© 2006 Thomson-Wadsworth Chapter 6 A National Nutrition Agenda for the Public’s Health.
© 2007 Thomson - Wadsworth Chapter 13 Nutrition Care and Assessment.
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Transcript of © 2007 Thomson - Wadsworth Chapter 13 Nutrition Care and Assessment.
© 2007 Thomson - Wadsworth
Nutrition in Health Care
• Health problemsAlter nutrition
needsCan lead to
malnutrition
• Poor nutrition statusCan influence the
course of disease & body’s response to treatment
• Hospitalized patients40-60% with acute
illness are malnourished
Others decline in nutrition status within 3 weeks
© 2007 Thomson - Wadsworth
How Illness Affects Nutrition Status
• Reduced food intake Nausea Inflammation of
mouth Medications can
cause GI upset
• Interferes with digestion & absorption
• Alters metabolism & excretion
• Dietary restrictions for some surgeries or chronic illnesses
• Drain on financial resources
• Unable to prepare food
• Emotional upset
© 2007 Thomson - Wadsworth
Responsibility for Nutrition Care
• Registered Dietitians Provide medical
nutrition therapy Assess, diagnose,
develop,implement & evaluate nutrition care plans
Plan & approve menus Provide education
• Registered Dietetic Technician Assist the Registered
Dietitians
• Physicians Prescribe diet orders
• Nurses Screen patients Participate in nutrition
assessments Provide direct nutrition
care
• Other team members such as pharmacists & speech therapists consult
© 2007 Thomson - Wadsworth
Identifying Risk for Malnutrition
• Nutrition screening Identifies persons at
risk for nutrition problems
Must be done 24 hours after admission
Should be completed in 5-15 minutes
• ScreeningMedical diagnosisMedical recordPhysical
measurementsLab reportsDiet history
© 2007 Thomson - Wadsworth
Planning Care
• The Nutrition Care ProcessNutrition
assessmentNutrition diagnosisNutrition
interventionNutrition
monitoring & evaluation
• The Nursing ProcessAssessmentNursing diagnosisOutcome
identification & planning
ImplementationEvaluation
© 2007 Thomson - Wadsworth
The Nutrition Care Process
• Assessment Medical, social, &
dietary histories Anthropometric data Biochemical analysis Physical exam
• Diagnosis Actual or potential Problem, etiology,
signs & symptoms
• Intervention Dietary changes Nutrition education Medication
changes
• Monitoring & evaluation May need to
modify the plan Must be flexible
© 2007 Thomson - Wadsworth
Historical Information
• Medical historyAgeGenderWeightPrescription drugsOTC medicationsDietary
supplementsType of illness
• Social historyCultural heritageFinancial concernsWho prepares and
shops for foodLiving situation
• Diet historyFood intakeMeal patternsPhysical problems
© 2007 Thomson - Wadsworth
Dietary Assessment Methods
• 24-hour recallAll foods & beveragesTime of day eatenAmounts consumedFood preparationTypical day?
• Food frequency questionnaire
• Food recordRecorded over
several daysRecorded as
consumedDoes not rely on
memory
• Direct observationCalorie countingTime consuming
© 2007 Thomson - Wadsworth
Anthropometric Data
• Height: Adults• Length
Infants< 24 months
• WeightBMI% Usual body
weight% Ideal body
weight
• Head circumferenceAssesses brain
development< 3 years of age
• Circumference of waist & limbsEvaluates body fatEvaluates muscle
mass
© 2007 Thomson - Wadsworth
Biochemical Analysis
• Provides information aboutProtein-energy nutritionVitamin & mineral statusFluid & electrolyte balanceOrgan functioning
• Analysis of blood & urine samples
© 2007 Thomson - Wadsworth
Plasma Proteins
• AlbuminMost abundantSlow to reflect
changes in status
• TransferrinTransports iron Indicates PEM &
iron statusSlow to detect
changes in status
• Prealbumin & retinol-binding proteinAlso called
transthyretinResponds quickly
to changes in protein status
Expensive test
© 2007 Thomson - Wadsworth
Fluid Imbalance
• EdemaWeight gainFacial puffinessSwelling limbsAbdominal
distentionTight-fitting shoes
• Diseases of heart, kidney, liver, lungs
• Dehydration ThirstDry skin or mouthReduced skin tensionDark yellow or amber
urine with low volume
• Fever, sweating, vomiting, diarrhea, burns
© 2007 Thomson - Wadsworth
Assessment of Nutrition Status
• Functional AssessmentExercise toleranceRespiratory
muscle strength Immunity
• Integrating assessment dataSubjective Global
Assessment (SGA)Combines
historical information with results of physical examination