NUTRITION CARE

PROCESS
(ADIME PROCESS)

GROUP 2
ASSESSMENT OF NUTRITIONAL STATUS
A. ASSESSMENT OF NUTRITIONAL STATUS
• DIETARY INTAKE DATA

• NUTRIENT INTAKE ANALYSIS

• FOOD DIARY

• FOOD FREQUENCY

• 24 – HOUR RECALL
 WHAT IS NUTRITIONAL STATUS?
The nutritional status of an individual

•is a balance between the intake of the nutrients and

the expenditure of these in processes of growth,
reproduction and health maintenance.

•is influenced by food intake , quantity , quality and

physical health.

The spectrum of nutritional status spreads from

obesity to severe malnutrition.
 NUTRITIONAL ASSESSMENT WHY?
– To obtain precise information on prevalence and geographic
distribution of nutritional problems of given community.

– To identify individuals or populations

who are at risk of becoming malnourished &

who are already malnourished

– To develop health-care programs.

– To measure the effectiveness of nutritional programs and

interventions once initiated.
- An ideal nutritional status occurs when the supply of
nutrients conforms to the nutritional requirements or
needs.

- Diets are rated in quality according to the balance of

nutrients they provide, and not solely on the type of food
eaten or the amount of calorie acid.
 THE NUTRITIONAL STATUS OF AN
INDIVIDUAL HAS CONSEQUENCES:

• An optimal nutritional status is a powerful factor for health

and well being. It is a major, modifiable and powerful element
in promoting health, preventing and treating diseases and
improving the quality of life.

Malnutrition may increase risk of (susceptibility to) infection

and chronic diseases:
- Undernutrition may lead to increased infections and
decreases in physical and mental development, and

- Overnutrition may lead to obesity as well as to

metabolic
syndrome or type 2 diabetes.
 DIETARY INTAKE DATA
• Once all data has been collected, the record of total
intake can be analysed for its nutrient content using one
of several available computerized methods.

Several database choices for estimation of intake vary

by the nutrients analysed. Other data factored in, and
how the data are presented.
The diet history aims to discover the usual food intake
pattern of individuals over a relatively long period of tim.

It is an interview method composed of two parts.

1. The first part establishes the overall eating paver and

includes a 24hr recall: questions such as "What did you
have for breakfast yesterday?" coupled with "What do you
usually have for breakfast?", following through the entire
day in this way,
Subjects are asked to estimate portion sizes in household
measures with the aid of standard spoons and cups, food
photographs or food models.

2. The second part is known as the “cross-check”.This

is a detailed list of foods that are checked with the
subject.
 NUTRIENT INTAKE ANALYSIS
• Nutrient Intake Analysis The NIA is a tool used in various inpatient settings to
identify nutritional inadequacies by monitoring intakes before deficiencies develop.

• Information about actual intake is collected through direct observation or an

inventory of foods eaten based on observation of what remains on the individual's
tray or plate after a meal.

• Nutrient Intake Analysis The NIA is a tool used in various inpatient settings to
identify nutritional inadequacies by monitoring intakes before deficiencies develop.

• Information about actual intake is collected through direct observation or an

inventory of foods eaten based on observation of what remains on the individual's
tray or plate after a meal.
 FOOD DIARY
Food intake (types & amounts)
should be recorded by
the subject at the time of
consumption.

The length of the collection period

range between 1-7
days.
• Reliable but difficult to maintain.
 FOOD FREQUENCY
In this method the subject is given a list of around 100
food items to indicate his or her intake (frequency &
quantity) per day, per week & per month. It is
inexpensive, more representative & easy to use.

Limitations:

• Long questionnaire

• Errors with estimating serving size.

• Needs updating with new commercial food
products to keep pace with
changing dietary habits.
 24 – HOUR RECALL
• A trained interviewer asks the subject to recall all food
& drinks taken in the previous 24 hours.

