NUTRITIONAL ASSESSMENT

Signs of Good Nutrition

1. alert; responsive general appearance

2. Shiny, lustrous hair, healthy scalp
3. No enlargement in neck glands
4. Smooth slightly moist, good skin, face & neck color:
reddish pink mucous membrane
5. Bright, clear eyes, no fatigue circles
6. Moist lips w/ good color, no cracks at corner
7. Pink color tongue, firm, no swelling or bleeding
8. Straight no crowding, clean teeth, no discoloration,
well-shaped jaw
9. Smooth, good color, moist skin
10. Flat abdomen, no bloating
11. No tenderness weakness of legs & feet, and swelling
12. No skeletal malformation
13. Normal height & weight age & body build
14. erect posture, arms & legs straight, and in, chest out
15. Well-developed firm muscles
16. Nervous control: good attention span for age
17. Cheerful disposition: doesn't cry easily, not irritable 2. Body Composition
nor restless A. measurement of fat mass (fatness)
18. Good appetite & digestion; regular bowel &
urination The body mass index (BMI) or Quetelet index is a value
19. Gen. Vitality; energetic, vigorous, doesn't get tired derived from the mass (weight) and height of a person. The
easily BMI is defined as the body mass divided by the square of the
20. Sleeps well at night body height, and is universally expressed in units of kg/m2,
resulting from mass in kilograms and height in meters.
Nutritional assessment can be done using the ABCD
method: Calculating a patient's BMI

A. Anthropometric Measurement BMI = weight in kg

B. Biochemical or Biophysical methods
height in m2
C. Clinical methods
D. Dietary Methods PRACTICE
A. Anthropometric measurement Gina is 1.6 metres tall and weighs 70 kilograms
is the measurement of variations of the physical dimensions 70 = 70 = 27.34 = 27
and gross composition of the human body at different age
levels and degree of nutrition 1.6 x 1.6 2.56

1. Height and weight (for infant length and to include head

circumference)

• Head circumference s useful in assessing chronic

nutritional problems in children under 2years old.

Weight-for-age -is an index used in growth monitoring for

assessing children who maybe underweight

 -a sensitive indicator of current nutritional

status

Height-for-age-is an index for assessing stunting

• -less sensitive to change in growth rate.

Weight-for-height is an index use for assessing wasting (acute

malnutrition)

-most curate indicator of present or current state of nutrition.

B. measurement of fat-free mass (muscle mass)
• it is also very simple to use in screening a large
number of people. Therefore, use as a screening tool
for community based nutrition programs such as
outpatient therapeutic program (OTP).
• is the only anthropometric measure to assessing
nutritional status among pregnant woman.
• also used for screening target children and pregnant
women for severe acute malnutrition (SAM) and
moderate acute malnutrition (MAM).
an accurate way to measure fat-free mass is to measure the
mid upper arm circumference (MUAC)
C. skinfold thickness
this test estimate the percentage of body fat by measuring
skinfold thickness at specific locations on the body.
The seven (7) locations on the body
1. Triceps - The back of the upper arm
2. Pectoral - The mid-chest, just forward of the armpit
3. Subscapular - Beneath the edge of the shoulder blade 4.
Midaxilla - Midline of the side of the torso
4. Abdomen - Next to the belly button
5. Suprailiac - Just above the iliac crest of the hip bone
6. Quadriceps - Middle of the upper thigh
B. Biochemical Method
• Based on laboratory analyses of blood & urine
• Objective results
• Useful for diagnoses & therapy
• Laboratory test base on blood and urine can be
important indicators of nutritional status.
limitations of biochemical method
• Skilled personnel
• Expensive Analytical equipment
• Can't be applied on large scale
• No single test to evaluate short-term response to
medical nutritional therapy
• Lab test to be conducted several times over a certain
period
• Used in conjunction w/ the other methods
BIOCHEMICAL ANALYSES -protein energy nutrition, vitamin
and mineral status, fluid and electrolyte balances, and organ
function.
Serum proteins-protein energy status
Albumin-most abundant serum protein gauge severity of
illness
Transferrin-iron-transport protein-iron status, PEM
Pre-albumin and Retinol-binding protein decrease rapidly
during PEM and respond quickly to improved protein intakes
C. Clinical Method
• Provide information about the individual's medical
history, including acute and chronic illness and
diagnostic procedures, therapies or treatments that
may increase nutrient needs or induce
malabsorption.
• Simplest & practical method of ascertaining
nutritional status
• Medical- history & physical examination
• check signs of deficiency at specific places on body
or asking patient for any symptom suggesting
nutrient deficiency from the patient.
Physical Examination
a) Clinical Signs of Malnutrition-hair, skin, eyes, lips,
nails, mouth and gums
b) Hydration Status- fluid imbalances- fluid
retention/dehydration
c) Functional Assessment-hand-grip strength= wasting
(loss of muscle tissue)
D. Dietary Data
• During the nutrition interview the practitioners may
ask what the individual ate during the previous
24hrs.
• Nutritional intake measured through:
1.24 hour recall.
• -determine overall usual eating pattern
• Ask client recall actual intake for the past 24 hr.
Limitations: Depends on memory of informant. Ability to
estimate serving portions
• Best followed by food frequency questionnaire
2. Food frequency questionnaire
• List of specific food items to record intakes over a
given period (frequency per day, week,month)
 It is for use in hospitals, community and other care settings
and can be used by all care workers.

