HA CHAPTER 13: NUTRITION

nutritional status

balance between intake and requirements

undernutrition

• risk for impaired growth and development

• lowered resistance to infection

• delayed wound healing

• longer hospital stays

• higher costs

• vulnerable populations:

  • infants, children, pregnant women, hospitalized patients, recent immigrants, aging adults

overnutrition

• excess calories, sodium, and fat increase risk of heart disease, diabetes, osteoarthritis (weight-bearing on joints), sleep apnea, chronic kidney disease, gallstones, and acid reflux

• obesity = multifactorial

  • obesogenic environment = encourages large portions of high-fat and energy dense food; fails to encourage healthy behavior

findings:

• elevated BMI and waist circumference

• acanthosis

• hypertension

• assess: diet, portions, activity, environment

waist circumference

raises risk when >35in (females), or >40in (males)

BMI categories

<18.5 = underweight

18.5 - 24.9 = normal weight

25.0 - 29.9 = overweight

30.0 - 34.9 = obesity class I

35 = 39.9 = obesity class II

>40 = obesity class III (severe)

undernutrition findings/deficiencies: general

• cachectic: wasting appearance

• edema also signals nutritional problems

• protein-calorie undernutrition

undernutrition findings/deficiencies: skin

• dry, flaking, scaling, petechiae, bruising

• vitamin C/K; general malnutrition

undernutrition findings/deficiencies: hair

• dull, dry, sparse

• protein deficiency, general malnutrition

undernutrition findings/deficiencies: eyes

• plaques

• dryness

• pale (low iron/vitamin B12)

• red conjunctivae (low riboflavin - vitamin B2)

undernutrition findings/deficiencies: lips

• cheilosis (vertical cracks)

• angular stomatitis (sores at corners of mouth)

• vitamin B/iron deficiency; riboflavin (B2)

undernutrition findings/deficiencies: tongue

• glossitis: beefy red tongue

• pale

• low B vitamins (b12) and iron

undernutrition findings/deficiencies: gums

• bleeding gums

• low vitamin C

undernutrition findings/deficiencies: nails

• brittle, ridged (low iron)

• splinter hemorrhages (low vitamin C)

undernutrition findings/deficiencies: musculoskeletal

• pain in legs (low B1→thiamine)

• osteomalacia (low vitamin D)

• rickets= bowing of legs (low vitamin D or calcium)

• joint pain (low vitamin C)

undernutrition findings/deficiencies: neurologic

• hyporeflexia

• disorientation

• irritability

• B vitamin deficiency

MALNUTRITION: VITAMIN C DEFICIENCY

• bleeding gums

• splinter hemorrhages

• bruising/petechiae

• joint pain

MALNUTRITION: B VITAMIN/IRON DEFICIENCY

• glossitis

• cheilosis

• angular stomatitis

• pale conjunctivia

• brittle nails

• neuro irritability

nutrition subjective assessment

• eating patterns - fad diets, religious/cultural patterns

• usual weight - changes? loss/gain (intentional or not)?

• changes in appetite, taste, smell, chewing, swallowing

• nausea, vomiting, diarrhea, constipation

• food allergies/intolerances

• medications and supplements

• protein and fiber intake

• patient centered care: meal preparation, transportation/access to groceries, income for food, mealtime environment

• culture: hinduism → lacto-vegetarianism, islam → halal (no pork), orthodox judaism → kosher (non-slaughtered meat)

tools for nutritional assessment

• malnutrition universal screening tool (MUST)

• mini nutritional assessment (MNA) - older adults

• 24-hr diet recall (not most accurate)

• food frequency questionnaire

• food diaries (not recommended for those w/ anxiety about food intake)

• mobile apps

infants and children nutritional assessment

infants

• breastfed or bottle fed? - poor latch? cyanosis with feeding?

• timing and method of weaning

• introducing solid foods

children

• lifelong food habits form during childhood

• any special likes/dislikes?

• how much they eat

• aspiration education: avoid hot dogs, grapes, nuts, popcorn, round candy