• It is quick, easy & depends on short-term. memory, but

may not be truly representative of the person's usual
intake

• The individual completes a questionnaire or is

interviewed by a dietitian/ nutritionist or a nurse
experienced in dietary interviewing and is asked to
recall everything that he/she ate within the last 24
hours or the previous day.
PHYSICAL ASSESSMENT
 PHYSICAL ASSESSMENT

A structured physical examination allows the nurse to obtain a

complete assessment of the patient.

Observation/inspection, palpation, percussion and auscultation are

techniques used to gather information. Clinical judgment should
be used to decide on the extent of assessment required.
ANTHROPOMETRIC MEASUREMENTS
• Are noninvasive quantitative measurements of the body.

According to the Centers for Disease Control and Prevention (CDC),

anthropometry provides a valuable assessment of nutritional status in children
and adults. Typically they are used in the pediatric population to evaluate the general
health status, nutritional adequacy, and the growth and developmental pattern of the
child. Growth measurements and normal growth patterns are the gold standards by
which clinicians assess the health and well-being of a child. In adults, body
measurements can help to assess health and dietary status and future disease risk. These
measurements can also be used to determine body composition in adults to help
determine underlying nutritional status and diagnose obesity.
The core elements of anthropometry
Height
Weight
Body Mass Index (BMI)
Body Composition
Mid-arm Circumference (MAC)
Fat-fold for Skin-fold Thickness
HEIGHT
For children who can stand, a stadiometer should be used. The
child should stand up straight, with buttocks, shoulder blades, and
heels together touching the back of the stadiometer. The feet
should face outward at a 60-degree angle. If the patient has genu
valgum, separate the feet enough to avoid overlapping the knees
while maintaining contact between the knees. Arms should be
loosely hanging at the sides with palms facing the thighs. The
horizontal bar of the stadiometer should be lowered until the hair
is compressed to the crown of the head. Remove any objects on
the head and hair that may obstruct the bar from compressing
the hair to the crown of the head. The measurement should be
read to the nearest 0.1 cm or 1/8 of an inch. Repeat the
measurement twice to obtain two readings within 0.2 cm or 0.25
inches. The average of the two closest measurements should be
recorded.
WEIGHT

For children less than two years of age, use

a calibrated beam or a digital infant scale.
Ensure the infant is not wearing any clothes
and remove the diaper before measuring
the weight. The weight should be
measured to the nearest 0.01 kg or 0.5
ounces. For children older than 24 months,
a balanced floor scale or electronic floor
scale can be used.
 Anthropometric measurement in Body Mass Index
(BMI)

BMI is a calculation based on the height and

weight of the child and is recommended by the
CHDP guidelines for all children older than two
years of age.
The formulas for the calculation of BMI in
children are as follows:

● BMI = weight in pounds / [height in inches x

height in inches] x 703
● BMI = weight in kilograms / [height in meters
x height in meters]
 In adults, BMI is used to diagnose obesity as it correlates with
body fat. However, it does not directly measure body fat and has its
limitations when used in isolation. Percent body fat varies with age,
gender, and ethnicity. Percent body fat increases with age even if
the weight stays the same, making it a less accurate measure of
obesity in adults. Also, in athletes, increased muscle mass for a given
height and age will increase their BMI, even though they have a
very low percentage of total body fat.
 BODY COMPOSITION

Anthropometric measurement can be used to estimate

total body fat, regional fat, and fat distribution.
Anthropometric measures of relative adiposity or fatness
are BMI, skinfold thickness, waist, hip, and other girth
measurements.
MID-ARM CIRCUMFERENCE (MAC)
is an easy-to-obtain anthropometric measure as well as a good predictor of risk of
imminent death; it has been used for monitoring the nutritional status of patients in
emergency situations and recommended for the
assessment of acute malnutrition in adults.

