Nutrition Clinical Data (PDF)

occurs. **Clinical Data (Physical Examination)** Assessment focuses on rapidly proliferating tissues such as skin, hair, nails, eyes, and mucosa but also includes a systematic review comparable to any routine physical examination. **Calculating Percentage of Weight Loss** Accurate assessment of t...

occurs. **Clinical Data (Physical Examination)** Assessment focuses on rapidly proliferating tissues such as skin, hair, nails, eyes, and mucosa but also includes a systematic review comparable to any routine physical examination. **Calculating Percentage of Weight Loss** Accurate assessment of the client's height, current body weight (CBW), and usual body weight (UBW) is essential. Although the client's CBW can be compared with an ideal body weight discussed earlier, the IBW is based on healthy people and does not account for changes in the client's body composition that accompany illness or reflect any changes in weight. The client's UBW better indicates weight change and the possibility of malnutrition. **Dietary Data** Dietary data includes the client's usual eating patterns and habits; food preferences, allergies, and intolerances; frequency, types, and quantities of foods consumed; and social, economic, ethnic, or religious factors influencing nutrition. For a **24-hour food recall**, the nurse asks the client to recall all of the food and beverages the client consumes during a typical 24-hour period when at home. The data obtained are then generally evaluated according to the Food Guide to judge overall adequacy. A **food frequency record** is a checklist that indicates how often general food groups or specific foods are eaten. Frequency may be categorized as times/day, times/week, times/month, or frequently, seldom, never. This record provides information about the types of foods eaten but not the quantities. When specific foods or nutrients are suspected of being deficient or excessive, the health care professional may use a selective food frequency that focuses, for example, on fat, fruit, vegetable, or fiber intake. A **food diary** is a detailed record of measured amounts (portion sizes) of all food and fluids a client consumes during a specified period, usually 3 to 7 days. A **diet history** is a comprehensive time-consuming assessment of a client's food intake that involves an extensive interview by a nutritionist or dietitian. It includes characteristics of foods usually eaten and the frequency and amount of food consumed. It may include a 24-hour recall, a food frequency record, and a food diary. Medical and psychosocial factors are also assessed to evaluate their impact on nutritional requirements, food habits, and choices. **Diagnosing** NANDA International includes the following diagnostic labels for nutritional problems: Imbalanced Nutrition: Less Than Body Requirements Obesity Overweight Readiness for Enhanced Nutrition Many other NANDA nursing diagnoses may apply to certain individuals, because nutritional problems often affect other areas of human functioning. In this case, the nutritional diagnostic label may be used as the etiology of other diagnoses. Examples include: **Activity Intolerance** related to inadequate intake of iron-rich foods resulting in iron deficiency anemia **Constipation** related to inadequate fluid intake and fiber intake **Chronic Low Self-Esteem** related to obesity **Risk for Infection** related to immunosuppression secondary to insufficient protein intake. **Planning** Major goals for clients with or at risk for nutritional problems include the following: Maintain or restore optimal nutritional status. Promote healthy nutritional practices. Prevent complications associated with malnutrition. Decrease weight. Regain specified weight. **CLINICAL MANIFESTATIONS** **Implementing** Nursing interventions to promote optimal nutrition for hospitalized clients are often provided in collaboration with the primary care provider who writes the diet orders and the dietitian who informs clients about special diets. The nurse creates an atmosphere that encourages eating, provides assistance with eating, monitors the client's appetite and food intake, administers enteral and parenteral feedings, and consults with the primary care provider and dietitian about nutritional problems that arise. **Assisting with Special Diets** Alterations in the client's diet are often needed to treat a disease process such as diabetes mellitus, to prepare for a special examination or surgery, to increase or decrease weight, to restore nutritional deficits, or to allow an organ to rest and promote healing. Diets are modified in one or more of the following aspects: texture, kilocalories, specific nutrients, seasonings, or consistency. **Clear Liquid Diet** This diet is limited to water, tea, coffee, clear broths, ginger ale, or other carbonated beverages, strained and clear juices, and plain gelatin. Note that "clear" does not necessarily mean "colorless." This diet provides the client with fluid and carbohydrate (in the form of sugar), but does not supply adequate protein, fat, vitamins, minerals, or calories. It is a short-term diet (24 to 36 hours) provided for clients after certain surgeries or in the acute stages of infection, particularly of the GI tract. **Full Liquid Diet** This diet contains only liquids or foods that turn to liquid at body temperature, such as ice cream. Full liquid diets are often eaten by clients who have GI disturbances or cannot tolerate solid or semisolid foods. This diet is not recommended for long-term use because it is low in iron, protein, and calories. **Soft Diet** The soft diet is easily chewed and digested. It is often ordered for clients who have difficulty chewing and swallowing. It is a low-residue; (low-fiber) diet containing very few uncooked foods. The **pureed diet** is a modification of the soft diet. Liquid may be added to the food, which is then blended to a semisolid consistency. **Examples of Foods for Clear Liquid, Full Liquid, and Soft Diets** **Diet as Tolerated** "Diet as tolerated" is ordered when the client's appetite, ability to eat, and tolerance for certain foods may change. For example, on the first postoperative day a client may be given a clear liquid diet. If no nausea occurs, normal intestinal motility has returned as evidenced by active bowel sounds and client reports passing gas, and the client feels like eating, the diet may be advanced to a full liquid, light, or regular diet. **Modification for Disease.** a client with diabetes mellitus may need a diet recommended by the American Diabetes Association, an obese client may need a calorie-restricted diet, a cardiac client may need sodium and cholesterol restrictions. **Dysphagia.** Some clients may have no difficulty with choosing a healthy diet but be at risk for nutritional problems due to dysphagia. These clients may have inadequate solid or fluid intake, be unable to swallow their medications, or aspirate food or fluids into the lungs---causing pneumonia. Clients at risk for dysphagia include older adults, those who have experienced a stroke, clients with cancer who have had radiation therapy to the head and neck, and others with cranial nerve dysfunction. Consider dysphagia if the client exhibits the following behaviors: coughs, chokes, or gags while eating; complains of pain when swallowing; has a gurgling voice; requires frequent oral suctioning. **Stimulating the Appetite** **Assisting Clients with Meals.** Whenever possible, the nurse should help clients feed themselves rather than feed them. Some clients become depressed because they require help and because they believe they are burdensome to busy nursing personnel. When feeding a client, ask in which order the client would like to eat the food. If the client cannot see, tell the client which food is being given. Always allow ample time for the client to chew and swallow the food before offering more. Also, provide fluids as requested or, if the client cannot communicate, offer fluids after every three or four mouthfuls of solid food. Make the time a pleasant one, choosing topics of conversation that are of interest to clients who want to talk. Although normal utensils should be used whenever possible, special utensils may be needed to assist a client to eat. For clients who have difficulty drinking from a cup or glass, a straw often permits them to obtain liquids with less effort and less spillage. Special drinking cups are also available. One model has a spout; another is specially designed to permit drinking with less tipping of the cup than is normally required.