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NUTRITIONAL ASSESSMENT
Perdana Samekto T.S., M.Sc, RD

Nutrition scope

Cellular/molecular Organism Community

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Nutritional assessment

CLINICAL NUTRITION COMMUNITY NUTRITION

Nutritional assessment at community level

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Example: Nutrition in Disaster

Wasting
prevalence≥15%
1. Ransom
Serious 2. Supplementary feeding for
vulnerable population, especially
Wasting prevalence situation infants and pregnant women
3. Blanket supplementary feeding
10-14.9%
+ aggravating
factors

Nutritional assessment at clinical setting

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clinical nutrition = hospital

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Nutrition care process

Nutrition screening
• Nutrition screening is the process of identifying characteristics
known to be associated with nutrition problems.
• Its purpose is to pinpoint individuals who are malnourished or at
nutritional risk

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Nutrition assessment
• Obtain adequate information in order to identify nutrition-related
problems
• Systematic process of:
• Obtaining data
• Verifying data
• Interpreting data
• Make decisions about the nature and cause of nutrition related
problems
• Re-assessment at subsequent encounters addresses Monitoring and
Evaluation parameters

Nutrition assessment
• The purpose of nutrition assessment is to obtain, verify, and
interpret data needed to identify nutrition-related problems, their
causes, and significance.
• It is an ongoing, nonlinear and dynamic process that involves data
collection and continual analysis of the patient/client’s status
compared to specified criteria.
• This contrasts with nutrition monitoring and evaluation where food
and nutrition professionals use the same data to determine changes
in patient/client* behavior, nutritional status, and the efficacy of
nutrition intervention

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Critical thinking skills


• Determining appropriate data to collect
• Determining the need for additional information
• Selecting assessment tools and procedures that match the situation
• Applying assessment tools in valid and reliable ways
• Distinguishing relevant from irrelevant data
• Distinguishing important from unimportant data
• Validating the data

Results of Nutrition Assessment


• Leads to appropriate initial determination that a nutrition
diagnosis/problem exists
• If a nutrition diagnosis can be made, the RDN labels the problem
and creates a PES (Problem, Etiology, Signs/Symptoms) statement in
Step 2 of the Nutrition Care Process
• If a nutrition problem is not identified, further information or testing
may be necessary to make a determination
• If the assessment indicates that no nutrition problem currently exists
that warrants a nutrition intervention, the term “No nutrition
diagnosis at this time (NO-1.1)” may be documented

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Results of Nutrition Assessment/


Reassessment
The RDN will determine:
• If a nutrition diagnosis/problem exists
• The plan for continuation of care, specifically:
• Progression through the NCP
• Need for additional information/testing
• Discharge from nutrition care

Data Sources and Tools


• Screening or referral form
• Patient interview
• Medical or health records
• Consultation with caregivers and family
• Community based surveys
• Statistical reports, administrative data,
epidemiological studies

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Nutrition Assessment: THEN

•Anthropometric Measurements
•Biochemical Data, Medical Tests, Procedures
•Clinical-Physical Findings
•Dietary

Nutrition Assessment: NOW

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Nutrition Assessment: NOW


• Food/Nutrition Related History
• Anthropometric Measurements
• Biochemical Data, Medical Tests, Procedures
• Nutrition-Focused Physical Findings
• Client History

Journal of the American Dietetic Association 108, no. 8 (2008)

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Food/Nutrition-Related History
• Food and nutrient intake
• Food and nutrient administration
• Medication
• Complementary/Alternative medicine use
• Knowledge/Beliefs
• Food and supplies availability
• Physical activity
• Nutrition quality of life

Anthropometric Measurements
• Height, weight,
• Body mass index (BMI),
• Growth pattern indices/percentile ranks
• Weight history

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Biochemical Data, Medical Tests, and


Procedures
• Lab data (e.g., electrolytes, glucose)
• Tests (e.g., gastric emptying time, resting metabolic rate)

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Nutrition-Focused Physical Findings


• Physical appearance
• Muscle and fat wasting
• Swallow function
• Appetite
• Affect

