Nutritional Assessment PDF

RNB11903 BIOCHEMISTRY AND NUTRITION ASSESSMENT OF NUTRITIONAL STATUS  LEARNING OUTCOMES At the end of this session, students should be able to: 1. define nutritional assessment; 2. state the purposes of nutritional assessment; 3. discuss the various methods for assessing the...

RNB11903 BIOCHEMISTRY AND NUTRITION ASSESSMENT OF NUTRITIONAL STATUS  LEARNING OUTCOMES At the end of this session, students should be able to: 1. define nutritional assessment; 2. state the purposes of nutritional assessment; 3. discuss the various methods for assessing the nutritional status; 4. describe the nutrition care process. 2  INTRODUCTION The nutritional status of an individual is often the result of many inter-related factors. It is influenced by food intake, quantity & quality, & physical health. The spectrum of nutritional status spread from obesity to malnutrition. Health problems can alter nutritional needs and lead to malnutrition. 40-60% hospitalized patients are malnourished 3 RESPONSIBILITY FOR NUTRITION CARE Registered Dietitians Physicians ‒Provide nutrition therapy ‒Prescribe diet orders ‒Assess, diagnose, develop, implement & evaluate nutrition care plans Nurses ‒Screen patients ‒Plan & approve menu ‒Participate in nutrition ‒Provide dietary education assessments ‒Provide direct nutrition Registered Dietetic care & health education Technician Other team members such ‒Assist the Registered as pharmacists & speech Dietitians therapists may also take part in nutrition care 4  NUTRITIONAL ASSESSMENT Nutritional assessment involves the collection of information needed to evaluate a patient’s nutrition status and dietary needs. The assessment data are used to develop a plan of action to prevent or correct nutrient imbalance and help to determine whether a care plan is effective. 5 PURPOSE OF NUTRITIONAL ASSESSMENT Identify individual or 1 population at risk for malnutrition To develop health care programs that meet the 2 community needs which are defined by the assessment To measure the effectiveness 3 of the nutritional programs & intervention once initiated 6 METHOD OF NUTRITIONAL ASSESSMENT The approach/method in nutritional assessment can be summarized as “ABCD” 1. Anthropometric measurement 2. Biochemical analysis, laboratory methods 3. Clinical examination 4. Dietary evaluation 7 ANTHROPOMETRIC MEASUREMENT Measurements of the physical growth Techniques used are weight for age, weight for height, and height for age, circumference for head, chest, arm and skin fold. BodyMass Index (BMI) is calculated to determine the nutritional status. BMI = Weight (kg) ÷ Height (m)2 ‒Obese : 30 or more ‒Overweight : 25 - 29.9 ‒Normal : 18.5 - 24.9 ‒Underweight : 18.5 8 ANTHROPOMETRIC MEASUREMENT BMI (WHO - Classification) BMI Classification < 18.5 Underweight 18.5 – 24.5 Normal/Ideal body weight 25 - 30 Overweight (Grade 1 Obesity) 30 - 40 Obese (Grade 2 Obesity) > 40 Very obese (Morbid or Grade 3 Obesity) 9 ANTHROPOMETRIC MEASUREMENT Interpretation of BMI (School Health)_ BMI for Boy Classification BMI for Girls 14.4 – 19.9 BBN 14.4. – 20.9 < 14.3 KBB < 14.3 20.0 – 23.6 RBB 21.0 – 24.9 23.7 – 30 BBB 25.0 – 32 > 30 OBESITI > 32 < 13.5 BANTUT < 13.8 10 ANTHROPOMETRIC MEASUREMENT Itis used to evaluate both under & over nutrition. The measured values reflects the current nutritional status, does not differentiate between acute & chronic changes. Accurate measurement of height and weight is essential. The results can then be used to evaluate the physical growth of the child. 11 ANTHROPOMETRIC MEASUREMENT ANTHROPOMETRIC MEASUREMENT ANTHROPOMETRIC MEASUREMENT ANTHROPOMETRIC MEASUREMENT 15 ANTHROPOMETRIC MEASUREMENT 16 17  BIOCHEMICAL ANALYSIS Provide information about: ‒Protein-energy nutrition ‒Vitamin & mineral status ‒Fluid & electrolyte balance ‒Organ functioning Analysisof blood and urine samples Blood specimen is taken for investigation to measure the physiological or behavioral functions. 18  BIOCHEMICAL ANALYSIS Hemoglobin estimation is the most important test, & useful index of the overall state of nutrition. Beside anemia it also tells about protein & trace element nutrition. Stool examination for the presence of ova and/or intestinal parasites. Urine dipstick & microscopy for albumin, sugar and blood. 19  BIOCHEMICAL ANALYSIS Measurement of individual nutrient in body fluids (e.g. serum retinol, serum iron, urinary iodine, vitamin D). Detection of abnormal amount of metabolites in the urine (e.g. urinary creatinine) Analysis of hair, nails & skin for micro-nutrients. 