FAT-FOLD FOR SKIN- FOLD THICKNESS

use of skinfold thickness to predict body fat is one of the most common field
anthropometric techniques in body composition assessment. Skinfold thickness
has been used extensively as a means for estimating body density and fatness.
Administered correctly, skinfolds can give accurate results.
According to the American Academy of Pediatrics and the Child Health and
Disability Prevention (CHDP) Program Health Assessment Guidelines (guideline
#4), accurate serial anthropometric measurements can help identify underlying
medical, nutritional, or social problems in children. Abnormal anthropometric
measurements, especially in the pediatric population, warrant further
evaluation. Anthropometric measurements can also assess body composition in
athletes; this has been shown to optimize the competitive performance of
athletes and to help identify underlying medical problems, such as eating
disorders. Anthropometry-driven fitness programs in athletes have been
shown to improve cardiorespiratory fitness and strength. Anthropometric
measurements are also used to assess nutritional status in pregnant women and
to assess patients with obesity.
OTHER SOURCES OF DATA
OTHER SOURCES OF DATA

Malnutrition Universal Screening tool (MUST)

This tool is nationally validated and is used to determine someone’s
risk of malnutrition, it is used within care homes hospitals and within the
community.

 Identify the risk factors and consequences of malnutrition

 Know how to screen for malnutrition and calculate ‘MUST’
 RISK FACTORS OF MALNUTRITION
 Acute illnesses

 Constipation, diarrhea, nausea, or vomiting

 Poor appetite

 Anxiety or depression

 Swallowing difficulties

 Ill- fitting dentures

 Poor posture
CONSEQUENCE OF MALNUTRITION
INCREASED RISK OF
 Infection
 Muscle Weaknesses
 Poor wound healing
 Pressure ulcers
 Self-neglect
 Depression
 Falls
 Fatique
 Apathy
 Inactivity
CAN RESULT IN INCREASED
 Dependency

 Medical intervention

 Medication

 Length of hospital stay

 Number of deaths

 Micro deficiencies
 CONSEQUENCE OF DEHYDRATION
MILD SEVERE
• Dark urine • Sunken eyes
• Headache • Confusion
• Dizziness • Irritability
• Tiredness • Rapid weak pulse
• UTI • Cold hands & feet
• Constipation • Reduced skin elasticity
• Poor concentration
• Passing urine less often
UNINTENTIONAL WEIGHT LOSS
 Loose fitting dentures
 Loose jewelery
 Loose clothing
 Thinner limbs
 Loose shirt collar
 Waistbands and belts looser
 Poor wound healing
 Loose slippers and shoes
 Increase in colds and infections
FIVE STEPS “MUST”
Step 1
Body Mass Index (BMI) score
Step 2
Weight loss score
Step 3
Acute disease effect score
Step 4
Overall risk of malnutrition
Step 5
Management Guidelines
STEP 1
Calculating body mass index ( BMI)
BMI- Is measure of body fat (based on height and weight)

___Weight (kg)__
BMI=
height (m2)
74.6 _______
( 1.78 x 1.78)

= 23.6kg/m2
EXAMPLE

A woman has had her full arm amputated. She weighs 54kg. To
correct the weight, 49% of the actual weight should then be
added.
STEP 2: WEIGHT LOSS SCORE

• John current weighs 74.6kg.

• John weighed 86. 9kg. 6 months ago

STEP 3: CALCULATING DISEASE EFFECT
SCORE
This would only apply to people who are critically ill, in a catabolic state,
who have not eaten or are expected to eat for 5 days or more.
(unlikely to happen outside of hospital)

Example include:

Dysphagia, intestinal obstruction, unconsciousness, a head a critical injury

 SUBJECTIVE GLOBAL ASSESSMENT
PRESENTATION
• The SGA is a validated and reliable instrument for detecting nutritional status at a
given point in time.

• Finding from the assessment are mainly subjective, therefore we evaluate a number of
potential indicators of malnutrition to verify a diagnosis:

• Weight Change
• Dietary Intake
• GI Symptoms
• Functional Capacity
• Metabolic Stress
• Physical Examination
WEIGHT CHANGE
• Record

- Height
- Weight
- Usual Body Weight

• Weight changes in past 6 months (pounds vs. %

• Weight changes in past 2 weeks (pounds vs. %

• Assess for changes in fluid status that may mask weight loss/gain.
 CLASIFY WEIGHT LOSS

• If patient lose weight, then begin to gain it back, considered to be at lower risk.

• Patients may be considered well nourished if there is a recent stabilization in weight.

