1. Nutrition in Nursing Chapter 1

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. 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.

21. 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

22. 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

23. 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

24. 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

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