ASSESSING NUTRITIONAL STATUS (SIR PAUL)
 Information gathered during the nutritional
assessment provides insight into the client's
overall health status.
 identifies risk factors for obesity and is used to
guide health promotion.
 helps to identify nutritional deficits, which
impacts clients health.
NUTRITION
 Refers to complex processes by which nutrients
are ingested, digested, absorbed, transported,
used, and excreted. For adequate nutrition,
essential nutrients, including carbohydrates,
proteins, fats, vitamins, minerals, and water,
must be ingested in appropriate amounts.
 For adequate nutrition, essential nutrients-
carbohydrates, proteins, fats, vitamins, minerals
and wate- must be ingested in appropriate
amounts.
CARBOHYDRATES
 Composed of Carbon, hydrogen, oxygen
molecules
 Reffered as either simple or complex, depending
on the chemical structure.
 Simple carbohydrates are sugars with simple
structures that raises the blood glucose level and
can be converted quicly into energy.
 Complex carbohydrates, such as
 whole grains are starches that
 slowly convert into energy
Functions of Carbohydrates
1. Chief Source of Energy
2. Protein Sparer
3. Regulator of fat metabolism
4. Sole energy source for the brain and nerve tissue
5. Storage form of energy as glycogen, stored in
the liver and muscles
6. Regulator of intestinal peristalsis and provider of
bulk
PROTEINS
 Essential for normal growth and development
 Made up of amino acids and are stored in the
muscles, skin, bone, blood, cartilage, and the
lymph tissue
 Can be broken down for energy, but protein is a
less efficient form of energy production.
 Plant sources include whole grains, dark green
and yellow vegetables, nuts, and dried beans.
 Animal sources of proteins are dairy products,
meat, fish, poultry, and eggs.
 The recommended dietary allowance for protein
is 10% of the daily dietary intake for adults.
Functions of Proteins:
1. Primary function of protein are growth, repair,
and maintenance of body structures and tissues
2. making hormones such as insuli
3. act as enzymes for chemical reactions such as
digestion
4. found in blood as plasma proteins (albumin) to
maintain fluid and electrolyte balance
5. maintain normal pH balance, help transport
oxygen and lipids in the system
6. function in the immune system to protect from
disease and infection, and assist with clotting.
FATS
Are important part of a healthy, well-balanced
diet.
Stored in adipose cells and are classified as triglycerides,
which make up 95% of fats in foods, phospholipids, or
sterols.
May be classifies as:
1. Saturated fats- originating from animal sources,
or tropical oils, and are solid in room
temperature.
2. Unsaturated fats- originating from plant sources,
and soft or liquid at room temperature.
Functions of fats include:
1. Provide concentrated energy
2. Aids in absorption of fat-soluble vitamins
(A,D,E, and K)
 3. Supplying essential fatty acids for healthy skin
and are needed for growth and development
4. Insulating skin and nerve fibers
5. Protecting internal organs
6. Lubricating skin to slow water loss
The RDA for fats in healthy adults is 20% to35% of total
calories consumed; saturated fats should not exceed 10%
of the total calories.
CHOLESTEROL
Fat-like substance that the liver produces
Important to normal bodily functions:
1. is a component of bile salts that aid in digestion
2. Serves as an essential element in all cell
membranes
3. Production of several hormones such as
estrogen, testosterone, and cortisone.
VITAMINS
Required for energy to be released from carbohydrates,
proteins, and fats.
Necessary for the formation of red blood cells,
hormones, and genetic material , and for a proper
functioning nervous system.
Can be categorized into:
1. Fat-soluble vitamins
2. Water-soluble Vitamins
The RDA is based on the specific vitamins, as well as
age, lifestyle, and health condition.
MINERALS
Essential in promoting growth and maintaining and
maintaining health.
Can be found in all body fluids and tissues
Can be categorized as:
1. Macrominerals
2. Trace Minerals
RDA depends on specific mineral, age, lifestyle, and
health condition of
WATER
Accounts for 50% to 80% of the body weight, varying
based on age, and percentage of fat.
Funtions of Water:
1. Transporting nutrients, electrolytes and oxygen
2. Excreting wastes
3. Regulating body temperature
4. Lubricating joints and membranes
5. Medium for digestion
An average of 2-3L o water is needed by an average
adult.
HYDRATION
 Another important indicator of the client's
general health status, but may be overlooked or
confused with the signs and symptoms of
nutritional changes
Adequate hydration can be affected by various
situations, some examples:
1. exposure to excessively high environmental
temperature
2. inability to access adequate fluids (pts who are
unconscious, confused, physically or mentally
disabled)
3. excessive intake of alcohol, caffeine, carbonated
soft drinks)
4. people with impaired thirst mechanism
5. people taking diuretic medication
6. diabetic clients with severe hyperglycemia
7. people with high fevers
THE PINGGANG PINOY
 The Pinggang Pinoy is a nutrition tool for
preparing healthy food on a per meal basis. It
was developed by the Department of Science
and Technology’s Food and Nutrition Research
Institute (DOST-FNRI).
 The Pinggang Pinoy is intended to guide meal
planners in preparing food that is proportional
according to current nutritional guidelines for
different age groups.

