Nutrition FZM (Chap) 12(1)

Chapter 12: Nutritional Assessment

  • Reference: Jarvis, C. (2020)

  • Focus on understanding the osmosis of nutrition with respect to health.

Defining Nutritional Status

  • Nutritional Status: Degree of balance between nutrient intake and requirements.

    • Optimal Nutritional Status: Adequate nutrient intake for daily needs and metabolic demands (growth, pregnancy, illness).

    • Under Nutrition: Nutritional reserves depleted or intake inadequate for daily needs, leading to:

      • Vulnerable groups:

        • Infants

        • Children

        • Pregnant women

        • Recent immigrants

        • Low-income individuals

        • Hospitalized individuals

        • Elderly

    • Over Nutrition: Excess nutrient intake (calories, sodium, fats) leading to obesity.

Under-nutrition

  • Risks for vulnerable groups include:

    • Impaired growth and development.

    • Decreased resistance to infections.

    • Delayed wound healing.

    • Longer hospital stays and increased healthcare costs.

Over-nutrition (Obesity) Statistics

  • Childhood: 17% of children/adolescents (ages 2-19) are overweight.

  • Adulthood: 66% of adults in the US are either overweight or obese.

    • BMI definitions:

      • Children: Overweight = BMI ≥ 95th percentile.

      • Adults: Overweight = BMI ≥ 25; Obesity = BMI ≥ 30.

  • Childhood obesity is linked to adult obesity.

Developmental Competence: Infants And Children

  • Infants:

    • Growth: Most rapid in the lifecycle (birth to 4 months).

    • Milestones: Double weight by 4 months, triple by 1 year, increase length by 50% in the first year, double by 4 years.

    • Breastfeeding recommended for the first year.

  • Children:

    • By 2 years, brain is 50% of adult size; reaches 100% by age 8.

    • Essential fatty acids are critical for CNS growth.

Developmental Competence: Adolescence

  • Characterized by rapid physical growth, endocrine, and hormonal changes.

    • Increased caloric and protein needs—typically requires more than 3 meals/day with healthy foods and drinks.

Developmental Competence: Pregnancy and Lactation

  • Nutritional needs must be higher for synthesis of maternal and fetal tissues.

    • NAS recommends weight gains: 25-35 lbs (normal weight women), 28-40 lbs (underweight), and 11-20 lbs (overweight).

Developmental Competence: Adulthood

  • Nutritional needs stabilize; lifestyle factors may influence health.

Developmental Competence: The Aging Adult

  • Increased risk for either under-nutrition or over-nutrition in older adults due to:

    • Poor physical/mental health

    • Social isolation

    • Alcoholism

    • Limited functional ability

    • Poverty

    • Polypharmacy

Cultural Competence

  • Food customs vary widely across cultures, impacting nutritional status.

  • Immigrants may face nutritional risks due to various factors.

Cultural Factors and Dietary Practices

  • Religious Dietary Practices:

    • Buddhism: Varies by sect; may restrict meat and alcohol.

    • Catholicism: Meat restrictions during specific holy days.

    • Judaism: Foods must be kosher; certain meats and shellfish are restricted.

    • Islam: Prohibition of pork and alcohol.

Subjective Data Assessment

Eating Patterns & Access to Food

  • Collect data on eating habits and any food restrictions due to allergies or cultural practices.

  • Tools:

    • 24-hour food frequency

    • Food diary

    • Diet recall questionnaire

    • changes in diet, smell, chewing, appetite. GI issues and psychological symptoms

Physiological Factors

  • Changes in gastrointestinal symptoms, taste, smell, and appetite can indicate nutritional issues.

Chronic Conditions & Medications

  • Dietary modifications may be necessary due to chronic conditions or medications influencing absorption and dietary needs.

Focused Physical Assessment

Objective Data

  • General Appearance: Signs of fat and muscle wasting, edema, or excess tissue.

Waist-to-Hip Ratio

  • A measure for assessing body fat distribution:

    • Android obesity: Fat concentrated in the abdomen.

    • Gynecoid obesity: Fat concentrated in hips and thighs.

Signs in Skin, Hair, and Nails

  • Assess for rashes, dryness, brittleness, and other signs that may reflect nutritional deficiencies (e.g., Vitamin A, D, K, protein, iron).

  • dry eyes, dull hair, rashes on skin, brittle nails can indicate poor nutrition

Mouth and Oral Cavity Assessment

  • Look for inflammation, smoothness, discoloration, ulcers indicating potential deficiencies (e.g., iron, Vitamin B complex).

  • cheilosis can indicate deficiency in iron and vit b

Musculoskeletal & Neurological Systems

  • Assess posture, strength, movement, and sensation for signs of deficiencies (e.g., protein, several B vitamins).

Classification of Malnutrition

  • Types: Obesity

  • Marasmus not enough calories to function normally

  • Kwashiorkor is protein malnurition

    • Nutritional elements to consider include carbohydrates, fats, proteins, vitamins, and minerals.

Nutritional Consequences of Bariatric Surgery

  • Potential issues: malabsorption of protein/calories, necessitating small nutrient-dense meals, supplementation, and dietary restrictions to prevent blockages.

Laboratory Studies Related to Nutrition

  • Tests include:

    • Plasma glucose levels, HbA1c for average blood glucose monitoring.

    • Hemoglobin, hematocrit for anemia assessment.

    • Albumin for protein status.

    • Cholesterol testing (total and breakdown).

Assessment Question

  • Evaluate the following patients for nutritional deficits:

    • A 5-month-old exclusively breastfed infant.

    • A 2-year-old toddler in the 50th percentile.

    • A 13-year-old female who feels overweight.

    • A 65-year-old female on a fixed income taking multiple medications.