1. Nutritional Assessment

2. Nutritional assessment is focused on: The amount of food and fluids consumed in relation to metabolic needs. The degree to which the body demonstrates that the ingested nutrients are adequately used.

3. Consider the entire nutritional pattern The fact that a person’s nutritional intake is 2200 kcal/day does not in itself provide information about the physiologic status of nutrition. Wound healing Increased exercise Poor nutrition

4. Factors to Assess in Evaluating Nutrition and Metabolism: General appearance Pattern of food and fluid intake Understanding of a balanced diet Cultural and psychosocial factors affecting diet Metabolic state Physiologic alterations associated with nutritional dysfunction Physical indicators of malnutrition

5. The Health History General information about food and fluid consumption Food and fluid intake data Activity level Psychosocial, cultural, and personal influences on consumption The person’s knowledge of nutrition Pertinent physiologic alterations

6. General Information How the patient perceives his weight Impaired nutrient ingestion Whether the patient is following a special diet

7. Food and Fluid Intake Ask for a food recall Types of food Amounts of food Where eaten Why eaten

8. Activity Level Important because it influences nutritional requirements Exercise patterns—frequency and intensity Occupation—sedentary (office worker) or active (construction worker)

9. Psychosocial/Cultural/Personal Influences Personal preference Economic factors Ethnic background Religious beliefs (e.g. kosher diet) Nonreligious beliefs (e.g. vegetarian)

10. Nutrition Knowledge Assessing the patient’s knowledge of nutrition is helpful because malnutrition may be related to a lack of awareness about food nutrient values. Fad diets Food preparation

11. Physiologic Alterations Many diseases interfere with the basic nutritional process of ingestion, digestion, absorption, transport, and metabolism. Drugs can alter nutritional and metabolic states.

12. The Physical Examination Goals: To determine the status of the nutritional processes of ingestion, digestion, absorption, transport, and metabolism. To identify signs of altered nutrition.

13. The Physical Examination General inspection Anthropometric assessment Examination of the skin, hair, and nails Examination of the oral cavity Examination of the abdomen Examination of the thyroid gland

14. General Inspection Subcutaneous fat distribution Skeletal muscle mass Skin integrity

15. Body Composition Assessment Used to evaluate nutritional status. Include hydrostatic weighing, anthropomorphic assessment, BMI, and skin fold measurements.

16. Skin, Hair, and Nails Skin: jaundice (liver disease) Hair: loss (protein deficiency) Nails: spooning (iron deficiency anemia)

17. Examination of the Oral Cavity Oral mucosa Tongue and taste buds Teeth Palate Oropharynx

18. Abdominal Assessment GI motility (bowel sounds) Peritoneum Vasculature

19. Thyroid Gland The primary function of the thyroid gland is to regulate the metabolic rate.

20. Questions?