Week 10: Assessment of Nutrition Flashcards
Primary nutrients
Carbohydrates – energy
Protein – energy, build and repair muscle
Lipids – (ex, cholesterol) energy
Vitamins and Minerals
Supplements
Water – important for cells, BP, metabolism, etc.
Electrolytes
Health Promotion nutrition
Food literacy (not everyone knows food categories, god fat or bad fat, etc NOTE: Families influence food knowledge and intake especially cultures)
Food safety (how to cook properly and safely; choking hazards)
Food sensitivities/allergies (consider true allergies – some people think they are allergic to milk because they drink some and then feel sick. Same with gluten)
Travel safety (consider food and water – no street meat; rehydration recipe WHO) (Hep-A food and water borne)
Oral rehydration recipe/products
Immunizations (rota virus, dukarol)
Organic food sources? (herbicide, pesticide, antibiotics and hormones in beef and pork) (antibiotics in meat can be bad because it can build a resistance)
Food insecurity/desserts (big one – ex, indigenous reserves up north food costs more)
Lifespan considerations
Factors Influencing Nutrition
Medications (increase/decrease appetite – some meds interact w/ food; vitamin C enhances digestion) Other things make things taste different (ex, chemotherapy
lifestyle choices (occupation, business;
socioeconomic status ($$$)
geographical location
education
culture
Disability (mobility and knowledge how to cook food)
Media (body image)
Advertisement in grocery stores – “healthy choice”
Religion
For kids: parents
Nutrition: Social Trends/Fads & the Evidence
- KETO diet
LIFESPAN CONSIDERATIONS: Infants
nutrition
Breast is best - but supplement Vit D 400 IU/day (D-visol drops)
Formula: 150ml/kg/day & let baby guide
Introduction of solids at 6 months (including nuts/nut butters):
Iron-rich/proteins first! Like meats, eggs, tofu, rice cereal
Vegetables, other grains/cereals, fruit
Breastfeeding recommendations 2 + years
Choking hazards
Foods to avoid: honey (under 1 yr) – can cause botchalism
Children 1-2 yrs should drink whole milk – 3.25% extra fat for brain development -> not soy and almond be more forceful about that tell them the evidence refer to nutritionist
Whole dairy too –ie. yogurt should not be low fat or fat free
Avoid juice and sugary drinks
Peanuts/nut butters can be introduced at
https://www.healthunit.com/feeding-your-baby
LIFESPAN CONSIDERATIONS: Adolescents – where we build eating habits
Adolescents require more protein due to rapid growth (and extra calories)
Inquire about relationship with food: SCOFF questionnaire
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry that you have lost Control over how much you eat?
- Have you recently lost more than One stone (14 lb) in a 3-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
LIFESPAN CONSIDERATIONS: Pregnancy
nutrition
All women of childbearing years should take a folic acid supplement (0.4 mg) to reduce incidence of neural tube defects
Pregnant women need additional 350 cal/day in second trimester, 450 cal/day extra in third trimester
Weight gain 11.5-16kg if normal BMI pre-pregnancy
Methods to help with N&V (nausea and vomiting) in pregnancy (methods: ginger, medications - diclectin,
Foods to avoid: unpasteurized cheeses (listeria), deli meats (listeria – can lead to miscarriages), high mercury content fish (tuna), but fish recommended 2-3 times/week. (medication acutain, hot, well cooked meat, caffeine in moderation)
Alcohol, marijuana, other non-therapeutic/harmful drugs
The woman with health conditions that require daily medications would have a ‘cost-benefit’ type discussion with her provider as sometimes it may be less risky to continue with a medication than to stop it while pregnant
Breast feeding: no alcohol, some ways to have alcohol safely
LIFESPAN CONSIDERATIONS:
Elderly
nutrition
What factors affect nutrition in the older adult?
- illness or chronic disease, including depression or dementia (ability to make or get food (sequencing of events))
- Excessive or inadequate intake of a limited variety of foods, missing food groups, increased alcohol
- Dental concerns, missing teeth, loose dentures (sores under dentures)
- Low economic status – ability to afford food (not everyone gets a pention)
- Social isolation, eating alone, mobility issues, getting to grocery store
- Self care deficits, decreased apetite
- Use of medications
Specific Chronic Diseases:
Guidelines for eating
Mediterranean Diet – heart healthy
Low Fat – Cardiovascular diseases
DASH diet – Hypertension
Low sodium, fluid intake – Congestive Heart Failure (heart has to work harder)
Carbohydrate counting – Diabetes
NAS – no added salt
NSA - no sugar added
My parents are good examples of how a) food is love, and b) they understand just fine.
Collecting nutritional data
Ongoing process
Complete nutrition screening assessment
- Risk assessment
- Focused history of common symptoms
- Fluid and intake patterns
- Psychosocial profile
Physical examination
- Calculated measurements
- Lab values/blood work (especially during times of high metabolic demand, such as fever, pain, infection or during limited nutritional intake)
Approaching discussions about nutrition & weight
What language would you use/avoid? Does language change with the life stage of patient?
Use (about weight): ask permission “will it be ok if we talk about your weight today?” – if no say ok, it is something I would love to talk about when you’re ready
How would you approach misinformation?
- Where they got information
- Redirect
How do you incorporate SDoH into awareness & discussion with patient?
- No “don’t eat this and not that” because it isn’t feesable for everyone
Subjective Data Collection nutrition
- Dietary lifestyle changes
- Medications and OTC supplements
- Medication schedule
- Adverse effects
- Alcohol and drug use
- Weight history
- Appetite and taste changes
- Gastrointestinal symptoms
- Food and fluid intake patterns
- Eating patterns
- Food allergies or intolerances
- Psychosocial profile
- Cooking ability
- Assessment of risk factors
- Areas for health promotion
Objective Data Collection nutrition
Physical assessment
- Vital signs
- Body type
- General appearance
- Oral cavity
- Swallowing
- Elimination
- Body mass index (BMI)
- Weight calculations
- Waist circumference
- Waist-to-hip ratio
- Skinfold thickness
Signs and symptoms of malnutrition
Change in hair, nails, skin
Skin healing
Can have lymphadenopathy
Changes in energy level
Weight loss/body changes (Cachexia)
Edema
Muscle wasting
Vital sign deviations
Mood changes (depression)
Neurological symptoms: balance/coordination
Common Laboratory Testing - nutrition
Serum proteins
Hemoglobin and hematocrit
Lymphocyte count
Creatinine excretion
Nitrogen balance
Lipid measurements
