Lecture 23 Flashcards
Individual Nutrition Assessment
Nutritional assessment-the most important part!
Why?
-The more information you gather the more you are able to help your client
-Informs your diagnosis
-Informs your intervention
-Allows you to work out what you will monitor and evaluate
What skills does a practitioner need
- open ended questions
- reflection skills
- building trust and rapport
- active listening
- reflective paraphrasing
- clarification
- validation
- gather correct data
what qualities does the practitioner need
- empathetic
- non judgemental
- awareness of own bias
- analytical - problem solving
- accept feedback and self reflect
what is effective communication of the patient centred care approach
- exploring clients history, needs, values and environment
- while promoting active client participation
- via shared decision making and lifestyle education
communication with the client should be
articulate
accessible/understandable
emotionally balanced
professional
clients are more likely to respond and give you honest answers if they know …
why you are asking a question
Asking questions that the clients knows why you are asking them helps ….
Build trust with the client and affirms that you have the knowledge and know-how to help them
Active listening is a key aspect of
Effective consults and increases the likelihood that the patient knows you are listening to them
active listening involves :
- paying attention
- listening demonstratively
- providing feedback
- responding appropriately
- deferring judgement
Being non-judgemental
Labelling food good or bad, healthy or unhealthy…..
Remember we come ….
Labelling food good or bad, healthy or unhealthy, immediately places judgement upon these foods and those who eat them (use words like nutritious instead)
Remember we come from a place of privilege when it comes to nutrition knowledge
Bias awareness
What is it??
The conscious recognition and understanding of biases that we have, including the ones we might have at a subconscious level
Not everyone has the same …
Try and embrace ….
Not everyone has the same upbringing and thinks the same as you
Try to embrace diverse perspectives
what should you ask in self reflection
did you ask all the questions you needed to ask in the assessment ?
could you have explained a concept or structured the interview better?
why is it important to establish aims of the consultation
first opportunity for the client to tell you about their problem so active listening is required
so you can come back at the end of the consult to make sure you have met the clients aims
what are the 5 domains of assessment
anthropometric measurements
biochemical data
clinical
diet
extras
Anthropometry
-Height, weight, length
-BMI
-Percentile weight and height growth charts
-Body composition
-Skinfolds
-DXA and BIA machines, BOD POD
To weigh or not weigh?
Is it necessary?
shift towards more of a focus on body positivity or being healthy at every size
can cause unnecessary stigma or trigger body image issues
Anthropometric assessment
Questions that can be asked?
Weight history - weight and waist circumference over time
- Have they noticed clothes getting tighter or looser?
-Does the client use food to control weight or shape?
Biochemical
- the objective data that has come from their lab or medical tests
- Can ask the client to check their medical files
-Note dates of tests, any abnormal-ties and if they have been re-tested
what are common blood tests for nutritional assessment
- complete blood count
- vitamins and minerals
- lipids
- Hba1c
- thyroid
- coeliac testing
- inflammation
- electrolytes
what are the common medical imaging tests for nutritional assessment
- colonoscopy / endoscopy / gastroscopy
- biopsy
- X-ray / ultrasound
- barium swallow
- bone density scan (DXA)
what are common stool tests
- bacteria, fungi, viruses or parasites in GI tract
- blood
clinical findings are know as what in nutritional assessment
known as Nutrition Focused Physical Findings
clinical nutrition findings can include
objective data and subjective data
what are some examples of objective data
- oral health (dental records)
- injury, mobility history, grip strength (physiotherapy)
- blood pressure or weight history (nurse or GP)
what are examples of subjective data that the practitioner can come up with in clinical assessment
- changes in appetite
- hunger and satiety cues
- changes in body weight / composition
- body language ( body image and wellbeing)
- hydration status (urine colour)
- bloating / cramping or any other gut symptoms
bowel movements are an important aspect to ask the client, especially if they are having digestive issues : what should be asked
- how often they have. bowl movement
- stool colour
- stool consistency
- blood in stool or any changes lasting more than a few weeks
what chart is useful to use with clients when talking about bowel movements
Bristol Stool Chart : helps them identify their stool quickly and easily
what is the normal range of stool on the Bristol Stool Chart
normal range is somewhere between 3-5, 4 being ideal
