Chapter 17 - Nutrition Care and Assessment

Reduced Food Intake: causes

- anorexia d/t illness

- nausea and vomiting

- pain with eating

- difficulty chewing or swollowing

- depression

- inability to feed oneself

What treatments might cause reduced food intake?

- Restrictive diets

- bowel rest

- surgery

- side effect of med

Impaired digestion and absorption: causes and effects

- causes: inflammation associated with bowel conditions, insufficeint secretion of bile enzymes or salt

- effect: altered structure of function of internal mucosa

What treatments might cause impaired digestion and absorption?

- radiation therapy

- GI surgeries

- side effects of meds

Altered nutrient metabolism and excretion: causes and effects

- causes: nutrient losses d/t excessive bleeding, diarrhea, or frequent urination, changes in hydration, prolonged immobilization

- effects: elevated metabolic rate, muscle wasting

what treatments might cause altered nutrient metabolism and excretion?

- chemo

- use of diuretics

- side effect of meds

Preventing or correcting problems

requires ongoing assessment to provide appropriate intervention

Infectious diseases that malnourished people get

measles, malaria, acute respiratory infections, diarrheal diseases, TB

What is the significane of theses diseases

they are the major cause of morbidity and mortality in developing countries

Malnutrition effects on immune function

- increases risk for infection

- infection worsens malnutrition

How can illness and treatment lead to malnutrition

- reduced food intake

- interference with digestion and absorption

- altered nutrient metabolism and excretion

dietary changes during acute illness

- usually temporary

- tailor to individual preferences and lifestyle

Dietary changes for chronic illness

may require long-term dietary modifications

Physician: Responsibility

overseeing all of a patient's medical needs

- prescribes diet orders

- rely on other health professionals to alert them to nutrition problems, suggesting strategies, provide nutritional services

Registered Dietitian Nutritionist (RDN)

- provide medical nutrition therapy

- conduct nutritional and dietary assessments

- nutritional care plans

Nutrition and Dietetic Technician Registered

- work in partnership with RDNs

- assist in implementation and monitoring of nutrition services

- food temp checks

Nurses

- Interact closely with patients so are in an ideal

position to identify who would benefit from nutrition

services

- May screen patients for nutrition problems and

participate in nutrition and dietary

assessments

Info included in a nutritional screening

Admission data, anthropometric data, functional assessment data, historical info, lab test results, s/s

Mini Nutritional Assessment (MNA)

mini screen for malnutrition. The lower the number, the greater the risk

MNA stats

Max = 14

Normal = 12-14

At Risk = 8-11

Malnourished: 0-7

Scored Patient-Generated Subjective Global Assessment: WINED

W: weight

I: Intake

N: Nausea

E: Energy

D: Disease

Scored Patient-Generated Subjective Global Assessment: FLEA

F: Fat loss

L: Lean body mass loss

E: Edema

A: Acietes

Determine Checklist

the higher the score, the worse

Four Components of a Nutritional Assessment

History, Physical findings, anthropometrics, labs

Food intake data methods

- 24 hr recall

- food frequency questionnaire

- food records

- direct observation

Food frequency questionnaire

written or online survey of food consumed during a specific period of time (1 year)

Food records

written account of food consumed over several consecutive days, including a weekend day

76-100%

3/4 of all items eaten. All of three or more basic food groups

51-75%

1/2 to 3/4 of all items eaten. All of two basic food groups

26-50%

1/4 to 1/2 of all items eaten. All of one basic food group

0-25%

bites only. No basic food groups eaten

Refused

nothing eaten

Anthropometric Measurements

Length, height, weight

Obtaining a valid weight

same calibrated scales, same time of day, same amount of clothing, after voiding

BMI: Obese

30 and above

BMI: Overweight

25-30

BMI: Normal

18.5-25

BMI: Underweight

less than 18.5

BMI

weight (kg) / height (m^2)

Simple BMI

(weight (lbs)/height (In.^2)) x 703

Head circumference

assess brain growth and malnutrition in children up to 3

circumference of waist and limbs

- waist circumference correlates with abdominal fat

- circumferences of limbs can help evaluate effects of illness, aging, and PEM on skeletal muscle mass

Waist circumference

Males: 40 inches or over

Female: 35 inches or over

should be less than half of a person's height

Waist hip ratio

waist/hip

Male:

Weight change

10% involuntary weight loss within a 6 month period suggests risk for PEM vs weight gain may suggest fluid retention

Percent weight loss equation

[Usual Body Weight - Current Body Weight x 100] / UBW

percent weight loss meaning

>7.5% in 3 months suggests development of malnutrition

>10% in 6 months considered high risk

Biochemical data (labs)

based on analysis of blood or urine samples. repeated measures more helpful than single values

Estimating energy needs

indirect calorimetry is considered gold standard

Indirect calorimetry

measures resting engergy expendature

- measures O2 consumption and CO2 production

RBC count

Male: 4.3-5.7

Female: 3.8-5.1

Hemoglobin

Male: 14-18

Female: 12-16

Hematocrit

male: 39-39

female: 35-45

WBC

4500-11,000

Total protein

6.4-8.3

Albumin

3.4-4.8

prealbumin

20-40

Malnutrition classifications of edema

No Edema: 0

Edema below the ankles: +

Edema in both feet and legs, below the knees: ++

Edema on both feet, legs, arms, sacral pads, and eyelids: ++

Albumin half life

14-20 days. low levels effect how well the gut absorbs nutrients

Transferrin

Iron-transport protein

- raises as iron status worsens and falls as iron status improves

- half life is 8-10 days

prealbumin half-life

2-3 days

Retinol binding protein half life

12 hr

C-reactive protein

rises in response to inflammation or infection

Normal value:

wound healing nutrients

protein, viamins A and C, mineral zinc

tyrosine

responsible for giving the body pigment

Kwashiorkor

edema due to low albumin

Marasmus

skin and bones

CAGE-AID SUBSTANCE ABUSE SCREENING TOOL

1) every feel the need to cut down?

2) have people annoyed you by criticizing your abuse?

3) ever feel guilty?

4) every felt a need to drink first thing in the morning? (eye opener)

Thiamin deficiency

wet beriberi = HF

dry beriberi = nerve damage

what drops rapidly during PEM

prealbumin and retinol binding protein