OVERNUTRITION
NUTRITIONAL PROBLEMS
 Nutritional Assessment is crucial due to the
serious health problems resulting from unhealthy
eating habits, inappropriate food choices, and
food availability issues
 Diet related chronic diseases including
cardiovascular diseases, hypertension, diabetes,
various type of cancer, osteoporosis, and
gastrointestinal disorders are heavily influenced
by dietary factors.
MALNUTRITION
DEHYDRATION
 Malnutrition is a condition that results from
eating in a diet, in which one or more nutrients
are either not enough or too much such that the
diet causes health problems.
 The clinical signs and symptoms of malnutrition
are often confused with those of other disease or
conditon, and may manifest only until
malnutrition is profound.
RISK FACTORS FOR MALNUTRITION
1. Lower socioeconomic status
2. Lifestyle of long work/study hours and obtainng
one or more meals from fast food chains/
vending machines
3. Poor food choices
4. Chronic dieting
5. Chronic diseases
6. Dental and other factors such as difficulty
chewing, loss of taste sensation, depression
7. Limited access to sufficient food regardless of
SES
8. Disorders whereby food is self-limited or
refused
9. Illness or trauma that increases client’s
nutritional needs but interferes with the ability to
ingest adequate nourishment.
 Overnutrition is the increase caloric
consumption, especially of food high in fat and
sugar, with decrease energy expenditure.
 Obesity is an excessive body fat, in relation to
lean body mass
 Generally, a person who is 10% over the ideal
body weight(IBW) is considered overweight,
whereas, one who is 20% over IBW is
considered obese.
 However, weight alone is not a completely
reliable criterion. Muscle, bone, fat, and body
fluid can account for excess body weight.
Muscle is heavier than fat, an athlete who has
increased muscle mass may be inaccurately
categorized as overweight when referring to a
standard weight chart.
 is a condition that can occur when the loss of
body fluids, mostly water, exceeds the amount
that is taken in. With dehydration, more water
is moving out of individual cells and then out of
the body than the amount of water that is taken
in through drinking.
 Because the thirst mechanism is poorly
developed in humans, dehydration can develop
unnoticed in normal people, under adverse
conditions. Often people may experience sense
of thirst only after dangerous excess or deficit of
electrolytes has occurred.
 OVERHYDRATION
 usually not a problem because the body is
effective in maintaining a correct fluid balance .
 Clients at risk for overhydration or fluid
retention are those with kidney, liver, and
cardiac disease.
 Clients on humudified ventilation or receiving
large amounts of parenteral fluids without close
monitoring of their hyration status.
HEALTH ASSESSMENT NUTRITION HISTORY
 Nutritional assessment is composed of
nutritional screening and a comprehensive
nutritional assessment that includes collection of
subjective data through a healthy history
interview, collection of objective data, including
anthropometric measurements, used to evaluate
the client’s physical growth, development, and
nutritional status.
 The nurse works closely with the dietician
through consultation and collaboration to
evaluate nutritional status.

NUTRITIONAL SCREENING TOOL

 24-Hour Food Recall is a structured interview
intended to capture detailed information about
all foods and beverages, consumed by the
respondent in the past 24 hours.
 an efficient and easy method of identifying
client's intake, however, this tool can only be
used with persons who is able to remember all
types and quantities of food and beverages
ingested.

Client’s 24‐Hour Diet Recall 
Name:_________________________________  Check which food record:   
Date Taken:_____________________________        Entry 
Pregnant:  Yes    Nursing:  Yes        Exit   

    No        No   

Taking Nutritional Supplements:    Yes  Activity Level:    Less than 30 min. 

      30‐60 minutes 
            No 
Amount Spent on Food last month:___________        More than 60 min. 