CATEGORIZATION OF WEIGHT CHANGE

- A = No weight loss, non-significant loss with regain

- B = Weight loss present, weight stable, no regain

-C = Significant weight loss, continued loss

 DIETARY INTAKE

• Determine change in oral intake in the previous 2 weeks

- Measured relative to normal intake

- Classified as no change vs. change

• Duration
• % of normal intake
TYPES OF CHANGE

• Suboptimal Solid
• Hypocaloric Solid
• Full Liquid
• Starvation
DIETARY INTAKE
• Categorization of dietary intake

- A = No change; borderline but increasing

- B = Borderline or decreased with no recent increased

- C = Poor and decreasing

 GI SYMPTOMS
Those that have persisted for at least 2 weeks

• Nausea
• Diarrhea
• Anorexia
• Dysphagia • Categorization of GI symptoms

- A = None

- B = 1-2 Symptoms

- C = Multiple symptoms, prolong

 FUNCTIONAL CAPACITY
• Often subjectively classified through patient
interview
ꟷ Difficulty ambulating, feeling fatigued frequently
ꟷ No change
ꟷ Bedridden

• Quantify length of time

ꟷ May perform hand grip assessment to determine
strength • Categorization of functional capacity

-A = No change, improving
-B = Decreased ADLs or poor hand grip strength
-C = Bedridden, progressive decline or unable to
complete hand grip measurement
 METABOLIC STRESS
• Metabolic demands of underlying disease state
- No stress
- Low stress= chronic , non- infected wound
- Moderate stress= sepsis

• Categorization of metabolic stress

- A = No Stress
- B= Below/ moderate stress
- C= High Stress
 PHYSICAL ASSESSMENT
• Determine
 Loss of Subcutaneous fat
Both the fat pads under the eyes and fat stores in the triceps
area can provide physical evidence of subcutaneous fat wasting
 Muscle wasting
Muscle around the clavicle, shoulder and quadriceps can provide
physical evidence of muscle wasting
 Edema/ Ascites

• Examine in context with other findings:

 Do not need to have change in weight to discover significant physical
findings
ꟷ Physical assessment findings are more significant when they
coincide with decrease dietary intake, GI symptoms, functional
status, etc.

ꟷ Normally thin patient may appear to have significant physical

assessment findings, but SGA would be normal without weight
change, decreased dietary intake, etc.
MINI NUTRITIONAL ASSESSMENT
• Guigoz Y & Vellas B (1994) in France

• A validated screening and assessment tool for identifying geriatric

patients at risk of malnutrition

• 15 question & 3 anthropometric measurements screening ( 5 question + 1

measurements ) and assessment ( 10 question + 2 measurements)

• malnourished ( MNA < 17 points), at risk for malnutrition

( 17-23.5 points ) and well nourished (>23.5 points)
 GERIATRIC NUTRITIONAL RISK INDEX
(GNRI)
• Bouillanne et al. ( 2005) Am J Clin
• replaced the usual weight in the formula by ideal weight according to
the Lorentz formula ( Wlo ), creating a new index called the Geriatric
Nutritional Risk Index ( GNRI )
• consider ideal bw and albumin concentration
• GNRI = [ 1.489 x albumin ( g/L ) ]+ [41.7x present bw/ideal bw ( WLo ) ]
• Major risk ( GNRI: <82), moderate risk ( GNRI: 82 TO <92), low risk (
GNRI: 92 TO 98), and no risk ( GNRI:>98)

 For men: WLo = Hꟷ100ꟷ[(Hꟷ150)/4]

 For women: WLo = Hꟷ100[(Hꟷ150)/2.5]
NUTRITION DIAGNOSIS AND PLAN OF CARE
NUTRITION DIAGNOSIS
• Nutritional Problem

- Diagnose problems associated with disease

• Names and describes the problem

- What are you going to solve?

