Nutrition Assessment: Dietary Intake Assessment Flashcards
What are the components of the nutrition care process?
- Nutrition assessment
- Nutrition diagnosis
- Nutrition intervention
- Monitoring and Evaluation
What is required for success in the nutrition care process?
- Dietetics knowledge
- Skills and competencies
- Critical thinking
- Collaboration
- Communication
- Evidence-based practice
- Code of Ethics
What precedes the nutrition assessment?
nutrition screening
* quickly identifies clients/ groups at risk of malnutrition (under/ over) who may require nutrition intervention
* Compares specific client characteristics to cut-off points of factors associated with nutrition risk
What is an important aspect of nutrition screening?
involves interdisciplinary collaboration
* interaction with other professionals –> OTs, PTs, social workers etc.
What does nutrition screening ask?
- What is the condition now?
- Is the condition stable?
- Will the condition get worse?
- Will the disease process accelerate nutritional deterioration?
Why assess nutrition status in the hospital?
Identify patients with malnutrition
* associated with poor outcomes, longer hospital stays etc.
Define malnutrition
Malnutrition is an acute, sub-acute or chronic state of nutrition, in which varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function (ASPEN 2010)
Diagnosis for malnutrition
- starvation-related
- chronic disease-related
- acute disease or injury-related
What is malnutrition in hospital patients associated with?
- complications
- nosocomial infections
- hospital costs
- mortality rates
- LOS in hospital
What is latrogenic malnutrition?
HCP induced malnutrition
* Treatment can have more of an effect on nutritional status than disease/condition itself, HCPs need to be aware of what might compromise nutrtional status (diet restrictions).
How does disease/condition affect nutritional requirements?
- Metabolic rate –> increases so need more calories
- Food intake –> typically condition reduces intake
- Losses: fluids, nutrients, electrolytes
- Malabsorption –> gut that doesnt work
- Fever –> level of inflammation may lead to hyper-metabolic rate
- Catabolism
- Food/Nutrient intolerances
- Medication effects –> can interfere with important cycles
How does a change in metabolic rate affect nutritional requirements?
primary organs affected by disease start to overwork and require more caloric intake to continue but this is usually difficult because symptoms of of disease typically lower caloric intake
What is the nutrition assessment process?
- obtain/ collect important and relavent information
- analyze/ interpret collected data with evidence-based standards
- document
What is the purpose of the nutrition assessmnent?
- Identifies individuals at risk
- Provides justification for the nutrition care plan (the why)
- Forms the basis for evaluating the nutrition care plan (see if condition improves)
describe
Identifies individuals at nutrition risk
- Assessment often preceded by screening for individuals with specific risk factors
- objective measures of nutritional status (serum albumin, weight loss)
- subjective information provided by patient or caregivers (appetite, living environment, functional status)
Describe
Provides justification for the nutrition care plan
Basis for the formulation of goals, each with a specific action plan
* made with patient/client, family, health care team
* realistic and measureable
* ongoing monitoring required
* outcome based
Describe
Forms the basis for evaluating nutrition care plans
- Baseline measures to compare goals and outcomes to
- need to compare changes for individuals - improvements rather than “normal” values
What information is collected in the nutrition assessment?
- patient history (medical, social, dietary)
- biochemical data, medical tests and procedures
- anthropometry and body composition
- nutrition-focused physical findings
- food/nutrition related history
- Estimation of energy, protein and fluid requirements
What medical history information should be collected?
Thorough medical history should be obtained upon admission to hospital and found in chart and verified with pt/ family
* diagnosis if known - new or old (if relevant); primary and secondary
* All diseases over lifetime (emphasis on most recent/ relevant)
* All surgical procedures undergone (emphasis on recent)
* All symptoms pt is experiening (may or may not be related to diagnosis)
* cover all systems in body
What social history information should be collected?
- living arrangements
- cooking and shopping abilities
- religion (food restrictions) –> RESPECT
- socioeconomic status/ food security
What does method of diet history collection depend on?
- capabilities of pt
- time constraints
- information from secondary source
What are some coomon dietary assessment methods?
- 24 hour recall
- food records (i.e. 3 day)
- FFQ
- direct observation
- in hospital
features of 24 hr recall
what? pros/cons?
retrospective for previous 24 hrs
* pros: quick, inexpensive, low client burden
* cons: likely not usual intake
* memory dependant
Features of food records
what? pros/cons?
prospective for set time period which considers actual intake through recording (or weighing) of food intake
* pros: ↑ accuracy with ↑ time period, can be used in hospital
* cons: higher client burden, eating behaviour may change
Features of FFQ
what? pros/cons?
Retrospective food intake over specific time period typically using a food list, consumption frequency, portion size
* pros: considered usual intake, can examine specific nutrients
* cons: not good in clinical → better for assessing groups
rarely used in clincal; usually for population research studies
Features of direct observation
Prospective done by watching patients eat whether independantly or with assistance
* pros: low client burden
* cons: only in controlled setting, likely not usual intake
When is direct observation typically used?
frequently used in hospital setting when concerned about pt’s intake
How is dietary history typically collected in hospital?
combination of methods → A usual intake history of what they usually eat during the week and the weekend and approximate times
Why is dietary history important to collect?
diet history needs to determine any changes to diet with disease/symptom onset
* e.g omitting food groups, decrease or increase in total intake, changes in pattern of eating
What is a dietary assessment evaluation?
Determine missing food groups/ nutrients by comparing to reference values (DRIs)
* comparing to CFG to get approximate quality of intake
* Nutrient analysis through food composition tables or software and compared
What are the DRIs?
- RDA - Recommended Dietary Allowance
- EAR - Estimated Average Requirement
- AI - Adequate Intake
- UL - Tolerable Upper Intake Level
Describe the RDA
Recommended Dietary Allowance (RDA)
* amount that is adequate for 97-98% of healthy population
Describe the EAR
Estimated Average Requirement (EAR) → Does not mean you are deficient just assesses relative risk
* estimated average requirement adequate in 50% of the population
* MAY be used to assess diets of individuals and groups
* would be used as reference values for nutrition analysis programs
Describe the AI
Adequate Intake
* Used when no RDA or EAR exists due to lack of evidence
* MAY be used to assess diets of individuals and groups
* Would be used as reference values for nutrient analysis programs when no EAR exists
Describe the UL
Tolerable Upper Intake Level
* Maximum nutrient intake NOT associated with side effects
