Chapter 13

Nutrition Care
and
Assessment

2007 Thomson - Wadsworth

 Nutrition in Health Care

Health problems Hospitalized

Alter nutrition patients
needs 40-60% with
Can lead to acute illness are
malnutrition malnourished
Poor nutrition Others decline in
status nutrition status
Can influence the within 3 weeks
course of disease
& bodys response
to treatment

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

 Planning Care

The Nutrition Care The Nursing

Process Process
Nutrition Assessment
assessment Nursing diagnosis
Nutrition diagnosis Outcome
Nutrition identification &
intervention planning
Nutrition Implementation
monitoring & Evaluation
evaluation

2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth
The Nutrition Care Process
Assessment Intervention
Medical, social, & Dietary changes
dietary histories Nutrition education
Anthropometric data Medication changes
Biochemical analysis Monitoring &
Physical exam evaluation
Diagnosis May need to modify
Actual or potential the plan
Problem, etiology, Must be flexible
signs & symptoms

2007 Thomson - Wadsworth

 Historical Information

Medical history Social history

Age Cultural heritage
Gender Financial concerns
Weight Who prepares and
shops for food
Prescription drugs
Living situation
OTC medications
Diet history
Dietary
Food intake
supplements
Meal patterns
Type of illness
Physical problems

2007 Thomson - Wadsworth

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

2007 Thomson - Wadsworth

Food Frequency Questionnaire

2007 Thomson - Wadsworth

 Anthropometric Data

Height: Adults Head

Length circumference
Infants Assesses brain
< 24 months development
Weight < 3 years of age
BMI Circumference of
% Usual body waist & limbs
weight Evaluates body fat
% Ideal body
weight Evaluates muscle
mass

2007 Thomson - Wadsworth

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Biochemical Analysis

Provides information about

Protein-energy nutrition
Vitamin & mineral status
Fluid & electrolyte balance
Organ functioning
Analysis of blood & urine
samples

2007 Thomson - Wadsworth

 Plasma Proteins

Albumin Prealbumin &

Most abundant retinol-binding
Slow to reflect protein
changes in status Also called
Transferrin transthyretin
Transports iron Responds quickly
to changes in
Indicates PEM &
protein status
iron status
Expensive test
Slow to detect
changes in status

2007 Thomson - Wadsworth

 Fluid Imbalance

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

2007 Thomson - Wadsworth

 Assessment of
Nutrition Status
Functional Integrating
Assessment assessment data
Exercise tolerance Subjective Global
Respiratory Assessment (SGA)
muscle strength Combines
Immunity historical
information with
results of physical
examination

2007 Thomson - Wadsworth

 2007 Thomson - Wadsworth