1. Copyright 2002, Delmar, A division of Thomson Learning Chapter 7 Nutritional Assessment

2. Copyright 2002, Delmar, A division of Thomson Learning Competencies Describe the recommended dietary allowances for adequate nutritional intake for all age groups. Identify nutritional differences for different age groups. Perform a nutritional history and physical assessment. (continues)

3. Copyright 2002, Delmar, A division of Thomson Learning Competencies Perform anthropometric measurements. Describe the most common pathophysiologies for abnormal findings. Describe laboratory analyses needed and their clinical significance to the nutritional assessment.

4. Copyright 2002, Delmar, A division of Thomson Learning Dietary Guidelines Recommended dietary allowances (RDA) Food guide pyramid  Six food groups  Fats, oils, and sweets: use sparingly  Milk, yogurt and cheese: 2–3 servings/day  Meat, poultry, fish, eggs: 2–3 servings/day (continues)

5. Copyright 2002, Delmar, A division of Thomson Learning Dietary Guidelines  Vegetables: 3–5 servings per day  Fruits: 2–4 servings per day  Breads, cereal, rice, pasta: 6–11 servings per day

6. Copyright 2002, Delmar, A division of Thomson Learning Nutrition Through the Life Cycle Children  Daily needs change based on age group Infants  Rapid growth and development  Preferred to breast feed for first 12 months (continues)

7. Copyright 2002, Delmar, A division of Thomson Learning Nutrition Through the Life Cycle  Assess reflexes—sucking, rooting, swallowing  Assess physical development

8. Copyright 2002, Delmar, A division of Thomson Learning Infant Feeding Guidelines Introduce foods one at a time Begin with foods that are least allergenic Avoid egg whites and citrus fruits until 12 months old Avoid honey in infants under 12 months

9. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Assessment of Infants Breastfed? How often? How long? Bottle-fed? How often? How much? Formula preparation? Storage? How does the infant respond to eating? Constipation? Diarrhea? Is the infant ever put in bed with a bottle?

10. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for Toddlers Physical growth slows Increased independence Small portions Offer one new food at a time Serving size 1–2 tbsp for each year of age Routine mealtimes

11. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for Preschoolers Independence May become a picky eater Offer food choices Serve small servings Finger foods Routine mealtimes Involve in food preparation

12. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for School-Age Children Erratic growth and eating patterns Strong food preferences Balanced diet Limit highly sweetened snacks and foods

13. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Assessment of Young Children Concerns with child’s eating? Child’s food preferences? Involvement in sports? Physical activity? Child’s meal schedule? Balanced diet? Food allergies?

14. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for Adolescents Period of rapid growth and change Fluxuating nutritional needs Concerns with body image Risks for eating disorders Adjustments to caloric needs based on physical activity level

15. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Assessment of Adolescents Participation in physical activity? Adhere to a specific diet or meal plan? Skip meals? Satisfaction with current weight? Consumption of snacks? Have you ever induced vomiting, used laxatives, diuretics, or diet pills to control weight?

16. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for Young and Middle- Aged Adults Growth and caloric needs stabilize Eating habits may be influenced by activity levels, life stressors Nutritional risks for development of disease  Obesity  Osteoporosis (continues)

17. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for Young and Middle- Aged Adults  Type 2 Diabetes Mellitus  Atheroschlerosis

18. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Assessment of Young and Middle- Aged Adults Caloric intake? Adherence to specific diet? Satisfaction with current weight? Physical activity? Consumption of snacks? Typical meal patterns?

19. Copyright 2002, Delmar, A division of Thomson Learning (continues) Nutritional Guidelines for Pregnant and Lactating Women Role of proper nutrition in development of healthy infant Target weight gain for pregnancy Iron supplements Prenatal vitamins

20. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for Pregnant and Lactating Women Folic acid Additional caloric intake for pregnancy and lactation Adhere to food guide pyramid Fluid consumption

21. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Assessment of Pregnant Women Prepregnancy weight? Ideal body weight (IBW)? Use of supplemental vitamins? Consumption of caffeine, artificial sweeteners, alcohol? Presence of constipation, nausea, vomiting, or heartburn? Presence of food cravings?

22. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for the Older Adult Decreased caloric requirements Adhere to food guide pyramid, except consume decreased portion size Encourage to eat in a sitting position Encourage adequate fluid intake and high fiber diet (continues)

23. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Guidelines for the Older Adult Nutritional risk factors  Difficulty chewing or swallowing  Decreased appetite  Decreased ability to feed self  Decreased taste and smell  Decreased esophageal emptying time

24. Copyright 2002, Delmar, A division of Thomson Learning Nutritional Assessment of Older Adults Presence of physical limitations that affect eating? Difficulty chewing or swallowing? Presence of dental problems? Difficulty obtaining or preparing foods? Do you eat alone?

25. Copyright 2002, Delmar, A division of Thomson Learning Cultural Differences in Nutrition Cultural beliefs related to the consumption of food Religious beliefs related to the consumption of food  Food restrictions  Periods of fasting

26. Copyright 2002, Delmar, A division of Thomson Learning Components of a Nutritional Assessment Nutritional history Physical assessment Anthropometric measurements Laboratory data Diagnostic data

27. Copyright 2002, Delmar, A division of Thomson Learning Nutritional History General diet information  Changes in past 12 months  Ability to obtain and prepare foods  Food preferences  Adherence to particular diet  Consumption of fast foods (continues)

28. Copyright 2002, Delmar, A division of Thomson Learning Nutritional History Food intake history  24-hour recall  Food diary Calorie count Evaluation of adequacy of diet  Food guide pyramid

29. Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Head to toe Assess for subjective and objective signs and symptoms of poor nutritional status

30. Copyright 2002, Delmar, A division of Thomson Learning Signs and Symptoms of Poor Nutritional Status Subjective data  Fatigue  Weight changes  Changes in appetite  Weakness  Changes in bowel habits (continues)

31. Copyright 2002, Delmar, A division of Thomson Learning Signs and Symptoms of Poor Nutritional Status Objective data  Weight changes  Dry, rough, scaly skin  Dry, cracked lips  Swollen, bleeding gums  Edema  Decreased muscle tone

32. Copyright 2002, Delmar, A division of Thomson Learning Anthropometric Measures Height Weight Ideal body weight, percent IBW Percent weight change Triceps skinfold BMI Mid-arm circumference Waist/hip ratio

33. Copyright 2002, Delmar, A division of Thomson Learning Laboratory Data Hematocrit and hemoglobin Cholesterol and triglyceride levels Transferrin, TIBC, iron Total lymphocyte count Albumin and prealbumin Glucose Creatinine and nitrogen

34. Copyright 2002, Delmar, A division of Thomson Learning Diagnostic Data Radiographic studies