Nutritional Assessment: Study Guide

Nutritional Assessment Study Guide

• Nutritional Status involves balancing nutrient intake with bodily needs, influenced by physiological, psychosocial, cultural, and economic factors
• Optimal Nutrition refers to adequate intake which supports metabolism, growth, and repair
• Undernutrition occurs with insufficient nutrient intake, leading to impaired immunity, poor growth and healing, and increased infection risk, especially in infants, the elderly, and pregnant women
• Overnutrition means excess intake that contributes to obesity, hypertension, diabetes, cardiovascular diseases, and certain cancers
• Nutritional Indicators includes skin, hair, and nail health that reflect hydration and nutrient balance

Nutrition Basics: Anatomy & Physiology

• Basal Metabolic Rate (BMR) is the energy needed at rest to maintain vital bodily functions

  • BMR is influenced by age, gender, muscle mass, hormones, and nutrition

• Carbohydrates are the primary energy source (4 kcal/g) with a recommended daily allowance (RDA) of 130g/day, constituting 55%-60% of total daily calories

• Proteins are essential for growth, repair, enzyme production, and immune support (4 kcal/g)

  • Complete proteins contain all essential amino acids (meat, eggs, dairy), while incomplete proteins are plant-based (beans, nuts, grains)
  • The RDA for protein is 56g/day for men, 46g/day for women, and 71g/day for pregnant individuals

• Fats are for energy storage, hormone production, and vitamin absorption (9 kcal/g)

  • Saturated fats should constitute less than 7% of daily intake and are typically from animal sources
  • Unsaturated fats, considered healthy, are found in fish, nuts, and oils
  • Cholesterol intake should be less than 300 mg/day

• Vitamins are classified as water-soluble (B-complex, C), which are not stored and must be consumed daily, or fat-soluble (A, D, E, K), which are stored in body fat and can be toxic in excess

• Minerals are categorized as major (greater than 100 mg/day), including calcium, magnesium, sodium, and potassium, or trace (less than 100 mg/day), including iron, zinc, iodine, and copper

• Water is essential for transport, temperature regulation, and waste elimination with an RDA of 2.5-3 liters per day; this increases with illness or exercise

Nutrient Deficiency Signs

• Vitamin A deficiency leads to night blindness and dry eyes
• Vitamin D deficiency causes rickets in children and osteomalacia in adults
• Vitamin E deficiency results in neuropathy and anemia
• Vitamin K deficiency shows excessive bleeding
• Vitamin C deficiency leads to scurvy, characterized by bleeding gums and slow healing
• B-complex deficiencies:
  • B1: Beriberi, Wernicke's encephalopathy
  • B2: Cracked lips, glossitis
  • B3: Pellagra (diarrhea, dermatitis, dementia)
  • B6: Anemia, neuropathy
  • B9: Megaloblastic anemia, birth defects
  • B12: Pernicious anemia, neurological issues
• Mineral deficiencies:
  • Iron: Fatigue, anemia, brittle nails
  • Zinc: Hair loss, slow healing
  • Copper: Anemia, bone issues
  • Iodine: Goiter, hypothyroidism
  • Magnesium: Muscle cramps, arrhythmias

Biochemical Nutritional Indicators

• Protein markers:
  • Prealbumin: Short term indicator, sensitive to diet changes
  • Albumin: Long term marker, affected by hydration status
• Serum Total Protein measures protein levels
• CBC detects anemia and deficiencies
• Electrolytes identifies imbalances
• Lipid Panel assesses cholesterol and triglycerides
• Vitamin/Mineral Levels detects deficiencies (e.g., vitamin D, iron)
• CRP differentiates malnutrition from inflammation

Nutritional Health Assessment

• Key areas to consider are:
  • Health History (current conditions, medication use, weight changes, family history)
  • Lifestyle factors (physical activity, dietary habits, food accessibility
  • Dietary Restrictions (religious, cultural, allergies, intolerances)
  • Psychosocial Factors (economic status, social support, substance use)

Nutritional Considerations by Life Stage

• Infants/Children require high nutritional demands, and exclusive breastfeeding is recommended for 6 months; dehydration risks must also be considered
• Adolescents need more protein, iron, and calcium, and they are prone to poor dietary habits
• Pregnancy/Lactation increases the need for iron, folate, and calcium; weight gain should be monitored based on BMI
• Stabilized nutritional needs in Adults indicates that diet impacts long-term disease risk
• Older Adults are at a higher risk of malnutrition due to reduced taste, chewing issues, and limited mobility
• Cultural and Nutritional Considerations are seen In Mediterranean diets (healthy fats, whole grains, seafood), Asian diets (rice, vegetables, soy, fish, low dairy), Western Diets (processed foods, high sugar/fat), and Latin American diets (corn, beans, plantains, lean proteins)
• Religious Considerations, for example, Kosher diet (Judaism): no pork, shellfish, or dairy-meat mix
• Halal diet (Islam): excludes pork/alcohol and follows specific slaughtering rules
• Hindu/Buddhism: vegetarianism is common

