Nutritional Assessment Flashcards
Define Nutritional Status
he degree of balance between nutrient intake and nutrient requirements. This balance is affected by many factors, including physiologic, psychosocial, developmental, cultural, and economic.
Optimal nutritional status
- Achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness.
- Persons having optimal nutritional status are more active, have fewer physical illnesses, and live longer than persons who are malnourished.
undernutrition
occurs when nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands.
- Vulnerable groups—infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults—are at risk for impaired growth and development, lowered resistance to infection and disease, delayed wound healing, longer hospital stays, and higher health care costs.
Overnutrition
caused by the consumption of nutrients—especially calories, sodium, and fat—in excess of body needs. A major nutritional problem today, overnutrition can lead to obesity and is a risk factor for heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers, and osteoarthritis.
Adolescents- young boys vs. young girls
In general, boys grow taller and have less body fat than girls. The percent of body fat increases in females to about 25% and decreases in males (replaced by muscle mass) to about 12%. Typically, girls double their body weight between the ages of 8 and 14 years; boys double their body weight between the ages of 10 and 17 years.
Important nutrition requirements for young adults
Caloric and protein requirements increase to meet demand from hormonal and endocrine changes, and because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase.
- Typically, these increased requirements cannot be met by three meals per day; therefore nutritious snacks play an important role in achieving adequate nutrient intake.
Normal physiological changes in aging adults that affect nutrition status
poor dentition, decreased visual acuity, decreased saliva production, slowed gastrointestinal motility, decreased gastrointestinal absorption, and diminished olfactory and taste sensitivity.
Important nutritional features of aging adult
- A decrease in energy requirements due to loss of lean body mass (the most metabolically active tissue)
- increase in fat mass.
- Because protein and vitamin and mineral needs remain the same or increase (e.g., vitamin D and calcium), nutrient-dense food choices (e.g., milk, eggs, cheese, and peanut butter) are important to offset lower energy/calorie needs.
Nutrition related problems in Immigrants
They frequently come from countries with limited food supplies caused by poverty, poor sanitation, war, or political strife. General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries are among the more common nutrition-related problems of new immigrants from developing countries.
Factors contributing to immigrant nutrition problems
- They are in a new country with a completely new language, culture, and society.
- They are faced with unfamiliar foods, food storage, food preparation, and food-buying habits.
- Many familiar foods are difficult or impossible to obtain.
- Low income may also limit their access to familiar foods.
Cultural differences in nutrition
- studies have shown that Black women have lower hemoglobin levels than white women independent of iron intake and that their risk for osteoporosis is significantly less despite lower overall calcium intake. Or, cultural values may conflict with optimum nutrition (e.g., many cultures worldwide consider obesity an indication of beauty, affluence, and well-being).
- The 24-hour dietary recalls or 3-day food records used traditionally for assessment may be inadequate when dealing with people from culturally diverse backgrounds. Standard dietary handbooks may not provide culture-specific diet information because nutritional content and exchange tables are generally based on Western diets. Another source of error may be cultural patterns of eating. For example, many low-income ethnic groups eat sparingly or moderately during the week (i.e., simple rice or bean dishes), whereas weekend meals are markedly more elaborate (i.e., meats, fruits, vegetables, and sweets are added).
- you may assume that the term “food” is a universal concept, you should have the person clarify what is meant by the term.*
What is the purpose of the nutritional assessment?
(1) identify individuals who are malnourished or are at risk for developing malnutrition, (2) provide data for designing a nutrition plan of care that will prevent or minimize the development of malnutrition, and (3) establish baseline data for evaluating the efficacy of nutritional care.
What is the nutritional screening?
the first step in assessing nutritional status, is required for all patients in all health care settings within 24 hours of admission.21 Based on easily obtained data, nutrition screening is a quick and easy way to identify individuals at nutrition risk, such as those with weight loss, inadequate food intake, or recent illness. Parameters used for nutrition screening typically include weight and weight history, conditions associated with increased nutritional risk, diet information, and routine laboratory data.
Describe 24-hr recall
- easiest, most popular method for obtaining info about diet intake
- individual or family member completes a questionnaire and asked to recall everything eaten within the last 24 hours.
- An advantage of the 24-hour recall= can elicit specific information about dietary intake over a specific period of time.
