocery stores, physical limitations, income, and social isolation interfere with acquisition of balanced diet Multiple medications that have a potential for interaction with nutrients and with one another Multiple medications that have a potential for interaction with nutrients and with one another Slide 11-14

15. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence  Foods and eating customs are culturally diverse, and each person has unique cultural heritage that may affect nutritional status  Immigrants commonly maintain traditional eating customs long after language and manner of dress of adopted country become routine Occupation, class, religion, gender, and health awareness also have a great bearing on eating customs Occupation, class, religion, gender, and health awareness also have a great bearing on eating customs Not only do food habits change to accommodate their new cultures, but also their food habits have influence on their adoptive country Not only do food habits change to accommodate their new cultures, but also their food habits have influence on their adoptive country Slide 11-15

16. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Newly arriving immigrants may be at nutritional risk for a variety of reasons Frequently come from countries with limited food supplies caused by poverty, poor sanitation, war, or political strife Frequently come from countries with limited food supplies caused by poverty, poor sanitation, war, or political strife General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries are among more common nutrition-related problems of new immigrants from developing countries General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries are among more common nutrition-related problems of new immigrants from developing countries They are in a new country with a completely new language, culture, and society They are in a new country with a completely new language, culture, and society Slide 11-16

17. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  When immigrants arrive in U.S., other factors contribute to their nutritional problems  Faced with unfamiliar foods, food storage, food preparation, and food-buying habits Familiar foods are difficult or impossible to obtain Familiar foods are difficult or impossible to obtain Low income may also limit their access to familiar foods Low income may also limit their access to familiar foods When traditional food habits are disrupted, borderline deficiencies or adverse nutritional consequences may result When traditional food habits are disrupted, borderline deficiencies or adverse nutritional consequences may result  As an example, Japanese immigrants to U.S. have increased risk of colon and breast cancer as they adapt to diet higher in saturated fats and cholesterol Slide 11-17

18. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Cultural heritage also plays a role in nutrient needs Cultural values may conflict with optimum nutrition, for example, many cultures worldwide consider obesity an indication of beauty, affluence, and well-being Cultural values may conflict with optimum nutrition, for example, many cultures worldwide consider obesity an indication of beauty, affluence, and well-being Best way to learn about the eating patterns of people is to talk with them, eat with them, and ask about their dietary customs Best way to learn about the eating patterns of people is to talk with them, eat with them, and ask about their dietary customs Recent immigrant groups, such as Southeast Asians, are often shorter and weigh less than Western counterparts, so standard tables of weight for age, height for age, and weight for height may not be appropriate to evaluate growth and development of immigrant children Recent immigrant groups, such as Southeast Asians, are often shorter and weigh less than Western counterparts, so standard tables of weight for age, height for age, and weight for height may not be appropriate to evaluate growth and development of immigrant children Slide 11-18

19. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Cultural factors that must be considered  Cultural definition of food  Frequency and number of meals eaten away from home  Form and content of ceremonial meals  Amount and types of foods eaten, and regularity of food consumption Slide 11-19

20. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Lactose intolerance is condition found in 30 to 50 million Americans  Up to 80% of African Americans  80% to 100% of American Indians  90% to 100% of Asian Americans  Least common among people of northern European descent Slide 11-20

21. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  It is necessary to avoid cultural stereotyping  Tendency to view individuals of common cultural backgrounds similarly and according to a preconceived notion of how they “ought” to behave Aggregate dietary preferences among people from certain cultural groups, however, can be described, for example, characteristic ethnic dishes, methods of food preparation Aggregate dietary preferences among people from certain cultural groups, however, can be described, for example, characteristic ethnic dishes, methods of food preparation Cultural food preferences are often interrelated with religious dietary beliefs and practices Cultural food preferences are often interrelated with religious dietary beliefs and practices Many religions use foods as symbols in celebrations and rituals Many religions use foods as symbols in celebrations and rituals Slide 11-21

22. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Knowing person’s religious practices related to food  Enables you to suggest improvements or modifications that do not conflict with dietary laws  Other issues are fasting and other religious observations that may limit a person’s food or liquid intake during specified times Muslims fast from dawn to sunset during month of Ramadan in Islamic calendar and eat only twice a day, before dawn and after sunset Muslims fast from dawn to sunset during month of Ramadan in Islamic calendar and eat only twice a day, before dawn and after sunset Jews observe a 24-hour fast on Yom Kippur Jews observe a 24-hour fast on Yom Kippur Slide 11-22

23. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function: Cultural Competence(cont.) Structure and Function: Cultural Competence (cont.)  Kosher is term that refers to dietary laws of observant Jews  Not mixing milk and meat products, prohibition of eating pig meats and crustaceans are examples of many rules within system  Halal is term that refers to Islamic dietary laws, here, too, prohibition of pig meat is one of many dietary laws Slide 11-23

24. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function  Purposes and components of nutritional assessment  Purposes of nutritional assessment Identify individuals who are malnourished or are at risk of developing malnutrition Identify individuals who are malnourished or are at risk of developing malnutrition Provide data for designing a nutrition plan of care that will prevent or minimize development of malnutrition Provide data for designing a nutrition plan of care that will prevent or minimize development of malnutrition Establish baseline data for evaluating efficacy of nutritional care Establish baseline data for evaluating efficacy of nutritional care Slide 11-24

25. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Nutrition screening First step may be completed in any setting (e.g., clinic, home, hospital, long-term care) First step may be completed in any setting (e.g., clinic, home, hospital, long-term care) Based on easily obtained data, nutrition screening is quick and easy way to identify individuals at nutrition risk, such as those with weight loss, inadequate food intake, or recent illness Based on easily obtained data, nutrition screening is quick and easy way to identify individuals at nutrition risk, such as those with weight loss, inadequate food intake, or recent illness Parameters include weight and weight history, conditions associated with increased nutritional risk, diet information, and routine laboratory data Parameters include weight and weight history, conditions associated with increased nutritional risk, diet information, and routine laboratory data Slide 11-25

26. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Nutrition screening (cont.) A variety of valid tools are available for screening different populations A variety of valid tools are available for screening different populations  Admission Nutrition Screening Tool validated for use by nurses in hospital settings  Nutrition Screening Initiative form designed and validated in outpatient, geriatric population Slide 11-26

27. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Nutrition screening (cont.) Individuals identified at nutritional risk during screening should undergo a comprehensive nutritional assessment, which includes: Individuals identified at nutritional risk during screening should undergo a comprehensive nutritional assessment, which includes:  Dietary history and clinical information  Physical examination for clinical signs  Anthropometric measures  Laboratory tests Slide 11-27

28. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Nutrition screening (cont.) Various methods for collecting current dietary intake information are available Various methods for collecting current dietary intake information are available  24-hour recall  Food frequency questionnaire  Food diary  During hospitalization, documentation of nutritional intake can best be achieved through calorie counts of nutrients consumed and/or infused Slide 11-28

29. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  24-hour recall Easiest and most popular method for obtaining information about dietary intake Easiest and most popular method for obtaining information about dietary intake Individual or family member completes questionnaire or interviewed and asked to recall everything eaten within last 24 hours Individual or family member completes questionnaire or interviewed and asked to recall everything eaten within last 24 hours Slide 11-29

30. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  24-hour recall (cont.) However, several significant sources of error may occur when this method is used However, several significant sources of error may occur when this method is used Individual or family member may not be able to recall type or amount of food eaten Individual or family member may not be able to recall type or amount of food eaten Intake within last 24 hours may be atypical or unusual Intake within last 24 hours may be atypical or unusual Individual or family member may alter truth for variety of reasons Individual or family member may alter truth for variety of reasons Snack items and use of gravies, sauces, and condiments may be underreported Snack items and use of gravies, sauces, and condiments may be underreported Slide 11-30

31. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Food frequency questionnaire May be used to counter some of difficulties inherent in 24-hour recall method May be used to counter some of difficulties inherent in 24-hour recall method With this tool, information collected on how many times per day, week, or month individual eats particular foods With this tool, information collected on how many times per day, week, or month individual eats particular foods Drawbacks to use of food frequency questionnaire Drawbacks to use of food frequency questionnaire  Does not quantify amount of intake  Relies on individual’s or family member’s memory for how often a food was eaten Slide 11-31

32. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Food diaries or records Require asking individual or family member to write down everything consumed for certain period of time Require asking individual or family member to write down everything consumed for certain period of time Three days, including two weekdays and one weekend day, are customarily used Three days, including two weekdays and one weekend day, are customarily used Food diary is most complete and accurate if individual instructed to record information immediately after eating Food diary is most complete and accurate if individual instructed to record information immediately after eating Slide 11-32

33. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Food diaries or records (cont.) Potential problems with food diary include: Potential problems with food diary include:  Noncompliance  Inaccurate recording  Atypical intake on recording days  Conscious alteration of diet during recording period Slide 11-33

34. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Direct observation Can lead to detection of problems not readily identified through standard nutrition interviews Can lead to detection of problems not readily identified through standard nutrition interviews Observing typical feeding techniques used by parent or caregiver and interaction between individual and caregiver can be of value in assessing failure to thrive in children or unintentional weight loss in older adults Observing typical feeding techniques used by parent or caregiver and interaction between individual and caregiver can be of value in assessing failure to thrive in children or unintentional weight loss in older adults The Food Guide Pyramid, Dietary Guidelines, and Daily Reference Intakes (DRIs) are three guides commonly used to determine adequacy or inadequacy of a diet The Food Guide Pyramid, Dietary Guidelines, and Daily Reference Intakes (DRIs) are three guides commonly used to determine adequacy or inadequacy of a diet Slide 11-34

35. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  Access Food Guide Pyramid for additional information plus interactive features that allow you and your patients to create individualized nutrition and health plans  It can be easily adapted to patients with various cultural backgrounds, lifestyles, and health problems Slide 11-35

36. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Structure and Function(cont.) Structure and Function (cont.)  Purposes and components of nutritional assessment(cont.)  Purposes and components of nutritional assessment (cont.)  DRIs are recommended amounts of nutrients to prevent deficiencies and reduce risk of chronic diseases  In addition to recommending adequate intakes, also specify upper limits of nutrients to avoid toxicity With increased use of dietary supplements, risk for nutrient toxicities is on rise With increased use of dietary supplements, risk for nutrient toxicities is on rise Slide 11-36

37. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data  Eating patterns  Usual weight  Changes in appetite, taste, smell, chewing, swallowing  Recent surgery, trauma, burns, infection  Chronic illnesses  Vomiting, diarrhea, constipation  Food allergies or intolerances  Medications and/or nutritional supplements  Self-care behaviors  Alcohol or illegal drug use  Exercise and activity patterns Slide 11-37

38. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Eating patterns  Number of meals/snacks per day?  Kind and amount of food eaten?  Fad, special, or alternative diets?  Where is food eaten?  Food preferences and dislikes?  Religious or cultural restrictions?  Able to feed self? Slide 11-38

39. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Usual weight  What is your usual weight?  20% below or above desirable weight?  Recent weight change?  How much lost or gained?  Over what time period?  Reason for loss or gain? Slide 11-39

40. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Changes in appetite, taste, smell, chewing, swallowing  Type of change?  When did change occur?  Recent surgery, trauma, burns, infection  When?  Type?  How treated?  Conditions that increase nutrient loss, for example, draining wounds, effusions, blood loss, dialysis? Slide 11-40

41. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Chronic illnesses  Type?  When diagnosed?  How treated?  Dietary modifications?  Recent cancer chemotherapy or radiation therapy? Slide 11-41

42. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Nausea, vomiting, diarrhea, constipation  Any problems?  Due to?  How long?  Food allergies or intolerances  Any problematic foods?  Type of reaction?  How long? Slide 11-42

43. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Medications and nutritional supplements  Prescription medications?  Nonprescription?  Use over a 24-hour period?  Type of vitamin or mineral supplement? Amount? Duration of use?  Herbal and botanical products? Specific type/brand and where obtained? How often used? Who recommended? How does it help you? Any problems? Slide 11-43

44. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Self-care behaviors  Meal preparation facilities?  Transportation for travel to market?  Adequate income for food purchase?  Who prepares meals and does shopping?  Environment during mealtimes? Slide 11-44

45. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Alcohol or illegal drug use  When was last drink of alcohol?  Amount taken that episode?  Amount alcohol each day? Each week?  Duration of use? Repeat questions for each drug used Repeat questions for each drug used  Exercise and activity patterns  Amount?  Type? Slide 11-45

46. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Family history  Family or personal history of heart disease, osteoporosis, cancer, gout, gastrointestinal disorders, obesity, or diabetes?  Effect of each on eating patterns?  Effect on activity patterns? Slide 11-46

47. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Additional history for infants and children  Dietary histories For infants and children generally obtained from child’s parents, guardian, babysitter, or daycare center For infants and children generally obtained from child’s parents, guardian, babysitter, or daycare center Usually, person responsible for food preparation is able to provide fairly accurate dietary history Usually, person responsible for food preparation is able to provide fairly accurate dietary history Having caregivers keep thorough daily food diary and occasionally requesting 24-hour recalls during clinic visits are most commonly employed techniques for this population group Having caregivers keep thorough daily food diary and occasionally requesting 24-hour recalls during clinic visits are most commonly employed techniques for this population group Slide 11-47

48. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data  Additional history for infants and children (cont.)  Gestational nutrition Maternal history of alcohol or illegal drug use? Maternal history of alcohol or illegal drug use? Any diet-related complications during gestation? Any diet-related complications during gestation? Infant’s birth weight? Infant’s birth weight? Any evidence of delayed physical or mental growth? Any evidence of delayed physical or mental growth?  Infant breastfed or bottle-fed? Type, frequency, amount, and duration of feeding? Type, frequency, amount, and duration of feeding? Any difficulties encountered? Any difficulties encountered? Timing and method of weaning? Timing and method of weaning? Slide 11-48

49. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Additional history for infants and children (cont.)  Child’s willingness to eat what is prepared Any special likes or dislikes? Any special likes or dislikes? How much will child eat? How much will child eat? How do you control nonnutritious snack foods? How do you control nonnutritious snack foods? How do you avoid food aspiration? How do you avoid food aspiration? Slide 11-49

50. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Additional history for the adolescent  Your present weight What would you like to weigh? What would you like to weigh? How do you feel about your present weight? How do you feel about your present weight? On any special diet to lose weight? On any special diet to lose weight? On other diets to lose weight? If so, were they successful? On other diets to lose weight? If so, were they successful? Constantly think about “feeling fat?” Constantly think about “feeling fat?” Intentionally vomit or use laxatives or diuretics after eating? Intentionally vomit or use laxatives or diuretics after eating? Slide 11-50

51. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Additional history for the adolescent (cont.)  Use of anabolic steroids or other agents to increase muscle size and physical performance? When? When? How much? How much? Any problems? Any problems? Use of caffeinated, energy boosting drinks? When? Type? Duration? Use of caffeinated, energy boosting drinks? When? Type? Duration?  What snacks or fast foods do you like to eat? When? When? How much? How much? Slide 11-51

52. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Additional history for the adolescent (cont.)  Age first started menstruating What is your menstrual flow like? What is your menstrual flow like? Slide 11-52

53. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Additional history for the pregnant woman  How many times have you been pregnant? When? When? Any problems encountered during previous pregnancies? Any problems encountered during previous pregnancies? Problems this pregnancy? Problems this pregnancy?  What foods do you prefer when pregnant? What foods do you avoid? What foods do you avoid? Crave any particular foods? Crave any particular foods? Slide 11-53

54. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Subjective Data(cont.) Subjective Data (cont.)  Additional history for the aging adult  How does your diet differ from when you were in your 40s and 50s? Why? Why? What factors affect the way you eat? What factors affect the way you eat? Slide 11-54

55. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  Observation of general appearance  Obese, cachectic (fat and muscle wasting), or edematous, can provide clues to overall nutritional status More specific clinical signs and symptoms of nutritional deficiencies can be detected through physical examination More specific clinical signs and symptoms of nutritional deficiencies can be detected through physical examination Because clinical signs are late manifestations of malnutrition, only in areas in which rapid turnover of epithelial tissue occurs, skin, hair, mouth, lips, and eyes, are nutritional deficiencies readily detectable Because clinical signs are late manifestations of malnutrition, only in areas in which rapid turnover of epithelial tissue occurs, skin, hair, mouth, lips, and eyes, are nutritional deficiencies readily detectable These signs may also be nonnutritional in origin These signs may also be nonnutritional in origin Therefore, laboratory testing required to make accurate diagnosis Therefore, laboratory testing required to make accurate diagnosis Slide 11-55

56. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  Anthropomorphic measures  Measurement and evaluation of growth, development, and body composition  Most commonly used anthropometric measures Height Height Weight Weight Triceps skinfold thickness Triceps skinfold thickness Elbow breadth Elbow breadth Arm and head circumferences Arm and head circumferences Slide 11-56

57. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  Anthropomorphic measures  Derived weight measure Three derived weight measures are used to depict changes in body weight Three derived weight measures are used to depict changes in body weight  Body weight as a percentage of ideal body weight  Percent usual body weight  Body Mass Index Body mass index is practical marker of optimal weight for height and an indicator of obesity or protein-calorie malnutrition Body mass index is practical marker of optimal weight for height and an indicator of obesity or protein-calorie malnutrition Slide 11-57

58. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  Waist-to-hip ration  Waist-to-hip ratio assesses body fat distribution as an indicator of health risk Android obesity: persons with greater proportion of fat in upper body, especially in abdomen Android obesity: persons with greater proportion of fat in upper body, especially in abdomen Gynoid obesity: persons with most of fat in hips and thighs Gynoid obesity: persons with most of fat in hips and thighs Waist circumference is measured in inches at smallest circumference below rib cage and above umbilicus Waist circumference is measured in inches at smallest circumference below rib cage and above umbilicus Hip circumference is measured in inches at largest circumference of buttocks Hip circumference is measured in inches at largest circumference of buttocks  In addition, waist circumference alone can be used to predict greater health risk Slide 11-58

59. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  Skinfold thickness  Measurements provide an estimate of body fat stores or extent of obesity or undernutrition Although other sites can be used (biceps, subcapsular, or suprailiac skinfolds), triceps skinfold (TSF) is most commonly selected because of its easy accessibility and because standards and techniques are most developed for this site Although other sites can be used (biceps, subcapsular, or suprailiac skinfolds), triceps skinfold (TSF) is most commonly selected because of its easy accessibility and because standards and techniques are most developed for this site To measure TSF thickness To measure TSF thickness  Have ambulatory person stand with arms hanging freely at the sides and back to examiner  Nonambulatory persons should lie on one side with uppermost arm fully extended and palm of hand on thigh Slide 11-59

60. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  To measure TSF thickness Using the thumb and forefinger of your left hand, gently grasp a fold of skin and fat on posterior aspect of person’s left upper arm, midway between acromion process of scapula and olecranon process, tip of elbow Using the thumb and forefinger of your left hand, gently grasp a fold of skin and fat on posterior aspect of person’s left upper arm, midway between acromion process of scapula and olecranon process, tip of elbow Gently pull skinfold away from underlying muscle Gently pull skinfold away from underlying muscle While grasping skinfold, pick up calipers with your right hand and depress spring-loaded lever While grasping skinfold, pick up calipers with your right hand and depress spring-loaded lever Apply caliper jaws horizontally to fat fold Apply caliper jaws horizontally to fat fold Release lever of calipers while holding skinfold Release lever of calipers while holding skinfold Wait 3 seconds, then take a reading Wait 3 seconds, then take a reading Repeat three times and average three skinfold measurements Repeat three times and average three skinfold measurements Slide 11-60

61. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  To measure TSF thickness (cont.)  Record measurements to nearest 5 mm (0.5 cm) on nutritional assessment data form  Compare person’s measurements with standards by age, sex, and body frame size Slide 11-61

62. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  Mid-upper-arm circumference (MAC)  Estimates skeletal muscle mass and fat stores  Two newer techniques to measure body composition  Bioelectrical impedance analysis (BIA)  Dual-energy x-ray absorptiometry (DEXA) Both BIA and DEXA measure fat and lean body mass Both BIA and DEXA measure fat and lean body mass In addition, DEXA measures bone mineral density In addition, DEXA measures bone mineral density Slide 11-62

63. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  Arm span or total arm length  Useful for situations in which height difficult to measure, such as children with cerebral palsy; or scoliosis or in aging persons with spinal curvature Arm span, which is nearly equivalent to height, is sometimes used clinically instead of height Arm span, which is nearly equivalent to height, is sometimes used clinically instead of height Ask person to hold arms straight out from sides of body Ask person to hold arms straight out from sides of body Measure distance from tip of middle finger on one hand to that on other hand Measure distance from tip of middle finger on one hand to that on other hand Slide 11-63

64. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data(cont.) Objective Data (cont.)  Frame size  Calculated to determine appropriate range of ideal body weight Most weight standards of ideal weight for height, contain classifications of weight by frame size Most weight standards of ideal weight for height, contain classifications of weight by frame size Elbow breadth, a measure of skeletal breadth, is most accurate method to determine frame size Elbow breadth, a measure of skeletal breadth, is most accurate method to determine frame size To measure it, you must be familiar with use of flat-blade sliding calipers or broad-blade anthropometer To measure it, you must be familiar with use of flat-blade sliding calipers or broad-blade anthropometer Slide 11-64

65. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Developmental Competence  Infants, children, and adolescents  Weight During infancy, childhood, and adolescence, height and weight should be measured at regular intervals, because longitudinal growth is one of best indices of nutritional status over time During infancy, childhood, and adolescence, height and weight should be measured at regular intervals, because longitudinal growth is one of best indices of nutritional status over time  Skinfold thickness Determination of skinfold thickness and/or body mass index may be useful in evaluating childhood and teenage overnutrition Determination of skinfold thickness and/or body mass index may be useful in evaluating childhood and teenage overnutrition Slide 11-65

66. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Developmental Competence (cont.)  Pregnant woman  Weight Measure weight monthly up to 30 weeks’ gestation Measure weight monthly up to 30 weeks’ gestation Then every 2 weeks Then every 2 weeks During last month of pregnancy weight should be measured weekly During last month of pregnancy weight should be measured weekly Slide 11-66

67. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Developmental Competence (cont.)  Aging adult  Height With age, height declines in both men and women very slowly from early 30s With age, height declines in both men and women very slowly from early 30s Height measures may not be accurate in individuals confined to a bed or wheelchair or those over 60 years of age because of osteoporotic changes Height measures may not be accurate in individuals confined to a bed or wheelchair or those over 60 years of age because of osteoporotic changes Therefore, arm span, which is correlated with height, may be better measure for elderly Therefore, arm span, which is correlated with height, may be better measure for elderly Slide 11-67

68. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Developmental Competence (cont.)  Aging adult(cont.)  Aging adult (cont.)  Other Measurements MAC and TSF measures may not be accurate and are difficult to obtain in older adults because of sagging skin, changes in fat distribution, and declining muscle mass MAC and TSF measures may not be accurate and are difficult to obtain in older adults because of sagging skin, changes in fat distribution, and declining muscle mass Body mass index and waist-to-hip ratio are better indicators of obesity in this age group Body mass index and waist-to-hip ratio are better indicators of obesity in this age group Slide 11-68

69. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies  Laboratory studies are objective and can detect preclinical nutritional deficiencies and can be used to confirm subjective findings  Use caution when interpreting test results that may be outside normal ranges, because they do not always reflect nutritional problems and because standards for aging adults have not yet been firmly established Slide 11-69

70. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies(cont.) Objective Data: Laboratory Studies (cont.)  Best routinely performed laboratory indicators of nutritional status  Hemoglobin  Hematocrit  Cholesterol  Triglycerides  Total lymphocyte count  Serum albumin Glucose, low- and high-density lipoproteins, prealbumin, transferrin, and total protein levels also provide meaningful information Glucose, low- and high-density lipoproteins, prealbumin, transferrin, and total protein levels also provide meaningful information Slide 11-70

71. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies(cont.) Objective Data: Laboratory Studies (cont.)  Skin testing  Adequate immunity can be demonstrated by a positive reaction to multiple skin test antigens In these tests of immune function, at least six antigens injected intradermally in forearm area, and response (redness and/or induration) noted at 24 and 48 hours In these tests of immune function, at least six antigens injected intradermally in forearm area, and response (redness and/or induration) noted at 24 and 48 hours 5 mm or greater response to more than one antigen is generally considered to be positive reaction, i.e., indicative of adequate immunity 5 mm or greater response to more than one antigen is generally considered to be positive reaction, i.e., indicative of adequate immunity Commonly used antigens include Candida, tetanus toxoid, diphtheria toxoid, streptococcus, old tuberculin, proteus, and trichophyton Commonly used antigens include Candida, tetanus toxoid, diphtheria toxoid, streptococcus, old tuberculin, proteus, and trichophyton Slide 11-71

72. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies(cont.) Objective Data: Laboratory Studies (cont.)  Nitrogen Balance  Also used as an index of protein nutritional status Nitrogen is released with catabolism of amino acids and excreted in urine as urea Nitrogen is released with catabolism of amino acids and excreted in urine as urea Indicates whether person is anabolic (positive nitrogen balance) or catabolic (negative nitrogen balance) Indicates whether person is anabolic (positive nitrogen balance) or catabolic (negative nitrogen balance)  Creatinine-height index  Method of estimating skeletal muscle mass Creatinine derived from breakdown of creatine, an energy-containing complex found in muscle Creatinine derived from breakdown of creatine, an energy-containing complex found in muscle Excreted unchanged in urine at constant rate in proportion to amount of body muscle Excreted unchanged in urine at constant rate in proportion to amount of body muscle Slide 11-72

73. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies(cont.) Objective Data: Laboratory Studies (cont.)  Developmental competence  Infancy and childhood Laboratory tests performed only when undernutrition suspected or if child has acute or chronic illnesses that affect nutritional status Laboratory tests performed only when undernutrition suspected or if child has acute or chronic illnesses that affect nutritional status  Adolescence Unless overt disease suspected, laboratory evaluation of hemoglobin and hematocrit levels, and urinalysis for glucose and protein levels, are adequate Unless overt disease suspected, laboratory evaluation of hemoglobin and hematocrit levels, and urinalysis for glucose and protein levels, are adequate Slide 11-73

74. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies(cont.) Objective Data: Laboratory Studies (cont.)  Developmental competence (cont.)  Pregnant woman Hemoglobin and hematocrit values can be used to detect deficiencies of protein, folacin, vitamin B12, and iron Hemoglobin and hematocrit values can be used to detect deficiencies of protein, folacin, vitamin B12, and iron Urine frequently tested for glucose and protein (albumin), which can signal diabetes, preeclampsia, and renal disease Urine frequently tested for glucose and protein (albumin), which can signal diabetes, preeclampsia, and renal disease  Aging adults All serum and urine data must be interpreted with understanding of declining renal efficiency and tendency for aging adults to be overhydrated or underhydrated All serum and urine data must be interpreted with understanding of declining renal efficiency and tendency for aging adults to be overhydrated or underhydrated Slide 11-74

75. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies(cont.) Objective Data: Laboratory Studies (cont.)  Cultural competence  Biocultural variations in laboratory studies Biocultural variations occur with some laboratory tests, such as hemoglobin/hematocrit, serum cholesterol, and serum transferrin Biocultural variations occur with some laboratory tests, such as hemoglobin/hematocrit, serum cholesterol, and serum transferrin Normal hemoglobin level for African Americans is 1 g lower than levels for other groups, a factor that should be considered in treatment of anemia Normal hemoglobin level for African Americans is 1 g lower than levels for other groups, a factor that should be considered in treatment of anemia Data indicate that Native Americans, Hispanics, Asian Americans, and whites do not differ in this factor Data indicate that Native Americans, Hispanics, Asian Americans, and whites do not differ in this factor Slide 11-75

76. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies(cont.) Objective Data: Laboratory Studies (cont.)  Cultural competence(cont.)  Cultural competence (cont.)  Sickle-cell anemia is a hemoglobin-related, genetic health problem It is a genetically inherited trait that may have been an adaptation to fight malaria in Africa It is a genetically inherited trait that may have been an adaptation to fight malaria in Africa Sickle-cell anemia occurs in African Americans and causes normal red blood cell to assume a sickle shape Sickle-cell anemia occurs in African Americans and causes normal red blood cell to assume a sickle shape Slide 11-76

77. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data: Laboratory Studies(cont.) Objective Data: Laboratory Studies (cont.)  Cultural competence(cont.)  Cultural competence (cont.)  Sickle-cell disease comprises following blood characteristics Presence of two hemoglobin-S genes (Hb SS) Presence of two hemoglobin-S genes (Hb SS) Presence of the hemoglobin-S gene with another abnormal hemoglobin gene (Hb SC, Hb SD, etc.) Presence of the hemoglobin-S gene with another abnormal hemoglobin gene (Hb SC, Hb SD, etc.) Presence of hemoglobin-S gene with a different abnormality in hemoglobin synthesis Presence of hemoglobin-S gene with a different abnormality in hemoglobin synthesis Some people (carriers) have sickle-cell trait but do not experience symptoms of disease Some people (carriers) have sickle-cell trait but do not experience symptoms of disease  A similar phenomenon found among people from China and Italy Slide 11-77

78. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Objective Data  Serial assessment  To monitor nutritional status in malnourished individuals or in individuals at risk for malnutrition Serial measurements of nutritional assessment parameters are made at routine intervals Serial measurements of nutritional assessment parameters are made at routine intervals At a minimum, weight and dietary intake should be evaluated weekly At a minimum, weight and dietary intake should be evaluated weekly Because other nutritional assessment parameters change more slowly, data on these indicators may be collected biweekly or monthly Because other nutritional assessment parameters change more slowly, data on these indicators may be collected biweekly or monthly Slide 11-78

79. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Abnormal Findings: Classification of Malnutrition  Obesity  Marasmus (protein-calorie malnutrition)  Kwashiorkor (protein malnutrition)  Marasmus/Kwashiorkor mix Slide 11-79

80. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Nutritional Assessment Abnormal Findings: Nutritional Deficiencies  Pellagra  Scorbutic gums  Follicular hyperkeratosis  Bitot’s spots  Kwashiorkor  Rickets  Magenta tongue  HIV-associated malnutrition  Metabolic Syndrome (MetS) Slide 11-80