MEAL TYPE:   1 = Morning     SERVING ABBREVIATIONS:  Tablespoon   = TBSP   

     2 = Mid‐Morning              Cup     = c  
 
 
 
 
 3 = Noon  
 4 = Afternoon     
      
 
 
 
 
 
 
 
Teaspoon  
Pound    
= tsp 
= lb 
COLLECTING SUBJECTIVE DATA
     5 = Evening                Ounce     = oz  
     6 = Late evening    
Provides valuable information about client’s nutritional
        Slice     = sl   
What did the client eat and drink in last 24 hours? (Be thorough.)  

Foods and Beverages consumed. Describe in detail. List one food per line. 
AMOUNT 
EATEN  
MEAL TYPE   status
Begins with questions of client’s eating habits, and
should solicit information about average daily intake of
food, fluids, types and quantities consumed.
Information is used for the evaluation of client’s health
risk factors, and health education needs
Approach in a respectful, and non-judgmental manner
because self esteem and body issues may arise.
COLLECTING OBJECTIVE DATA
Physical Examination includes observing body build,
measuring weight and height, taking anthropometric
measurements and assessing hydration.
EQUIPMENTS
 Balance Beam Scale with Height Attachment
 Bathroom or Health Scale
 spring scale
 metric measuring tape
 marking pen
 skin fold calipers
ASSESSMENT PROCEDURE
1. Assess General Staus/ Appearance
2. Body Build
Observe body build as well as muscle mass and fat
distribution
There are three different body types which is classified
as Ectomorph, Mesomorph, and Endomorph, however,
not many people fall into one category, usually a
combination.
Ectomorph- lean and angular body shape, long limbs,
slender, slim narrow waist. Can loose weight easily and
have low levels of body fat, but find it difficult to gain
lean muscles.
Mesomorph- strong athletic body type, muscular build,
well developed shoulder, and slim hips. They have a
faster metabolism than the other body types and can
loose weight and gain muscle mass easily.
Endomorph- round body shape, short and tapering limbs,
larger boned than other body types, plump/stocky
appearance, usually with round faces, larger thighs and
hips, small hands and feet and high waist. Have higher
level of body fat than other body types, but can also
easily build muscle. Weight loss is difficult.
3. Anthropometric Measurements
Measuring height and weight
4. Determining the Ideal Body Weight (IBW)
Hamwi’s Method:
Female: 100lbs for 5 ft +/- 5lbs for each inch over 5ft +/-
10% for small or large frame
Male: 106lbs for 5 ft +/- 6lbs for each inch over 5ft +/-
10% for small or large frame
5. Determining the Body Mass Index (BMI)-
calculated based on height and weight regardless
of gender.
6. Determine Waist Circumference- used to
determine the extent of abdominal visceral fat in
relation to body fat.
have the client stand straight with feet together and arms
at the side
place measuring tape snugly around the waist at the
umbilicus, yet not compressing the skin.
instruct client to relax the abdomen and take a normal
breath, when client exhales, record the waist
circumference
7. Determine Waist-to-Hip Ratio
after measuring the client's waist circumference, measure
the hip circumference at the largest area of the buttocks.
to obtain the ratio, divide the waist measurement by the
hip measurement
waist circumference = waist-to-hip ratio
hip circumference
Normal finding: female- less than or equal to 0.80, male-
less than or equal to 0.90
6. Mid Arm Circumference
have the client fully extend and dangle the non dominant
arm freely next to the body.
locate the arms midpoint (halfway between the top of the
acromion process and the olecranon process)
mark the midpoint and measure the MAC.
 6. Measure the Tricep Skin Fold Thickness
evaluate the degree of subcutaneous fat stores.
instruct the client to stand and hang the non-dominant
hand freely.
grasp the skin fold and subcutaneous fat between the
thumb and forefinger midway between the acromion and
the tip of the elbow
pull the skin away from the muscle and apply the
calipers.
repeat three times and take the average, record in mm
ASSESSING HYDRATION
Inpatient setting
Measure the intake and output. Measure all fluids taken
in orally and parenterally, through irrigation tubes,
medications in solutions, and through tube feedings.
Measure all fluid output (urine, stool, drainage from
tubes, emesis)
All setting
weigh clients at risk for hydration changes daily.
take blood pressure and palpate the pulse.
check skin turgor: pinch a small fold of skin, observing
the elasticity, and watch how quickly the skin returns to
its original position.
check for pitting edema