NUTRITION: Nutritional Assessment Flashcards
how is nutritional screening carried out (on admission)?
Ideally, all patients should be assessed for nutritional risk, on admission, using a ‘validated’ screening tool, e.g. MUST
This is usually undertaken by nursing staff and forms the basis of referral to the dietetic department for dietary intervention.
what is nutritional assessment?
Nutritional Assessment is a detailed, specific and in-depth evaluation of an individual’s nutritional state.
Determines the extent to which an individual’s nutritional needs have been met, or are being met, over a period of time.
Why assess nutritional status?
It allows for specific nutritional care plans to be developed for an individual.
It serves as a baseline against which nutritional interventions can be monitored.
Relevant for both ill people & well people.
what 5 factors must be considered when assessing nutrition?
- Anthropometry (body measurements)
- Biochemistry
- Clinical presentation
- Dietary aspects
- Physical state / condition
what should be considered with nutritional assessment in relation to clinical presentation?
Diagnosis: does it have a dietary implication e.g. Diabetes; Liver disease; Coeliac disease?
Past medical history: Are there pre- existing influences on nutritional requirements e.g. renal disease? Diabetes? Allergy?
Previous gastric surgery or intestinal surgery, Coeliac disease?
how can acute or chronic illness, injury & surgery effect nutritional status (directly and indirectly)
Directly due to effects of disease or injury
or Indirectly via possible effects on food intake
can result in Increased nutritional requirements, Increased nutrient losses and Impaired nutrient ingestion, digestion, absorption
why may a patient have increased nutritional requirements?
o Metabolic response to trauma or surgery
o Metabolic costs of repairing tissue damage
o Sepsis / infection
o Involuntary activity / movements (e.g. spasm or tremor)
o Certain conditions e.g. Cystic fibrosis
why may a patient have increased nutrient losses?
o Diarrhoea & Vomiting o Bleeding o Wound / fistula exudates o Surgical drains o Renal excretion o Impaired nutrient ingestion,digestion &/or absorption
why may a patient have impaired nutrient ingestion, digestion, absorption?
o Lack / loss of appetite
o Lack of digestive enzymes i.e. pancreatitis
o Loss of absorptive surface i.e. coeliac disease
o Difficulty self feeding / chewing / swallowing
o Effects of other conditions on eating e.g. breathlessness, dysphagia
o Effects of other treatment to GI tract, e.g. radiotherapy
how can nutritional needs vary during life-span?
- Consider energy for growth in children;
- Iron needs of teenage girls;
- Folate in pregnancy;
- Vitamin D in elderly.
how should the nurse assess nutritional status in relation to physical appearance?
Weight: thin, obese, pale, florid, loose dentures, loose clothing, loose rings.
Fluid retention or oedema may be due to disease or heart failure secondary to prolonged protein or thiamin deficiency.
Sunken eyes, dry mouth, fragile skin may indicate dehydration
how should the nurse assess nutritional status in relation to mobility?
Weakness / impaired movement from loss of muscle mass – may affect independence.
how should the nurse assess nutritional status in relation to vision?
may affect ability to maintain self-care, to shop and cook, ability to read dietary advice given.
how should the nurse assess nutritional status in relation to mood?
Apathy, lethargy & poor concentration may indicate under nutrition & exacerbate lack of interest in food. Confusion can indicate dehydration.
how should the nurse assess nutritional status in relation to poor healing/pressure sore?
May reflect impaired immune function due to under nutrition or vitamin deficiency.
how should the nurse assess nutritional status in relation to physical/social conditions?
Poverty, isolation, disabilities can all affect nutrient intake & lead to under or over nutrition.
what dietary aspects need considered when assessing nutrition?
current diet and fluid intake
Duration & severity of changes in appetite & oral intake
Factors affecting food & fluid intake, e.g. change in appetite may be a side-effect of drugs/treatment, an early indication of deteriorating health or be related to mood
what is anthropometry?
External measurement of body composition.
Most commonly assessed measurements in clinical practice are:
• Body weight (incl. % weight change)
• Height
• Adiposity (waist circumference, Waist-Hip-Ratio)
• Muscle mass (MAMC, grip strength)
• Estimates of body water content & body composition
• BMI
what aspects would be considered in anthropometry?
• The importance of technique to gain accurate and reproducible measurements
• How do we improve reproducibility of results?
• What are the limitations of the measurements or
equipment?
• What are the significance of results obtained?
what 6 things can effect measurement reliability?
- Intra-measurer variability
- Inter-measurer variability
- Technique
- Precision
- Reproducibility
- Equipment
what can taking measurements assess?
o Mass o Fatness o Distribution of adipose tissue o Growth o Nutritional status
give examples of things that can mask true weight
Oedema and ascites (fluid retention), solid tumor, dehydration, amputation
when is weight loss of clinical significance?
unintentional wt loss > 10% over 3-6 months OR
A patient has a BMI <20kg/m2 & unintentional
wt loss of >5% over 3-6 months.
what are drawbacks of BMI
- Does not distinguish between fat and fat free mass
* Should not be used in isolation but in conjunction with other measures