3. Three, five, seven day records (Food Diary)

• Prepared by client for the next day's intake.

• covers days when informant has different meal
patterns over the weekend

• Week's record for patient requiring to stabilize

dietary regimen, if under nutritional therapy obesity,
food allergies or uncontrolled DM)
• Reliable but difficult to maintain

4. WEIGHED FOOD RECORD OBSERVATION OF FOOD

INTAKE).

• More involved method

• Food consumed over a defined period is weighed.
• Samples be saved individually composite-nutrient
analysis

Limitations:

CALCULATING AND INTERPRETING THE % DEVIATION

FROM USUAL BODY WEIGHT AND % WEIGHT LOSS
CALCULATING % USUAL CALCULATING %WEIGHT
BODY WEIGHT LOSS
% USUAL BODY WEIGHT %WEIGHT LOSS=
Current weight x100 U.W -Current weight x100
Usual body weight U.W

Mild malnutrition 85-90% USUAL WEIGHT =U.W

Moderate m. 75-84% Severe weight loss
Severe m. less than 74% >5% over 1month
>7.5% over 3 months
>10% over 6 months

• Tendency of subject to change usual pattern Subjective Global Assessment

(simplify weighing/impress investigator).
• motivated & willing participants
• Expensive.
• For metabolic balance studies or controlled lab
experiments
Malnutrition Universal Screening Tool
• . is a simple bedside method of assessing the risk of
malnutrition and identifying those who would
benefit from nutritional support.
• is a proven nutritional assessment tool that has been
found to be highly predictive of nutrition-associated
complications.

'MUST' is a five-step screening tool to identify adults, who are

malnourished, at risk of malnutrition (undernutrition), or
obese. It also includes management guidelines which can be
used to develop a care plan.
* SGA fulfils the requirements of a desirable system of Mini Nutritional Assessment
nutritional assessment by:
• Is a validated nutrition screening and assessment
• Identifying malnutrition tool that can identify geriatric patients age 65 and
• Distinguishing malnutrition from a disease state above who are malnourished or at risk of
• Predicting outcome malnutrition.
• Identifying patients in whom nutritional therapy can • the most well validated nutrition screening
alter outcome
GERIACTRIC NUTRITIONAL RISK INDEX -simple method to
assess nutritional condition, which utilizes only three
objective parameters of body weight, height and serum
albumin. useful tool for the assessment of nutritional status,
not only for elderly patients but also for chronic
haemodialysis patients.
is a simple but useful tool to assess nutritional status in
chronic haemodialysis patients. Our study demonstrates that
lower GNRI is a significant predictor for mortality in these
patients.
Nutrition Care Process
• is a systematic approach to providing high-quality
nutrition care.
• the process provides a framework for the RDN to
individualize care, taking into account the
patient/client's needs and values and using the best
evidence available to make decisions.
• -nutrition care can be planned and implemented.
• -counseling, education
• -consider=food habits, lifestyle, other personal
factors
• -goals stated
• Ex. overweight person with diabetes-improve blood
glucose & weight
- change dietary behavior
4. Nutrition Monitoring and Evaluation
• -achieved the goals
• -making progress towards the planned goals
• -effectiveness of plan of care
• -adjustment of goals Exchange in medical treatment
or new medication- alter tolerance to food

1. Nutrition Assessment

The RND collects and documents information such as: food or

nutrition related history, biochemical data, medical record,
physical examination, laboratory analyses, medical
procedures, an interview with the patient or caregiver,
consultation

2. Nutrition Diagnosis

• -Data collected during the nutrition assessment

guides in selection of appropriate nutrition
diagnosis.
• Each nutrition problem = separate diagnosis
• -formatted to include the specific nutrition problem,
the etiology or cause, and signs and symptoms
• Ex. "Unintentional weight loss (the problem) related
to insufficient kcaloric intake (the etiology or cause)
as evidenced by a 10-pound weight loss [8 percent of
body weight in the past few months (the sign or
symptom)."
• -can change during the course of an illness

Nursing Diagnoses with Nutritional Implications

• Chronic confusion
• Chronic pain
• Constipation
• Diarrhea
• Disturbed body image
• Feeding self-care deficit
• Imbalanced nutrition less than body requirements
• Imbalanced nutrition: more than body requirements
• Impaired dentition
• Impaired oral mucous membrane
• Impaired physical mobility
• Impaired swallowing
• Insufficient breast milk
• Nausea
• Readiness for enhanced nutrition
• Risk for aspiration Risk for deficient fluid volume
• Risk for unstable glucose level

3. Nutrition Intervention

• -selects the nutrition intervention that will be

directed to the root cause of the nutrition problem
and aim in alleviating the signs and symptoms of the
diagnosis