20  CLINICAL EXAMINAITON It is an essential approach of nutritional assessment. It is the simplest & most practical method of ascertaining the nutritional status of individual. It includes history taking collecting information on a number of physical signs, specific & non specific, that are associated with malnutrition and deficiency of vitamins and micronutrients. Medical history or physical examination is used to determine the sign and symptoms of malnutrition. ‒Goiter related to iodine deficiency ‒Oedema due to Kwashiorkor ‒Pallor indicative of iron deficiency 21  CLINICAL EXAMINATION History taking in nutrition assessment: Medical History Social History Diet History Current complaints Socioeconomic Dietary pattern Past medical status Dietary restrictions conditions Cultural/ethnic Use of alcohol Family history or identity Food allergies and illness Education intolerance Surgical history background Chewing and Medication history Living situation swallowing ability Use of Shopping Need for feeding dietary/herbal/tradit arrangements assistance ional supplements Cooking facilities Types of diet/therapeutic diet 22  CLINICAL EXAMINAITON Symptoms are non-specific, usually develop at the advance stage of malnutrition, findings are usually supported with laboratory results. Head to toe physical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones, & thyroid gland. Detection of relevant signs helps in establishing the nutritional diagnosis. 23 CLINICAL EXAMINAITON 24  CLINICAL EXAMINAITON Goiter is a reliable sign of iodine Joints and bones help to detect signs of deficiency. vitamin D deficiency (Rickets) & vitamin C deficiency (Scurvy) 25 CLINICAL EXAMINAITON 26  DIETARY EVALUATION Obtaining an accurate information of a person’s usual food intake is challenging, as results may vary depending on the individual’s memory and honesty, as well as the assessor’s skill and training. The common methods used in dietary evaluation: i. 24-hour dietary recall ii. Food frequency questionnaire iii. Food dairy/Food record iv. Direct observation 27 DIETARY EVALUATION: 24-Hour Recall A trainedinterviewer/nurse asks the patient to recall all food & drink taken in the previous 24 hours. It is quick, easy, & depends on short-term memory, but may not be truly representative of the person’s usual intake. Information include: ‒ Time eaten ‒ Frequency of meal ‒ Amounts consumed ‒ Food preparation ‒ Food sources ‒ Storage of food ‒ Eating behavior 28  DIETARY EVALUATION: Food Frequency Questionnaire Inthis method the patient is given a list of around 100 food items to indicate his or her intake (frequency & quantity) per day, per week & per month. Is a written survey of food consumption. Inexpensive, more representative & easy to use. 29  DIETARY EVALUATION: Food Frequency Questionnaire 30  DIETARY EVALUATION: Food Diary Written account of food consumed during a specific period, usually several consecutive days. Thelength of the collection period range between 1-7 days. Reliable, accuracy is improved by including weights or measures of food; but difficult to maintain. Recorded as consumed, does not rely on memory. 31 DIETARY EVALUATION: Food Diary 32 DIETARY EVALUATION: Direct Observation Observationof meals trays or shelf inventories before and after eating. The most unused method in clinical practice, but it is recommended for research purposes. Themeal eaten by the individual is weighed and contents are exactly calculated (calorie counting). The method is characterized by having a high degree of accuracy but expensive & need much effort and time consuming. 33  THE NUTRITION CARE PROCESS A systematic approach to nutrition therapy. The steps of nutrition care process based on the concept of “Nursing Process”: i. Nutrition assessment ii. Nutrition diagnosis iii. Planning and nutrition intervention iv. Nutrition monitoring and evaluation Each step of the nutrition care process must be documented in the medical record/nursing notes, providing a record for future reference and facilitating communication among members of healthcare team. 34 IDENTIFYING RISK FOR MALNUTRITION Nutrition screening Screening ‒Identifies persons at ‒Medical diagnosis risk for nutrition ‒Medical record problems ‒Physical ‒Must be done 24 examination hours after admission ‒Lab reports ‒Should be completed ‒Diet history in 5-15 minutes  PLANNING CARE The Nutrition Care The Nursing Process Process i. Nutrition i. Assessment assessment ii. Nursing ii. Nutrition diagnosis diagnosis iii. Outcome iii. Nutrition identification & intervention planning iv. Nutrition iv. Implementation monitoring & v. Evaluation evaluation © 2007 Thomson - Wadsworth SUMMARY OF NUTRITION CARE PROCESS Assessment Intervention ‒Medical, social, & ‒Dietary changes dietary histories ‒Anthropometric data ‒Nutrition education ‒Biochemical ‒Medication changes analysis ‒Physical exam Monitoring & evaluation ‒May need to modify the Diagnosis plan ‒Actual or potential ‒Must be flexible ‒Problem, etiology, signs & symptoms SUMMARY OF NUTRITION CARE PROCESS Nutrition assessment Nutrition Nutrition monitoring & diagnosis evaluation Nutrition intervention 39  REVIEW NOTES Nutrition assessments include historical information, anthropometric measurement, biochemical analysis, clinical examination and dietary evaluation. Anthropometric measurement help to evaluate growth patterns, over nutrition and undernutrition. Physical assessment help to detect signs of nutrient deficiency, fluid and electrolytes imbalance and functional impairments related to nutritional problems. By combining all the data obtained from different methods of assessment, nurses and dietitians can better identify patients who are most likely to develop nutrition problems. 40 41