NUTRITION (MODULE 4 & 5)
nursing diagnoses, are for- matted to
CRITERIA FOR IDENTIFYING MALNUTRITION
RISK:
Admission data – Age, medical diagnosis,
severity of illness or injury.
Anthropometric data – Height and weight, body
mass index (BMI), unintentional weight changes,
loss of muscle or subcutaneous fat
Functional assessment data – Low hand grip
strength, general weakness, impaired mobility
Historical Information – History of diabetes,
renal disease, or other chronic illness, use of
medications that can impair nutrition status,
extensive dietary restrictions; food allergies or
intolerances; requirement for nutrition support,
depression, social isolation, or dementia.
Laboratory test results – blood test results that
suggest presence of inflammation or anemia
Signs & symptoms – reduced appetite or food
intake, problems that interfere with food intake
(such as chewing or swallowing difficulty or
causes & vomiting), localized or general edema,
presence of pressure sores
NUTRITION CARE PROCESS
Registered dietitians use a systematic approach
to medical nutrition therapy called the nutrition
care process. The steps of this process include
nutrition screening, nutrition assessment,
nutrition monitoring and evaluation, nutrition
diagnosis, nutrition intervention
A. Nutrition assessment - involves the
collection and analysis of health-related
data in order to identify specific
nutrition problems and their underlying
causes. The information may be
obtained from the medical record
B. Nutrition diagnosis - Each nutrition
problem identified by the nutrition
assessment receives a separate
diagnosis, Nutrition diagnoses, similar to
include the specific nutrition problem,
the etiology or cause, and signs and
symptoms that provide evidence of the
problem.
Each Nutrition problem = separate diagnosis
- Format: specific nutrition problem +
etiology or cause + signs/symptoms
- Ex: Unintentional weight loss related to
insufficient kcaloric intake as evidenced
by a 10-pound weight loss in the past
few months
- Can change during the course of an
illness
C. Nutrition Intervention - After nutrition
problems are identified, the appropriate
nutrition care can be planned and
implemented, A nutrition intervention
may include counseling or education
about appropriate dietary and lifestyle
practices, a change in medication, or
other treatment.
- Ex: overweight person with diabetes –
improve blood glucose & weight /
change dietary behavior
D. Nutrition Monitoring & Evaluation
- the effectiveness of the nutrition care
plan must be evaluated periodically: the
patient's progress should be monitored
closely, and updated assessment data or
diagnoses may require adjustments in
goals or outcome measures.
- patient progress & effectiveness of plan
of care
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
NURSING PROCESS: Assessment, Nursing
diagnosis, Outcome identification/planning,
Implementation, Evaluation
Historical information: Medical History,
Medication and Supplement History, Personal
and Social History, Food and Nutrition History
Dietary Assessment - Obtaining accurate food
intake data is challenging, as the results may vary
depending on the individual's memory and
honesty and the assessor's skill and training.
• 24-hour Dietary Recall - interview-
food/beverage consumed in 24 hours
• Food frequency questionnaire - written
survey food consumption in 1 year.
• Food record - food consumed in several
consecutive days, to include weights and
measures of food
• Direct observation- observations of meal
trays before and after eating
➢ Body Wight – Weight loss could be PEM
➢ PROTEIN – ENERGY MALNUTRITION
▪ Marginal energy but insufficient protein
intake
- Kwashiorkor – “the disease that the first
child gets when the new child comes”
- Kwashiorkor - too much fluid in the
body's tissues, which causes swelling
under the skin (oedema)
- Thin end brittle hair, moon face, bulging
abdomen (ascites)
▪ Insufficient protein & energy intake
- Marasmus – “to waste away” or “drying
away”
- Marasmus - severe undernutrition — a
deficiency in all the macronutrients that
the body requires to function / causes
stunted growth in children.
- Thin & brittle hair, Simian facies, Loss of
muscle mass
• Anthropometric assessment in infants &
children height, weight, head circumference
= growth chart
• BMI to age
ESTIMATE AND EVALUATE %UBW and %IBW
%UBW = current weight (pounds) / usual weight
(pounds) x 100
%IBW = current weight (pounds) / ideal weight
(pounds) x 100
BMI – weight (kg) / height x height (metro)
• UNDERWEIGHT – BMI LESS THAN 18.5
• NORMAL – BMI 18.5 to 24.9
• OVERWEIGHT – BMI 25 to 29.9
• OBSES – BMI 30 to 39.9
• EXTREMELY OBESE – BMI 40 & ABOVE
• Skin-fold measurement « determine fat
stores. The most common site for
measurement is the triceps skinfold
• Mid-am circumference MAC measure of
fat, muscle, and skeleton
• Mid-arm muscle circumference (MAMC)
calculated by using the reference tables or
by using a formula that incorporates the
TSF and the MAC. The MAMC is an
estimate of lean body mass, or skeletal
muscle reserves.
• Formula to calculate MAMC: (MAMC =
MAC(cm)-3.143 TSF (mm) / 10
BIOCHEMICAL ANALYSES - protein in enerpy
nutrition, vitamin and mineral status, fluid and
electrolyte balances, and organ function
- Serum proteins-protein energy status
Albumin-most abundant
- Albumin – most abundant
▪ Gauge severity of illness
 ▪ Level fall only when malnutrition is
prolonged
- Transferrin- rise as iron level decreases;
can affect protein evaluation
- Pre-album in and Retinol/binding
protein- decrease rapidly during PEM
and respond quickly to improved protein
intakes
- Mean corpuscular volume – measure
average of RBC Hemoglobin is the
protein in blood. Rbcs are smaller when
they don’t have enough hemoglobin

BODY COMPOSITION

more accurate indicator of ideal body weight

than are weight and height tables in determining
the fatness or leanness of a person.

- adult body = 65% water

- higher in lean persons because muscle
tissue contains more water than fat
tissue
- Minerals- 6% of body weight – bones
- lean body mass can range from 40% to
70%, depending upon size and activity
- Lean body mass decreases with age
*Body fat also fluctuates
- Males - 15% to 30%
- women 20% to 35%

GERIATIC NURTRIONAL RISK INDEX – simple

method to assess nutritional condition, which
utilizes only three objective parameters of body
weight, height, & serum albumin

- useful tool for the assessment of

nutritional status, not only for elderly
patients but also for chronic
hemodialysis patients.