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Nutrition Care and

Assessment


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2006 Thomson-Wadsworth

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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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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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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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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Length

Measured in infants and children upto age two or three

Height

Measured in older children and

adults


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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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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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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 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 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 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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