1 dnt 200 nutrition for health sciences nutrition intervention

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DNT 200NUTRITION FOR HEALTH

SCIENCES

NUTRITION INTERVENTION

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Nutrition Assessment• Defining nutrition status

– Assessor gathers information from many sources• Historical data• Anthropometric measurements• Biochemical analysis (laboratory tests)• Physical examinations

– Nutritional assessments define a person’s nutritional status

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NUTRITION INTERVENTIONNutrition Assessment

• Historical data– Health history -- identifies health-related factors that

affect nutrition status• Use records completed by attending physicians, nurses, or other

health care providers• Ask the patient• Include socioeconomic history

– Profoundly affects nutrition status

– Identifies personal, financial, and environmental influences on food intake

– Community customs can help the assessor evaluate nutrition status

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Nutrition Assessment

• Historical data– Drug history -- used to note food-drug interactions

– Diet history• Include

– Portion sizes

– How food is prepared

– Beverage consumption including alcohol

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Nutrition Assessment• Methods

– 24-hour Recall» Provides data for one day only» Usefulness is limited -- does not provide

enough accurate information to allow generalizations to be made about an individual’s usual food intake

» Advantage -- easy to obtain

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24-Hour Recall FormFOOD INTAKE FOR A 24-HOUR RECALL

Name and Address___________________ Date:_____________________

_____________________________________________________________

_____________________________________________________________

Did or do you take vitamin-mineralsupplements?__________________________________________________

If yes, what kind?____________________ Dose:_____________________

Please record the amount and type of foods and beverages consumed today.

Time of Day Food Amount(c, tbs, or piece)

Description (how cooked, how served)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Nutrition Assessment• Methods (con’t)

– Usual Intake» Uses form similar to 24-hour recall» Ask “What is the first thing you usually eat or

drink during the day?”» If data varies widely, the client may have

difficulty in answering the questions resulting in useless data for estimating nutrient intake

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Nutrition Assessment• Methods (con’t)

– Food Frequency Checklist» Purpose -- to determine how often an

individual eats a specific type of food per day, per week, or per month

» If used with a usual intake or 24-hour recall, permits cross checking of information to improve accuracy

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Food Frequency Checklist FormFOOD FREQUENCY CHECKLIST

The assessor helps the client estimate portion sizes and frequency of use.

1. How often do you eat the following foods:Number of Servings Frequency

Bread, toast, rolls,muffinsCereal (type)Rice or other cookedgrainsNoodles (macaroni,spaghetti)Pancakes or wafflesCrackers or pretzelsFruits or fruit juicesVegetables other thanpotatoesVegetable juicePotatoesDried beans and peasBeefPork or ham

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• Methods (con’t)– Food Records (Food Diary)

» Requires time, effort, and a cooperative patient» Record keeper assumes an active role -- may, for the

first time, become aware of personal food habits and begin to assume responsibility for them

» Are particularly valuable for overweight people trying to loose weight

» Major disadvantages- Poor compliance in recording data- Conscious or unconscious changes in eating habits may occur while the person is keeping the record

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• Analysis of food intake data– Informally -- requires a general knowledge of nutrients in the

different food groups– Food composition table

» Does not include data on the amount of nutrients actually absorbed

» May be uncertainty about portion sizes– Provides only a starting point and should be combined with other

sources to confirm or eliminate the possibility of suspected nutritional problems

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• Anthropometric measurements– Are physical measurements that provide an indirect

assessment of body composition and development– Purpose

• Evaluate the progress of growth in pregnant women, infants, children, and adolescents

• Determine under-nutrition and obesity in all age groups

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Nutrition Assessment– Types

• Abdominal girth -- reflects abdominal fluid retention• Height-weight

– Reflects over-nutrition and under-nutrition; growth in children– Can be difficult to evaluate

» Fluid retention can mask significant weight loss» Bedridden patient may be difficult to weigh

• Body mass index -- Especially useful in estimating risk to health associated with over-nutrition

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Nutrition Assessment– Types (con’t)

• Percent IBW, UBW, recent weight change -- reflects over-nutrition and under-nutrition

• Head circumference -- reflects brain growth and development in infants and children under 2

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Nutrition Assessment– Types (con’t)

• Fat-fold -- reflects subcutaneous fat and total body fat

• Mid-arm muscle circumference -- reflects muscle mass (protein status)

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Nutrition Assessment– Should be taken periodically

and compared with standards and previous measurements

– Requires minimal equipment but needs proper instruction and practice to ensure reliability

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Nutrition Assessment• Biochemical analysis

– Are laboratory tests

– Most based on blood or urine samples

– Interpretation requires skill

– No test reflects nutrition status alone

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• Biochemical analysis (con’t)– Assessment of protein-energy malnutrition

• Most commonly used tests– Serum albumin

» Accounts for over 50% of total serum proteins

» When protein status degenerates, serum albumin concentrations tend to decline slowly -- represent prolonged protein depletion

» Correlate well with survival of the hospitalized population

» Increase slowly with appropriate nutritional support -- measurement as an early response to nutritional therapy is of limited value

» Normal value = 3.5 grams/dL or greater

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• Biochemical analysis (con’t)– Total lymphocyte count

» Lymphocytes (white blood cells) are

important participants in the immune response

» Their numbers are reduced as depletion occurs

» Standard is 2,500 per cubic milliliter -- values

below 1,500 are considered depleted

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• Biochemical analysis (con’t)– Serum transferrin

» Is a protein that transports iron -- its

concentrations reflect both protein and

iron status

» Is relatively slow to respond to changes

in protein intake

» Standard is 200 or greater mg per dL

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• Biochemical analysis (con’t)– Prealbumin and Retinol-binding protein