• Problem may already exist, or may be at risk of occurring

• Not a medical diagnosis

NUTRITION Dx DOMAIN: INTAKE
Defined as “actual problem related to intake of energy, nutrients, fluids, bioactive substances
through oral diet or nutrition support (enteral or parenteral nutrition)

Class: Calorie energy balance (weight gain)

Class: Oral or nutrition support intake
- Post operation (type of diet)

Class: Fluid intake balance

- Renal patients

Class: Bioactive substances balance

- Metabolic, someone missing an enzyme

Class: Nutrients balance

-Deficiencies
NUTRITION Dx DOMAINS: CLINICAL
Defined as “nutritional findings/problems identified that relate to medical or physical
conditions

Class: function balance

- Physical or mechanical condition

Class: Biochemical balance

- Ability to metabolize nutrients

Class: Weight balance

- Chronic weight changes
 NUTRITION Dx DOMAINS:
BEHAVIORAL - ENVIRONMENTAL
Defined as “nutritional findings/problems identified that relate to knowledge,
attitudes/beliefs, physical environment, or access to food and food safety.

Class: Knowledge and beliefs

- State of the disease

Class: Physical activity, balance and function

-How they get around/function

Class: Food safety and access

- Economic status
NUTRITION DIAGNOSIS COMPONENTS

Problem - diagnostic label

Etiology – cause, contributing risk factor

Signs/Symptoms

Signs- observable and measurable

Symptoms – what the subject feels/expresses (objective)

PROBLEM
- Describes alterations in patients nutritional status

- Diagnostic labels

- Impaired

- Altered

- Inadequate/excessive

- Inappropriate

- Swallowing difficulty
ETIOLOGY
- Related factors that contribute to problems

- Identifies cause of the problem

- Helps determine whether nutrition intervention will improve problem

- Linked to problem

• excessive calorie intake related to regular consumption of large portion of high-fat

meals

• swallowing difficulty related to stroke

SIGNS/SYMPTOMS

- Evidence

- Linked to etiology
ETIOLOGY

Excessive calorie intake “related to” regular consumption of large

portions of high-fat meals as evidence by diet history and weight status.

Swallowing difficulty related to stroke as evidence by coughing following

drinking of thin liquids.
NUTRITION DIAGNOSIS

Sample of PES statements:

• Excessive calorie intake

• “related to” regular consumption of large portion of high-fat meals

• “as evidence by” diet history & 12 lb wt gain over last 18 mo

NUTRITION DIAGNOSIS COMPONENT

• Food, nutrition and nutrition-related knowledge deficit R/T lack of

education on infant feeding
practices as evidenced by infants receiving bedtime juice in a bottle

• Altered GI function R/T ileal resection as evidenced by medical history and

dumping syndrome symptoms after meals
 NUTRITION DIAGNOSIS STATEMENT
SHOULD BE:
• Clear, Concise

• Specific

• Related to one problem

• Accurate

• Based on reliable, accurate assessment data

NUTRITIONAL VS MEDICAL Dx
MEDICAL DIAGNOSIS NUTRITIONAL DIAGNOSIS

DIABETES Increased blood glucose, increased

carbohydrates intake

TRAUMA AND CLOSED HEAD INJURY Total nutrition support hydration, increased
energy needs

LIVER FAILURE Blood glucose stability (insulin) s/s increased

blood glucose levels
 GENERAL RULES FOR MENU PLANNING
1. Use the whole day as a unit rather than the individual meal. Make breakfast relatively
simple and standardized, than plan dinner lastly, plan lunch and snacks to supplement the
other two meals.
2. Use some food from each of the food groups daily (energy-giving food, body-building
foods, and body-regulating food).
3. Use some raw fruit or vegetables at least once a day.
4. Plan to have for each meal at least one food with staying power or high in satiety value,
one which contains roughage, generally some hot food or drink.
5. Combine or alternate foods of bland form with those of a more pronounced flavor.
6. Combine and alternate soft and crisp foods.
7. Have a variety of color, food, and food arrangement.
8. When more foods are served at one meal, decrease the size of portions and use fewer rich
foods.
SOME DON’T FOR MENU PLANNING

1. Avoid using the same kind of food twice a day without varying the form
in which it is served except staples like rice, bread, and milk.