- However, there are several significant sources of error: (1) the individual or family member may not be able to recall the type or amount of food eaten; (2) intake within the last 24 hours may be atypical of usual intake; (3) the individual or family member may alter the truth for a variety of reasons; and (4) snack items and use of gravies, sauces, and condiments may be underreported.
Why might a nurse use the food frequency questionnaire?
- To counter some of the difficulties inherent in the 24-hour recall method,
- information is collected on how many times per day, week, or month the individual eats particular foods, providing an estimate of usual intake.
- Drawbacks to the use of the food frequency questionnaire are (1) it does not always quantify amount of intake and (2) like the 24-hour recall, it relies on the individual’s or family member’s memory for how often a food was eaten.
What is a food diary
ask the individual or family member to write down everything consumed for a certain period of time. Three days—two weekdays and one weekend day—are customarily used. - Most complete and accurate way, if you teach the individual to record information immediately after eating. Potential problems with the food diary include (1) noncompliance, (2) inaccurate recording, (3) atypical intake on the recording days, and (4) conscious alteration of diet during the recording period.
What is direct observation
Directly observing the feeding and eating process can detect problems not readily identified through standard nutrition interviews.
- For example, observing the typical feeding techniques used by a parent or caregiver and the interaction between the individual and caregiver can help when assessing failure to thrive in children or unintentional weight loss in older adults.
Subjective: Eating Patterns?
Number of meals/snacks per day? • Kind and amount of food eaten? • Fad, special, or alternative diets? • Where is food eaten? • Food preferences and dislikes? • Religious or cultural restrictions? • Able to feed self?
Rationale for eating patterns
Most individuals know about or are interested in the foods they consume. If misconceptions are present, begin gradual instruction to modify ethnic/religious beliefs or feeding difficulties that may affect intake of certain foods.
Many alternative diets are not supported by scientific safety or efficacy data.
Subjective: Usual Weight?
What is your usual weight?
•20% below or above desirable weight?
•Recent weight change? How much lost or gained? Over what time period?
•Reason for loss or gain?
Rationale for usual weight
Persons with a recent weight loss or who are obese are at risk. Underweight individuals are vulnerable because their fuel reserves may be depleted. Excess weight is associated with hypertension, diabetes, heart disease, and even cancer. Protein and calorie needs are often overlooked in acutely ill obese persons.
Subjective: Changes in appetite, taste, smell, chewing, swallowing?
Type of change?
• When did change occur?
Rationale= These alterations interfere with nutrition intake
Subjective: Recent surgery, trauma, burns, infections?
• When? Type? How treated?
• Conditions that increase nutrient loss (e.g., draining wounds, effusions, blood loss, dialysis)?
Rationale= These conditions have caloric and nutrient needs that are two or three times greater than normal.*
Subjective: Chronic Ilnesses?
- Type? When diagnosed? How treated?
- Dietary modifications?
- Recent cancer chemotherapy or radiation therapy?
Rationale for chronic illnesses
Chronic illnesses that affect nutrient use (e.g., diabetes mellitus, pancreatitis, or malabsorption) or cancer treatment carries twice the risk for nutritional deficits.
Subjective: Nausea, vom, diarrhea, constipation?
Any problems? Due to? How long?
Rationale= Gastrointestinal (GI) symptoms interfere with nutrient intake or absorption.
Subjective: Food allergies or intolerances?
• Any problematic foods? Type of reaction? How long?
Rationale=
- Food allergies, especially peanut allergies, are on the rise and are a major health concern.
- Intolerances may result in nutrient deficiencies, such as diarrhea after milk ingestion.
Subjective: Medications and/or supplements?
Prescription medications?
• Nonprescription?
• Use over a 24-hour period?
- Type of vitamin/mineral supplement? Amount? Duration of use?
• Herbal and botanical products? Functional foods or foods enhanced with nutrients? Specific type/brand and where obtained? How often used? Who recommended? How does it help you? Any problems?
Rationale for Meds and Supplements
- Analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives, antineoplastic drugs, steroids, and oral contraceptives are drugs that interact with nutrients, impairing their digestion, absorption, metabolism, or utilization.
- Vitamin/mineral supplements have harmful side effects if taken in large amounts.
Use of herbal/botanical supplements is often not reported, so ask and discuss proper use and potential adverse effects.