Nutritional Assessment Methods

• Screening Tools:
  • MST (Quick malnutrition screening) and MNA (assesses older adults’ risk)
• Dietary Intake Methods:
  • Include 24-Hour Recall (short-term dietary record), FFQ (evaluates habitual intake), Food Diary (multi-day detailed log), Direct Observation (clinical monitoring), and Digital Tracking (apps for dietary monitoring)
• Anthropometric Measurements:
  • Include BMI (Underweight <18.5, Normal 18.5-24.9, Overweight 25-29.9, Obese ≥30), Waist-to-Hip Ratio (assesses fat distribution)
• Clinical Deficiency Signs:
  • Protein (brittle hair, flaky skin), Iron (pale skin, spoon nails), Vitamin C (bleeding gums, slow healing), Vitamin A (dry skin, night blindness), and Zinc (hair loss, impaired healing)

Common Nutritional Disorders

• Obesity: BMI ≥30; linked to heart disease, diabetes
• Hyperlipidemia: High cholesterol; diet and genetics as risk factors
• PCM (Protein-Calorie Malnutrition): Muscle wasting, low BMI
• Types of Eating Disorders include Anorexia (self-starvation, extreme thinness) and Bulimia (binge-purge cycles; electrolyte imbalances)
• Binge Eating is Uncontrolled eating without purging

Clinical Applications & Nutritional Interventions

• Interventions: Assessment (physical signs, dietary intake, weight trends), Intervention (nutritional plans, education, referrals), considerations for Older Adults (address barriers like mobility, isolation, finances), Biochemical Monitoring (adjust diet based on lab values), and Interdisciplinary Care (collaboration with healthcare teams for holistic patient management)

Skin, Hair, and Nails Assessment

• Integumentary System significance reflects overall health, hydration, and nutritional status
  • Functions include protection, sensation, temperature regulation
  • Linked to circulatory, respiratory, musculoskeletal, neurological, and gastrointestinal/genitourinary systems
• Skin Structure & Function, with the largest organ elasticity and regeneration, provides protection, and promotes temperature regulation, fluid balance, vitamin D synthesis
• Skin Layers include epidermis (outer layer), which creates an avascular outer barrier that protects from external factors, dermis (middle layer), which contain nutrients, sensory, and thermoregulation components, and a subcutaneous layer (anchoring skin providing insulation and cushioning
• The avascular epidermis includes the basal layer to reproduce new cells, and the stratum corneum layer to create a protective outer barrier
• Skin Appendages include:
  • Hair (protects, provides sensory input), Nails (protect fingertips, aid in motor function), Sweat Glands (Eccrine produces thermoregulation and Apocrine active at puberty) and sebaceous glands (secretion of sebum for lubrication

Health History Assessment

• Key Areas include:
  • Present Health Status: Chronic illnesses, medication affecting the skin, potential exposure that impacts the skin
  • Past & Family History: family or relevant health history that explains current symptoms and observations

Symptom Analysis

• Common Skin Concerns include: - Itching (Pruritus): Onset, duration, triggers, associated symptoms - Rash: Location, appearance, pattern, systemic symptoms, triggers

Skin Assessment Techniques

• Inspection:
  • Skin Color: Normal (moles, freckles, birthmarks), Abnormal (cyanosis, pallor, jaundice, erythema)
  • Lesions & bruising, wounds/ulcers and any signs of infection
  • Palpation to feel smooth, rough, or dry skin, as well as temperature
• Skin turgor: Elasticity with dehydration delays return
• Skin Thickness: Thin (aging, steroid use), Thick (chronic irritation, fungal infection)

Hair & Nail Assessment

• Hair Assessment:
  • Includes texture, distribution of hair and the scalp condition Nail Assessment:
    • Normal nails should be assessed based on shape and contour, color, thickness and quick capillary refill

Classification of Lesions

• Primary Lesions:
  • Macule: Flat, <1 cm
  • Papule: Raised, solid, <1 cm
  • Plaque: Raised, firm, >1 cm
  • Vesicle: Fluid-filled, <1 cm
  • Pustule: Pus-filled
• Secondary Lesions:
  • Crust: Dried exudate
  • Ulcer: Deep skin loss
  • Excoriation: Scratch marks
  • Lichenification: Thickened skin