what are some examples of other clinical, physical focused nutrition findings
- extremities : joint pain, arthritis, muscle fatigue
- skin observations : ulcers, eczema etc
- suck/swallow/breathe ability
- vital signs : blood pressure / pulse rate
- digestive : reflux, vomiting nausea
- nerves : communication, coordination, pain or dizziness
Diet history
This part of the nutrition assessment looks at the food and nutrition history of the client
what does the diet history include
-Dietary intake
-Fluid intake
-Macronutrients and micronutrients
- Food allergies and intolerances
-Current relationship with food
practitioners often ask their clients to fill out a food diary for how many days
3-5 days
what about their relationship with food (knowledge) should be asked about
- shopping, food preparation and cooking skills
- knowledge of diet disease relationship
what about their relationship with food (attitudes / beliefs) should be asked about
- body image
- family modelling
- motivation / readiness to change
- self efficacy
- self awareness
- mood / stress
what are the biological influences on food choice
hunger, satiety, appetite, taste
what are the personal influences on food choice
- aversions/dislikes
- eating disorder behaviours
- flavours/food preferences
- lifecycle stage
- personal routine / habits
- willingness / ability to adhere to dietary changes
what are the physical influences on food choice
- access to food and nutrition
- eating environment
- exposure to media / advertising
- food availability and variety
- food cost and security
- water supply
- challenges to preparing or eating food
family and medical history is important to assess for many reasons
- identifying genetic predispositions
- understanding pre-existing medical conditions
- medical conditions that may affect food choices
- impact of medications and any supplements
- prevention and early intervention
- smoking, drug and alcohol consumption
what is important about the clients nutrition orientated health history information
- previous nutrition input from other health professionals
- reason for referral and any relevant symptoms/challenges/info
- relationship with food and body image
- any relations with food/body image issues
what social aspects can affect a clients nutritional status
- socioeconomic status
- education level social support systems
- interactions with other people and connections to social groups
- general day - to - day life
Every client has a different culture- their culture pertains to the way they were brought up
It is your job as a practitioner to find out about a clients culture and this is more than just asking what ethnicity they identify with and if they have any cultural practices
what are some aspects of a clients cultural beliefs, values and practices we should be aware of
- everyone has different beliefs and this will influence the way you structure your goals and intervention
- be aware of cultural practices and differences
- always ask before you touch them
how can economics and food environment affect a clients nutritional status
- cost of food and affordability
- food security
- clients job / occupation
- where they live
- who they live with
what are some aspects to ask about and consider in terms of physical activity for the client
- age
- mobility
- current physical activity levels
- available time
- too much, too little
- injuries
sleep can have a big impact on the way people eat, questions to include :
- how many hours a night
- what time do they go to sleep/wake up ?
- do they wake up in the night ?
- use of screens before bed ?
mental and emotional wellbeing can also impact nutrition, how
is there anything stressful going on in their life right now?
is there anything about their wellbeing that is impacting their eating
what are other important assessment questions to ask a client
- menstrual cycle and - reproductive system questions
- digestive system
- gut microbiome information
- immune system
what is asked about gut microbiome information
antibiotic use
delivery at birth
What is asked about the immune system
do they get sick often ?
how fast do they recover ?
what are possible red flags that may be picked up in assessment which you may need to refer your client on to someone else
- nutrient deficiencies
- digestive symptoms that need further investigating
- disordered eating behaviours
- high levels of anxiety or stress affecting eating
- self harm
if something like a red flag comes up during assessment, you have the duty
have duty of care to refer : must be done with clients consent, unless their life is in danger
referrals could include referrals to
- General practitioner
- physiotherapists
- counsellors / psych services
- pharmacy clinic
at the novice level, practitioners should be able to
- state the diagnosis clearly
- define the intervention or basic plan
- use appropriate reference standards for comparison
at the competent level, practitioners are able to
determine which data is important and relevant to collect
determine which additional data to collect
selecting assessment tools that match the situation
