Chapter 11: Nutritional Assessment

 Optimal nutritional status

 Undernutrition
 Overnutrition
 Nutritional requirements at different ages
◦ Children
◦ Adolescence
◦ Adulthood
◦ The aging adult

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 2

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

 Typical day in the life

 Amount and type of food, and fluid
 Purposes of nutritional assessment  Method of preparation
 Nutrition screening  Multiple sources for same nutrients:
◦ Admission nutrition screening tool nutrient dense sources
◦ 24-hour diet recall
◦ Food frequency questionnaire  CLIENT PARTICIPATION=POSSIBLE
◦ Food diaries CHANGE
◦ Direct observation
 Canada’s Food Guide

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

 General appearance
 Vital signs
 Pattern of food preferences & food intake  Skin, hair, mucous membranes, teeth and
 Understanding of a balanced diet gums
 Metabolic state  Height and weight
 Physical indicators of nutritional status  Food intake, preferences
 Cultural , spiritual, social factors  Lifestyle, activity level, energy status
 Physiological status indicators friends, culture
 Knowledge of food and nutrients

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 Eating patterns Balanced scale


 Usual weight  Same scale
Changes in appetite, taste, smell, chewing, swallowing
 Void before weighing

 Recent surgery, trauma, burns, infection
 Chronic illnesses  Same time each day
Vomiting, diarrhea, constipation
 Same type of clothing

 Food allergies or intolerances
 Medications and/or nutritional supplements
 Self-care behaviours
 Alcohol or illegal drug use
 Exercise and activity patterns
 Family history

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

 Equipment needed
 Client stands straight, looks away from ◦ Skinfold calipers—Lange or Harpenden
scale or wall , & shoeless ◦ Measurement tape
 measure top (crown) of head to heels ◦ Anthropometer
 indicator of health status ◦ Pen or pencil
◦ Nutrition assessment data form
 Standardized charts re. weight/height re.
gender and age

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

 Anthropometric measures Weight (kg)

 Body mass index =
◦ Derived weight measures
 Body weight as percent of ideal body weight
Height (m)2
 Percent usual body weight
 Recent weight change

 Waist-to-hip ratio =
Waist circumference
Hip circumference

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

e) Engage in 30-60 mins of physical activity (most

days).
f) Follow food safety handling guidelines.

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Chapter 11: Nutritional Assessment

 http://www.hc-sc.gc.ca/fn-an/food-guide-
aliment/index-eng.php The Abdomen

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

Surface landmarks
Structure and Function


◦ Borders of abdominal cavity
 Subjective Data—Health History Questions ◦ Abdominal muscles
 Objective Data—The Physical Exam  Internal anatomy (viscera)
◦ Solid viscera
 Abnormal Findings  Liver
 Pancreas
 Spleen
 Adrenal glands
 Kidneys
 Ovaries
 Uterus

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

 Internal anatomy (viscera) (cont.)

◦ Hollow viscera
 Stomach
 Gallbladder
 Small intestine
 Colon
 Bladder

© Pat Thomas, 2006.

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

 Abdominal wall divided into four quadrants

◦ Right upper (RUQ)
◦ Left upper (LUQ)
◦ Right lower (RLQ)
◦ Left lower (LLQ)

© Pat Thomas, 2006.

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

 Appetite
 Dysphagia
 Food intolerance
 Abdominal pain
 Nausea/vomiting
 Bowel habits
 Abdominal history
 Medications
 Nutritional assessment

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 Preparation Inspect the abdomen

◦ Lighting and draping  Contour
◦ Measures to enhance abdominal wall relaxation  Symmetry
 Umbilicus
 Equipment needed  Skin
◦ Stethoscope  Pulsation or movement
◦ Small centimetre ruler  Hair distribution
◦ Skin-marking pen  Demeanor
◦ Alcohol swab

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

Auscultate the abdomen

 Bowel sounds
 Vascular sounds (bruits)

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

Percuss the abdomen

 General tympany Palpate the liver
 Liver span  Measures to enhance muscle relaxation
◦ Usual technique  Spleen
 Light palpation
◦ Scratch test
 Deep palpation (not in lab)  Kidneys
 Splenic dullness
 Bimanual palpation  Aorta
 Costovertebral angle
tenderness  Normally palpable structures
 Liver
◦ Usual technique
◦ Hooking technique

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Chapter 11: Nutritional Assessment Chapter 11: Nutritional Assessment

 Measures an individual can follow to protect ◦ Do not mix alcohol and medications
the liver: ◦ Do not use illegal drugs
◦ Practise safe sex ◦ Get vaccinated
◦ Don’t share items that may have bodily fluids on  Be aware of your risk for hepatitis
them ◦ Six hepatitis viruses have been identified, but three
◦ Be aware of your environment hepatitis A (HAV), hepatitis B (HBV) and hepatitis C
◦ Watch your diet and weight (HCV) cause about 90% of acute hepatitis cases in
◦ Travel wisely Canada
◦ Using medications wisely
◦ Do not mix medications without consulting a
healthcare professional
◦ Drink alcohol in moderation

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 Hypoactive bowel sounds A. Palpate that spot last, to prevent pain

 Hyperactive bowel sounds from interfering with the rest of the
examination
B. Palpate that spot first, to avoid
prolonging the patient’s anticipation
C. Avoid that spot entirely, as other
clinicians are going to palpate it after you
D. Palpate in the same order as you always
would, to avoid missing something
because you broke your routine

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