Common Skin Conditions

• Inflammatory disorders include Eczema (chronic pruritic, scaly patches), Contact Dermatitis (allergic or irritant reaction), Seborrheic Dermatitis (greasy scales on the scalp or face), and Psoriasis (autoimmune disorder with silvery plaques)
• Fungal Infections consist of Ringworm (circular, scaly plaques), Athlete’s Foot (scaling, itching between toes), Candidiasis (moist areas)
• Viral infections include warts, herpes, and chickenpox
• Parasitic Infestations include lice and scabies
• Benign tumors include Lipomas (soft, moveable fatty lumps) and Seborrheic Keratosis (warty, stuck-on lesions)
• Malignant Skin Cancers include Basal Cell Carcinoma, Squamous Cell Carcinoma, Melanoma, Kaposi's Sarcoma
• Skin Assessment & Diagnosis of disease: History, physical exams and possible labrotory testing for infection, or malignancies

Health Promotion & Prevention

• Treatment Strategies include: Topicals, oral medications, cryotherapy and surgery
• Sun Protection: SPF 30+, avoid peak UV exposure
• Regular Self Skin Exams: Check for mole changes
• Hygiene & wound care: Prevent infections

Head, Face, Neck, and Regional Lymphatics

• Skull:
  • bony structure protecting the brain
  • Cranial bones: Frontal, Parietal, Occipital, Temporal
• Sutures:
  • immovable joints connecting bones
  • Coronal to Parietal
  • Sagittal between parietal bones
  • Lambdoid: Occipital to parietal
• Facial bones provide structure, support for chewing, speaking
• Facial muscles are controlled by Cranial Nerve VII (Facial Nerve)
• Facial sensation are Regulated by Cranial Nerve V (Trigeminal Nerve)
• symmetry of Face : Check eye, ear, noise, mouth, eye lid drooping known as ptosis and nasolabial folds
• Neck supports the head
• key Neck Structures:
  • Cervical Vertebrae (C1-C7): Provide mobility
  • Sternomastoid muscle: Divides neck into triangles, aids movement
  • Trapezius muscle: Moves shoulders, extends head (Cranial Nerve XI).
  • Carotid Arteries & Jugular Veins: Major blood supply.
  • Thyroid Gland: Regulates metabolism (T3, T4 secretion).
  • Salivary Glands: Parotid, Submandibular, Sublingual..

Health and function of the Lymphatic System

Lymphatic System: to drain excess fluid and to fight infection

• Key Lymph Nodes: -Preauricular:-In front of ear -Posterior Auricular:- Behind ear. -Occipital:- Base of skull. -Sub mental:- Under chin. -Submandibular:- Under jawline. -Jugulodigastric:- Beneath ear. -Deep & Superficial Cervical:- Along sternomastoid. -Supraclavicular:- Above clavicle (serious is ilness indicator)

Developmental Considerations

- Infancy: fontanel development
-Adolescence: Development of facial hair and thyroid glands
-Pregnancy: Increase on Thyroid size and possible changes to ones face
-Adults: bone prominence in facial structure

Health History Assessment -Subjective Data

Assessing Headache-to evaluate sudden or gradual changes, locations of pain, description, duration and triggers To evaluate history of Head injury-circumstances? Loss of Consciousness?,symptoms? To evaluate Neck Pain-Onset & Location: Sudden, chronic, localized, associated,symptoms To evaluate Dizziness and Vertigo such as type of feeling and its triggers To evaluate Lumps & Swelling of all sizes, tenderness and other symptoms

Physical Examination

Physical examination requires objective evidence to be collected -Inspection of head, neck and face - to evaluate the size, shape, symmetry, skin condition and involuntary movements -Palpating the skull smooth and evaluating for tenderness -Checking on temporal artery -Checking on lymph nodes

• Abnormal findings: Hard, fixed, tender (infection/malignancy) -Evaluate shape, symmetry, tenderness of the Thyroid Gland

• Percussion & Auscultation: Includes using percussion for resonance suggests hydrocephalus and auscultation when bruits indicate increased blood flow

Common Conditions & Disorders

• Headaches: Tension (bilateral, band-like tightness, photophobia nausea Migraine (unilateral or pulsating) and Cluster headache
• Pediatric Abnormalities: Hydrocephalus, Cranicsynostosis, Down Syndrome
• Swelling and Masses: congenital Torticollis, Goiter/Thyroid gland enlargement, and Parotid Gland Enlargement
• Thyroid Disorders: Hyperthyroidism, Hypothyroidism
• Abnormal Facial Findings: Acromegaly, Cushing Syndrome, Bell Palsy, Stroke, Parkinson's

Health Promotion & Prevention:

• Infants : Tummy time for neck strength,Concussion prevention,Correct Posture

Clinical Application & Interdisciplinary Care

• Multidisciplinary Approach: -Neurology: Stroke, migraines. -Endocrinology : Thyroid disorder -Smoking sensation: Smoking cessation reduces vascular risks

