[telmeds.org]_17uncn7e.ppt_29-3-2010. (1)
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Nutrition Care and
Assessment
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Health Professionals and
Nutrition Care Physicians
Prescribe diet orders (nutrition
assessment and diet counseling) Registered Dietitians
Conduct dietary assessments
Diagnose nutritional problemsDevelop, implement and evaluate nutrition
care plans
Plan and approve menus
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Health Professionals and
Nutrition Care Nurses
Screen patients for nutrition problems may participate in nutrition and dietaryassessments
Provide diet / nutrition care
Encouraging patients to eat
Finding practical solutions to food-relatedproblems
Recording patients food intake
Answering questions about specific diets
Administering tube and intravenous feedings
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Health Professionals and
Nutrition Care Registered Dietetic Technicians
Work with dietician
Assist in implementation and monitoring ofnutrition services
Screen patients for nutritional problems
Provide patient education and counseling
Develop menus and recipes Ensure appropriate meal delivery
Monitor patients food choices and intakes
Often have supervisory positions in foodserviceoperations
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Health Professionals and
Nutrition Care Other Health Care Professionals
Pharmacists, physical therapists,occupational therapists, speech therapists,social workers, nursing assistants, homehealth care aides
Assist with nutrition care
Can be instrumental in alerting dietitiansor nurses to nutrition problems
May share relevant information about apatients health status or personal needs
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Nutrition Screening
Disease.
Eating poorly.
Tooth loss or mouth pain.
Economic hardship.Reduced social contact.
Multiple medications.
Involuntary weight loss or gain.
Need for assistance in self care.
Elder years (above age 80).
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The Nutrition Care Process
NutritionAssessment
Nutrition Diagnosis Nutrition
intervention
Nutrition monitoringand evaluation
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Nutrition Assessment
Medical, social, and dietary histories.
Anthropometric data.
Biochemical analyses.
Physical examinations.
Will be addressed in further depth in slidepresentation.
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Nutrition Diagnosis
Similar to nursing diagnoses
Stated in format that includes:
A specific nutrition problem
The etiology or cause
The signs and symptoms that provideevidence of the problem
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Nutrition Intervention
Treatments that can improve riskfactors and correct nutrition problems including:
Dietary modifications
Nutrition handouts
Change in medication
Evidenced-based on scientific rationaleand supported by results of high-quality research
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Nutrition Intervention
Goals of nutrition interventions arestated in terms of:
Measurable outcomes results of lab testsor anthropometric data
Positive changes in dietary behaviors andlifestyle
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Nutrition Monitoring and
Evaluation Original goals and outcomemeasures are
Reviewed at previously designateddates
Compared with earlier assessmentdata and diagnoses
If the goals are not metThe care plan must be redesigned
Include motivation techniques or
additional patient education
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Dietary Assessment Methods
The 24-hour recall
Food frequency questionnaire
Food record
Direct observation
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Anthropometric Measurements
Height/length and weight
Height/length and weight can help assess
growth in children and undernutrition andovernutrition in adults.
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Anthropometric Measurements
Length
Measured in infants and children upto age two or three
Height
Measured in older children and
adults
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Anthropometric Measurements
Weight
Body Mass Index (BMI)
Ideal Body Weight (%IBW)
Usual Body Weight (%UBW)
Obtaining a valid weight
Same calibrated scales
Same time of day
Same amount of clothing
After patient has voided
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Anthropometric Measurements
Head circumferenceCan help assess brain growth and
malnutrition in children up to three yearsof age.
To measure encircle the largestcircumference measure of a childs headwith a non-stretchable measuring tapejust above the eyebrows and ears, and
around the occipital prominence at theback of the head
*This measure may not necessarily be reducedin a malnourished child.
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Anthropometric Measurements
Circumferences of waist and limbs
Helps to evaluate body fat and muscle
mass contentWaist circumference correlates with
visceral fat evaluates overnutrition
Limb circumference more sensitive thanbody weight as indicators of muscle loss
In addition, skinfold measurements tocorrect for the subcutaneous fat in limbs
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Anthropometric Measurements
Anthropometric assessment in infantsand children
Monitored and compared with standardreference values on growth charts
Growth charts with BMI-for-agepercentiles used to assess risk ofunderweight and overweight in children
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Anthropometric Measurements
Anthropometric assessment in adults
Values recorded in charts and monitored
Weight loss can indicate malnutrition 10percent weight loss within a six monthperiod is significant
Weight gain may suggest fluid retention worsening of disease state (heart failure,liver cirrhosis, and kidney failure)
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Anthropometric Measurements
Anthropometric assessment in adultsFluid retention can mask weight loss
associated with protein-energymalnutrition.
Changes in body composition mayaccompany illness and aging.
Losses of height and lean tissue are
common in aging.Skinfold measurements and limb
circumferences help identify bodycomposition changes.
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Biochemical Analyses
Help to determine what is happeningto the body internally
Analyses of blood and urine samples,
which contain proteins, nutrients, andmetabolites that reflect nutritionstatus.
Lab values help to present a clearerpicture when utilized with otherassessment data.
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