Chapter 13

Assessing Nutritional Status

Factors Involved in Nutrition

• Healthy diet should consist of 45% to 65% carbohydrates

with 75% of those carbohydrates being complex.
• Certain diseases, disorders, or lifestyle behaviors can
place clients at risk for undernutrition or malnutrition and
can exacerbate or facilitate disease processes.
• Increased caloric consumption, especially of food high in
fat and sugar, with decreased energy expenditure has led
to near-epidemic obesity. Approximately two thirds of the
adult population in the United States are overweight and
nearly a third of this group is obese.

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Risk Factors for Nutrition Disorders and
Disease LLPC CDLDI

• Lower socioeconomic status (SES), making nutritious

foods unaffordable
• Lifestyle of long work hours and obtaining one or more
meals from a fast-food chain or vending machine
• Poor food choices by children, teens, and adults,
including fatty or fried meats, sugary foods, and few
fruits and vegetables
• Chronic dieting, particularly with fad diets, to meet
perceived societal norms for weight and appearance

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Risk Factors for Nutrition Disorders and
Disease (cont.)

• Chronic diseases (e.g., Crohn disease, cirrhosis, or

cancer) that may interfere with absorption or use of
nutrients
• Dental and other factors such as difficulty chewing,
loss of taste sensation, depression
• Limited access to sufficient food regardless of SES
such as being physically unable to shop, cook, or
feed one’s self

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Risk Factors for Nutrition Disorders and
Disease (cont.)

• Disorders whereby food is self-limited or refused (e.g.,

anorexia nervosa, bulimia, depression, dementia, or
other psychiatric disorders)
• Illness or trauma that increases client’s nutritional needs
dramatically but that interferes with the ability to ingest
adequate nourishment (i.e., extensive burns)

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Interview for Nutritional and Hydration
History
HPFL
• Nutritional screening tools
• Collection of subjective data: The nursing health history
– History of present health concern
– Personal health history
– Family history
– Lifestyle and health practices

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Cultural Considerations

• Approximately one third of the adult population in the United States is

obese, according to data from the Centers for Disease Control and
Prevention (2015b).
• CDC (2015b) noted that the rate for childhood obesity has remained
at approximately 17%, even though there has been a decrease in
obesity in children from 2 to 5 years of age.
• Healthy People 2020 (2016) reviews studies on prevalence of obesity
in the United States.
• The CDC (2015a) also reported that among U.S. adults, the obesity
prevalence is highest for middle-aged people between 40 and 59
years of age, and non-Hispanic Blacks have the highest age-adjusted
rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic
Whites (32.6%), and non-Hispanic Asians (10.8%).

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Cultural Considerations (cont.)

• In addition, approximately 17% children in the

United States between 2 and 19 years of age are
obese.
• Asieba (2016) reports that 33.05% of children in the
United States are overweight or obese, with 39% of
Hispanic children and 37% of non-Hispanic Black
children being obese.

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Physical Assessment

• Overall appearance
• Body build EME OBMF

– Ectomorph
– Mesomorph
– Endomorph
• Muscle mass
• Fat distribution

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Question

Is the following statement true or false?

Waist circumference is the most common measurement
used to determine the extent of abdominal visceral fat in
relation to body fat.

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Answer

True.

Waist circumference is the most common measurement

used to determine the extent of abdominal visceral fat in
relation to body fat.

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Physical Assessment: Equipment

• Balance beam scale with height attachment

• Metric measuring tape
BMMS
• Marking pencil
• Skin calipers

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Anthropometric Measurements

• Height and weight HBW MTM

• Body mass index (BMI)
• Waist circumference
• Mid-arm circumference
• Triceps skin-fold thickness
• Mid-arm muscle circumference

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Importance of Anthropometric
Measurements

• BMI: Estimate total body fat

• Waist circumference: Determine extent of abdominal
visceral fat in relation to body fat
• Mid-arm circumference: Assess skeletal muscle mass
• Triceps skin fold: Evaluate subcutaneous fat stores
• Mid-arm muscle circumference: Evaluate muscle reserve

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Body Mass Index

• BMI = weight in kilograms/height in meters squared

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Height and Weight Changes With Aging

• Wane in fifth decade because the intervertebral discs

become thinner and spinal kyphosis increases.
• Body weight may decrease with aging because of a loss
of muscle or lean body tissues.

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Hydration Assessment WISP SVN

• Weight
• Intake and output
• Skin turgor
• Pitting edema
• Skin for moisture
• Venous filling
• Neck veins in supine position with head elevated 45
degrees

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Hydration Assessment (cont.) TEELB

• Tongue furrows
• Eyeball palpation
• Eye position
• Lung sounds
• Blood pressure

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Factors Affecting Hydration

• Exposure to excessively high environmental

temperatures
• Inability to access adequate fluids, especially water
• Excess intake alcohol or other diuretic fluids
• Taking diuretic medications
• Impaired thirst mechanisms
• High fevers

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Overhydration Signs and Symptoms

• Weight gains of 6 to 10 lb in a week

• Pitting edema
• Visible neck veins
• Cracking lung sounds
• Elevated pulse rate and blood pressure

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Dehydration Signs and Symptoms

• Weight losses of 6 to 10 lb in 1 week

• Tenting
• Filling or emptying of venous filling more than 6 to 10 seconds
• Flat veins in supine client
• Tongue is dry
• Sunken eyes
• Blood pressure decreased with elevated pulse rate
• Radial pulse rate +1 and thready

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Question

Is the following statement true or false?

Dehydration in a healthy person is usually not a problem

because the body is effective in maintaining a correct fluid
balance.

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Answer

False.

In case of overhydration in a healthy person, the body is

effective in maintaining a correct fluid balance.

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Data Analysis

• Physical assessment
• Nursing diagnoses
• Collaborative problems
• Referrals

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