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Identifying
Fat
Wasting

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Identifying
Muscle
Wasting

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Identifying
Muscle
Wasting

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Dysphagia

Stroke/Neurological Fracture Esophageal cancer

Dysphagia = difficulty swallowing


Location:
• Oropharyngeal dysphagia, neuromuscular causes are more
frequent
• Esophageal dysphagia, structural causes are far more frequent than
disorders involving nerves or muscles

------------------------------------------------------------------------
• Odynophagia: Pain during swallowing. Cause: Infection or
inflammation in the esophagus

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Signs and symptoms of oral or pharyngeal


dysphagia
• Coughing or choking with swallowing
• Difficulty initiating swallowing
• Food sticking in the throat
• Sialorrhea
• Unexplained weight loss
• Change in dietary habits
• Recurrent pneumonia
• Change in voice or speech (wet voice)
• Nasal regurgitation

Signs and symptoms of esophageal


dysphagia
• Sensation of food sticking in the chest or throat
• Change in dietary habits
• Recurrent pneumonia
• Symptoms of gastroesophageal reflux disease (GERD), including
heartburn, belching, sour regurgitation, and water brash

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Client History
• Personal history
• Medical/Health/Family history
• Treatments and complementary/alternative medicine use
• Social history

Case Study
TERAPI DIET PADA KASUS BEDAH DIGESTIF
Skenario :
Pasien bernama Tn. W, usia 53 tahun adalah seorang petani, lulusan SLTP, datang ke RS dengan keluhan nyeri perut hilang
timbul sejak 1 minggu SMRS disertai mual dan muntah. Pasien memiliki riwayat hipertensi dan orangtuanya juga
mengidap hipertensi. Selama 20 HSMRS pasien tidak nafsu makan dan muntah ketika makan. Pasien BAB terakhir 20
HSMRS. Dua hari setelah masuk RS pasien menjalani operasi pengambilan tumor dan biopsi. Pada hari pengambilan
kasus, diagnosis medis pasien adalah Ileus Obstruksi Parsial ec massa intracolon descenden proximal post laparotomi
eksplorasi dan biopsi hari ke-3. Pasien mengeluh tidak nafsu makan, mual, dan perut terasa nyeri pascaoperasi.
Pascaoperasi, pasien mengeluh tidak nafsu makan dan mengalami nyeri perut ketika makan. Sebelum sakit, pola makan
pasien tidak teratur, sering menunda makan. Pasien makan 2x makanan utama sehari dengan 1-2x selingan. Nasi 2x/hari,
LH: ikan 2-3x/minggu,telur dan ayam jarang, LN: Tempe atau tahu 2-3x/hari, digoreng atau dicampur sayur, buah: jeruk,
pepaya 1-2x/minggu, sayur: daun kelor, daun singkong, atau bayam 1-2x/hari. Pasien jarang minum air putih dan gemar
teh manis/ kopi di pagi hari. Pasien sering mengonsumsi kopi dan merupakan perokok berat.
Hasil pengukuran antropometri didapatkan panjang ulna 26 cm, LLA 25 cm. Hasil pemeriksaan laboratorium adalah
albumin 2,5 g/dl, total protein 5,22 g/dL, Hb 12,4 g/dl, leukosit 13,7 103/uL, neutrofil 74,0 %, MCV 75,4 fL, MCH 22,5 fL,
MCHC 29,8 gr/dl, ureum 55 mg/dL, kreatinin 1,24 mg/dL, BUN 25,7 mg/dL. TD 150/90 mmHg, suhu 36,8ᵒ C, RR 20 x/mnt,
nadi 86 x/mnt. Kesan umum compos mentis, BB pasien turun ± 10% dalam 1,5 bulan Tanda fisik lain hipertimpani (+), BU
(+). Asupan makan pasien sehari sebelumnya 13% energi, 5,6% protein, 10.5% lemak, dan 17.7% KH. Terapi medis yang
diperoleh: infus RL:D5:aminofluid 1:1:1, metronidazol, ceftriaxone, paracetamol, ranitidin

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Summary
• Nutrition Assessment is the first step of the NCP
• Dynamic process that develops throughout the NCP
• Data is used for all other steps of the NCP
• New information may provide reason for
reassessment or change in approach and
intervention

TERIMA KASIH

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