2. Do not use the same food twice in the same meal even in different
forms.

3. Do not use the same food too often from day to day.
OTHER CONSIDERATION
1. Meal patterns. Meal or menu patterns are help in planning but they must take into
account the family’s habits and needs. For example the traditional pattern for
breakfast recommended by nutritionists are:

Fruit Bread or rice egg or substitute hot beverage

The following is a good menu guide for lunch and dinner:

meat, fish, or poultry rice vegetable fruit or dessert

2. Planning for the week . It is best to have weekly menu plan. In hospitals, the
practice of dietitians is to prepare a so-called “cycle menu”
NUTRITION INTERVENTION
C. Nutrition Intervention

Nutrition intervention involves both planning

and implementing an intervention to improve
the patient & nutritional health outcome,
specifically targeted at the nutrition diagnosis.

The first FOOD AND NUTRIENT DELIVERY is

the most commonly used and often the most
appropriate especially in the clinical setting.
1. Food and Nutrient Delivery

 This most commonly used domain for

nutrition intervention and it entails an
individual approach for providing food or
nutrients to the patient .

There are 6 classes in the domain

 Six Classes in Domain
ENTERNAL & PARENTERAL
MEAL & SNACK NUTRITION
Meal an Accassion when food is eaten and  Enteral is delivered through a tube to your
the snack is a small amount of food that is stomach or to the small intestine while parenteral
eaten. nutrition passes your entire digestive system from
your mouth to anus
 NUTRITION SUPPLEMENTS
Nutritional supplements are product used to
improve the diet and often contain vitamins,
minerals, herb or amino acid.
FEEDING ASSISTANCE
Determine the most appropriate food or
fluid textures to provide adequate intake in
a safe manner while still being placing to the
resident.

MANAGE FEEDING ENVIRONMENT
Example of these is meal location, manage
the prior to the food arriving and remove
any unpleasant odor
NUTRITION RELATED MEDICATION
AND MANAGEMENT
Optimizing drug therapy is an essential part
of nutritional care. The process involved in
prescribing an medication is very common
complex and includes when the drug is
Indicated.
These domain is most often used in the
clinical setting, such as in hospitals and
rehabilitation centers.
FOOD ADMINISTRATION
2. FOOD ADMINISTRATION

A food safety agency or food administration is a kind of agency

found in various countries and international organizations with
responsibilities related to food, primarily with ensuring the safety of
food sold or distributed to the population, and with ensuring that
food sellers inform the population of the origins and health qualities
and risks associated with food being sold.
The Food and Drug
Administration (FDA) is
responsible for protecting the
public health by ensuring the
safety, efficacy, and security
of human and veterinary
drugs, biological products,
and medical devices; and by
ensuring the safety of our
nation's food supply,
cosmetics, and products that
emit radiation.
 ORAL NUTRITION

Oral nutritional supplements (ONS) are nutrition

support products that provide an effective and
non-invasive way for people to meet their nutrition
needs or increase their nutritional intake. People
who take ONS may also be able to eat regular
food but cannot meet all their nutritional
requirements through a regular diet alone and
thus require supplemental nutrition.
ENTERAL NUTRITION
The term, enteral, refers to nutrition
administered via the gastrointestinal
tract. It may be administered orally or
via tube feeding.
 SHORT-TERM ENTERAL ACCESS

Short-term enteral access tubes are placed

into the nares or, sometimes, orally, usually at
bedside. The short-term access provides a
means to meet patient nutrient needs and can
provide a chance to assess tolerance of the
tube feedings if more permanent long-term
placement is determined to be required.
LONG-TERM ENTERAL ACCESS
Long-term enteral feeding requires the
establishment of permanent access to the
stomach or small bowel. The best way of
doing this is normally by introducing a
percutaneous endoscopic gastrostomy
(PEG) tube.
 PARENTERAL NUTRITION

Parenteral nutrition (PN) is the

intravenous administration (feeding into a
vein) of nutrients directly into the systemic
circulation, bypassing the gastrointestinal
tract. PN represents an alternative or
additional approach for nutrition
intervention when nutrition needs cannot
be met from the oral or enteral routes
alone, or are contraindicated.
MONITORING NUTRITIONAL STATUS
MONITORING NUTRITIONAL STATUS