Eyes

• Eye includes two features that include the External Anatomy and Internal Anatomy
• External Anatomy:
  • Eay ball is Housed in the orbital cavity, cushioned by fat. -Eyelids: to Protect from injury, bright light, and dust. -Palpebral Fissure: Open space between eyelids. -Canthus: Innerlouter corners; contains sebaceous glands. -Limbus :Border between cornea and sclera.
• Internal Anatomy: -outer Layer- Sclera and Cornea -Middle lyer - choroid vascular ciliary body ,Iris ,lens and Aqueous Humour -Inner Layer -Retina: Photoreceptors convert light into neural signals, Optic Disc ( Forms the optic nerve) and Macula( provides sharp vision)

Visual Pathway and Reflex

• Light refraction through the eye to retina -Optic Chiasm: Nasal fibers cross for binocular vision. -Pupillary Light Reflex: Pupil constriction in response to light.( cn III) -Fixation" Eyes maintain focus on an object. -Accommodation: Adjusts lens shape for near vision. -Visual acuity with Snellen chart

Devolpmental Considerations

• Infancy: Rapid improvement of vision
• Adulthood: Degeneration of the eye

Common eye disorder: such as Myopia and Hyperopia

Subjective Data

Assessment of

• Vision Problems like Blurring, double vision, blind spots
• Eye Pain unilateral , possible causes : Infection, inflammation, foreign body Redness , Swelling discharge caused by an infection Medical & occupational Hx

Objective Data (Physical Exam)

1-Visual Acuity -Snellen Chart: to check Distant vision - Normal: 20/20 2-Extraocular and Muscle Function -Corneal Light Reflex: Light reflection should be symmetric. -Six Cardinal Gaze Test: Checks EOM function, detects nystagmus Assessment of Conjunctiva and Sclera

Common Eye Disorder: Retina Opacity , Glaucoma and Macular Degeneration

EARs

Anatomy of the Ears

External Ear

• Auricle (Pinna): Funnels sound waves into external auditory canal
• External Auditory canal -S shaped.lined eith cerumen-producing glands: ends at the tympanic membrane
• Middle Ear
• Tympanic Cavity- Air filled space within the temporal bone housing the anditory ossicles

Auditory ossioles:

• Malleus and Stapes that transfers the air and vibrations
• Eustachian Tube: Connects the middle ear to the nasoparnyx

Inner Ear

• Contains balance and cochlea that converts stimuli of vibration to electrical and back
• Hearing Process -Sounds that transfers sound by vibration Brainstem Level

Evaluation of Heath-history of the EAR

Brain and Hearing Process Level The brain interprets signals as meaningful sounds music and noises pathways, and and Loss of sound

• Assessment of Earache -History if infection ,discharge an any ringing in the ears Objective Data Inspection of External part
• To evaluate the Size Symmetry any Skin Condition, redness, tenderness Palpating
• Tympanic Membrane: to evaluate sound when whispering Common Ear Disorders

Conditions of the Ear

• Rinne and Webner ear test to evaluate hearing in patients
• disorder such Otitis , swimmers ear
• middle : otitis , perforation of membrane Inner ear ;BPPV ( brief episode pf vertigo) Health promotion with cleaning ear and screenings

Nose, Mouth, and Throat

Nose: Structure and Function

• General Function: Warms, moistens, and filters inhaled air; primary sensory organ for smell (Cranial Nerve I - Olfactory Nerve); roles in resonance for speech. External Nose: composed of bone and cartilage more prominent in ageing adults
• Nasal cavity: lines with moist tissue to trap pathogens : Increase surface area for air filtration and humidification, draining pathways, olfactory receptors (location at for for smell receptor)

Paranasal sinuses

• Frontal, Maxillary, Ethmoid, and Sphenoid Sinuses. Functions: lightens skull, acting as voice resonanators, producing mucus for debris cleaning, Frontal and Maxillary

Mouth

• Structure and Function:

• General Function is Beginning of the digestive and respiratory systems: aids for breathing, and tasting

• Key Components of the mouth include teeth, gums , palates, and inner tongue: structure for speech, food intake, and taste

• connect mouth and nose to respiratory and digestive tracts. Nasopharynx: conatains eustachian the throat: part of respiratory system:

Consideration for infants and Children

evaluation for sinuses at birth, teeth that are temporary and saliva Pregnancy: congestion for sensitive women Evaluation of the aging adults

Subjective Assessment & Considerations

V. Cultural and Environmental Considerations Variation in cerumen type among ethic groups,and Socioeconomic factors impact oral health and their dietary Factors assessment of the Nose, mouth and throat by questioning the patient objective: to inspect face to assess the patients

Objective Examination

Objective Nasal : external for abnormalities to determine Mouth for lips and tongue Throat examination to asses signs of bacterial functions /disorders health information pertaining to this chapter