» Measures response to nutrition

therapy

» Respond quickly to changes in

protein intake

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• Biochemical analysis (con’t)– Classifying protein-energy status

• Acute malnutrition (kwashiorkor-type) (protein malnutrition)– Normal or above standard anthropometrics– Below normal indices of blood and organ proteins– Individual may be overweight -- therefore is easily overlooked

• Chronic malnutrition (marasmus-type)– Below standard anthropometrics– Normal or above indices of blood and organ proteins

• Mixed PEM– Below standard anthropometrics– Below normal indices of blood and organ proteins

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• Biochemical analysis (con’t)– Assessments can also reveal

• Energy over-nutrition• Vitamin and mineral

deficiencies and toxicity's• Poor dietary practices

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• Biochemical analysis (con’t)– Assessment of nutritional anemias

• A low hemoglobin or hematocrit level most frequently signals the presence of anemia

• Laboratory tests can pinpoint the cause of anemia and distinguish between nutritional anemia and non-nutritional causes to include blood loss, infections, sickle cell anemia, and chronic liver disease

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Laboratory Tests Useful In Evaluating Nutrition-Related Anemias

Test or Test Result What It ReflectsHemoglobin (Hgb) Total amount of hemoglobin in

the red blood cells. Normaladults = 13.5 g/dL or more(male) and 12 g/dL (female)

Hematocrit (Hct) Percentage of red blood cells inthe total blood volume. Normaladults = 41% or more (male)and 36% (female)

Serum ferritin Low values reflect early irondeficiency anemia withdepleted iron stores. Normaladults = more than 12 ng/ml

Serum folate Progressing folate deficiencyanemia. Normal adults = morethan 6 ng/ml

Serum vitamin B-12 Progressing vitamin B-12anemia

Schilling Test Absorption of Vitamin B-12

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• Physical examination– Most signs are non specific -- can reflect any of

several nutrient deficiencies• Hair -- if dull, brittle, dry, loose or falls out may reflect

PEM• Eyes -- pale eye membranes, spots, redness, adjusts slowly

to darkness may reflect vitamin A, B-vitamins, zinc, and iron status

• Teeth -- missing discolored, decayed, bleeding swollen and spongy gums may reflect mineral and vitamin C status

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Nutrition Assessment• Physical examination (con’t)

• Face -- off color, scaly, flaky, cracked skin may reflect PEM, vitamin A and iron status

• Glands -- swollen at front of neck may reflect PEM and iodine status

• Tongue -- sore, smooth, purplish and swollen may reflect B vitamin status

• Skin -- dry rough, spotty, “sandpaper” feel, sores, lack of fat under skin may reflect PEM, essential fatty acid deficiency, vitamin A, B vitamin and vitamin C status

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• Physical examination (con’t)• Nails -- spoon-shaped, brittle, ridged, pale may reflect iron status

• Internal systems -- abnormal heart rate, heart rhythm or blood pressure, enlarged liver or spleen, abnormal digestion, burning or tingling of hands, feet, loss of balance or coordination, mental confusion, irritability, fatigue may reflect PEM and mineral status

• Muscles and bones -- “wasted’ appearance of muscles, swollen bumps on skull or ends of bones, small bumps on ribs, bowed legs or knock-knees may reflect PEM, mineral and vitamin D status

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NUTRITION INTERVENTIONNutrition Screening

• Uses preliminary nutrition assessment techniques to identify people who are malnourished or are at risk for malnutrition

• Components– Review individual’s diet, drug, and health history -- does it

reveal risk factors for poor nutritional status?– Weigh each person on admission and regular intervals– Check laboratory reports --do they suggest malnutrition?– Look at the person -- are there obvious signs of malnutrition– Check meals -- see if food is being eaten– Communicate problems and follow-up to see that problems

are being managed

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NUTRITION INTERVENTIONIntervention

• The nutrition care process– Is an organized approach to problem solving consisting

of five steps• Assess nutrition status• Analyze assessment data to determine nutrient requirements• Develop plans of action (including client education) to meet

nutrient needs• Implement the nutrition care plan• Evaluate the effectiveness of the nutrition care plan through

ongoing assessment and make appropriate changes as needed

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• Nutrition care plans– Study the information gleaned from

analyzing the nutritional assessment data• Does the diet history show inadequacies?• Is the body weight appropriate?• Are the lab values out of line?

– Generate a problem list (this is the formal basis of the nutrition care plan)

– Include current and past conditions that impair nutrition status

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Intervention• Nutrition care plans (con’t)

– Include areas which may present future problems

– For each nutrition problem, specify the strategies needed to tackle it• Should provide detailed plans for reaching

specific goals• Should be tailored to deal with each nutrition

problem’s cause

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• Nutrition care plan implementation– Provide appropriate diet and education– Maintain daily contact with client and other providers– Care plan may change as medical status changes

• Evaluating nutrition care plans– Are the strategies meeting the needs of the client?– Have events occurred in the client’s life that have

changed the nutrition status or altered the client’s needs?

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NUTRITION INTERVENTIONProfessional Communication Networks

• Professionals communicate through the medical record• The medical record compiles

– History– Diagnosis– Therapy– Prognosis

• Progress notes– Describe new information gleaned from the client, laboratory

tests or other objective measurements– Provide a written assessment of the data and describe the actions

to be taken based on that assessment

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NUTRITION INTERVENTIONProfessional Communication Networks

• Examples of important nutrition-related information found in the medical record– Evaluation of the client’s current diet– Nutrition assessment data– Recommended nutrition therapy– Client’s acceptance and tolerance of the diet– Problems with the client’s food intake– Documentation of diet counseling– Any planned follow-up or referral to another person or agency– Client’s response to nutrition care– Client’s response to diet counseling

1 dnt 200 nutrition for health sciences nutrition intervention

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