Nutrition Monitoring and Evaluation

The purpose of nutrition monitoring and evaluation is to
determine and measure the amount of progress made for the
nutrition intervention and whether the nutrition related
goals/expected outcomes are being met. The aim is to promote
more uniformity within the dietetics profession in assessing the
effectiveness of nutrition intervention. Nutrition Monitoring and
Evaluation identifies outcomes/indicators relevant to the diagnosis
and nutrition intervention plans and goals.
1. Strategies to Address Age Related Changes Affecting
Nutrition

Strategies/practical Tips

Although there are many reasons why older people may become
malnourished, there are also practical ways for dealing with the problem. If
you or someone you care for is experiencing malnutrition or unintentional
weight loss, the best first step is to see the doctor, who may be able to
diagnose an underlying condition or alter a medication regimen that may be
contributing to the problem. A doctor can also provide a referral to a
registered dietitian, who can design a personalized eating plan. In additional,
here are some everyday tips for preventing malnutrition in older adults.
 . Make Meals and Snacks Nutrient-dense
This means making nutrient-rich foods the focus of the meal. For
example, instead of plain chicken broth, try a hearty chicken and vegetable
soup. Casseroles, stews, and roasts are also good meal ideas.

Add Extra Calories Without Extra Volume

For people who have a small appetite, there are ways to boost nutrition
without adding lots of extra food.
For example:
. Add extra sauces, gravies, and grated cheese to entrees and side dishes.
. Stir powdered skim milk into milk, milkshakes, and cold and hot cereals.
. Add honey, molasses, or maple syrup to hot cereal.
• Use Herbs and Spices When Preparing Foods
Because many elders have diminished sense of taste and smell, making
food as flavorful as possible is important. Try cooking with garlic and onion
powder, salt-free seasoning blends, and fresh and dried herbs, such as basil,
oregano, thyme, rosemary, and cilantro.

• Use Nutrition Supplements When Necessary

While a well-balanced diet is the best bet, some people may find it easier to
sip a nutrition supplement drink than to eat meal. But, talk to your doctor
or dietitian to see if this is something that you should do.
• Serve Several Small Meals and Snacks
Older people with diminished appetites are often overwhelmed by large
meals, so eating smaller, more frequent meals and snacks can be less
overwhelming.

• Make Meals Colorful and Appealing

Instead of regular mashed potatoes, try mashed sweet potatoes for a
colorful and nutritious boost. Instead of plain buttered noodles, try pasta
with a vibrant red tomato sauce.
2. Select Therapeutic Diets
Therapeutic Diets
A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. It
is part of the treatment of a medical condition and are normally prescribed by a physician
and planned by a dietician. A therapeutic diet is usually a modification of a regular diet. In
therapeutics diet, modifications are done in nutrients, texture and food allergies or food
intolerances.
Therapeutic diets are formulated by doctors or dietitians. Some examples of common
therapeutic diets are gluten-free diet, clear liquid diets, full liquid diets, no concentrated
sweet diet, diabetic (calorie controlled)diet, renal diet, low fat diet, high fiber diet, no added
salts diet. Diabetic diet is one of the most common therapeutic diets which involve limiting
high sugar foods to help blood sugar levels.
3. Recording and Reporting of Nutritional
Status
Ways of measuring Nutritional Status

. Anthropometric Measurements Outcome

- height, weight, body mass index(BMI), growth pattern
indices/percentile ranks, and weight history.

- Biochemical data, Medical tests and Procedure Outcomes – lab

test.
EVALUATION
MET

When the planned interventions are implemented, the

patient will respond positively and the expected outcomes
are
achieved.
NOT MET

When interventions do not assist in progressing the patient

toward the expected outcomes, the nursing
care plan must be revised to more effectively address the
needs of the patient.
 TTTNK TOUUUT
PRESENTED BY:
Talbo, Edchel Marie Labaclado, John Benneth Madolid, Mariel

Saac, Angel Cabuenos, Angel Palalon, Dian

Lampera, Christine Mae Angob, Grace Ann