Assessing

Nutritional
Status
Sherwyn Hatab RN.
• What happens when a person doesn’t get
enough or gets too much of a nutrient or
energy?
• If the deficiency or excess is significant over
time, the person experiences symptoms of
malnutrition.
• With a deficiency of energy, the person may
develop the symptoms of undernutrition.
• With a deficiency of a nutrient, the person may experience skin rashes,
depression, hair loss, bleeding gums, muscle spasms, night blindness,
or other symptoms.
• With an excess of energy, the person may become obese and
vulnerable to diseases associated with overnutrition such as heart
disease and diabetes.
NUTRITIONAL ASSESSMENT

• The nutritional assessment is composed of an interview and

anthropometric measurements, which are used to evaluate the
client’s physical growth, development, and nutritional status.
General Nutritional Status Interview

• The nutritional assessment should begin with questions regarding

the client’s dietary habits.
• Questions should solicit information about average daily intake of
food and fluids, types and quantities consumed, where and when
food is eaten, and any conditions or diseases that affect intake or
absorption.
General Nutritional Status Interview

• A 24-hour food recall is an efficient and easy method of identifying a

client’s intake but must be used with an individual who is able to
remember all types and quantities of foods and beverages taken in 24
hours.
• The 24-hour Dietary Recall (24HR) method provides comprehensive,
quantitative information on individual diets by querying respondents
about the type and quantity of all food and beverages consumed during
the previous 24-hour period (Gibson & Ferguson, 2008)
Anthropometric
measurements

• Anthropometric measurements are a

series of quantitative measurements
of the muscle, bone, and adipose
tissue used to assess the composition
of the body.
• The core elements of anthropometry
are height, weight, body mass index
(BMI), body circumferences (waist,
hip, and limbs), and skinfold
thickness.
Anthropometric measurements

• Anthropometric measurements help to evaluate the client’s physical

growth, development, and nutritional status.
• First, height and weight are obtained. By comparing these findings
to a standard table, the nurse can determine the client’s body mass
index (BMI)
Nutritional Problems

• Certain diseases, disorders, or lifestyle behaviors can place clients at

risk for under nutrition or malnutrition and can exacerbate or
facilitate disease processes.
BMI

1. Client height is 5 feet and 7 inches, weight is 84 kg

2. Client height is 4 feet and 11 inches, weight is 49 kg
3. Client height is 6 feet and 3 inches weight is 198 lbs
4. Client height is 5 feet and 4 inches, weight is 121 lbs
Nutritional Problems Risk
Factors
1. Lower socioeconomic status whereby
nutritious foods are unaffordable.
2. Lifestyle of long work hours and obtaining
one or more meals from a fast-food chain or
vending machine.
3. Poor food choices by children, teens, and
adults include lots of fatty or fried meats,
sugary foods, but few fruits and vegetables
Nutritional Problems
Risk Factors

4. Chronic dieting, particularly with fad diets, to

meet perceived societal norms for weight and
appearance
5. Chronic diseases that may interfere with
absorption or use of nutrients
6. Dental and other factors such as difficulty
chewing, loss of taste sensation, depression
Nutritional Problems Risk Factors

7. Limited access to sufficient food regardless of socioeconomic

status such as being physically unable to shop, cook, or feed self.
8. Disorders whereby food is self limited or refused
Clinical Signs and Symptoms of Malnutrition

• The clinical signs and symptoms of malnutrition are often confused

with those of other diseases or conditions. In addition, the signs and
symptoms may not manifest until the malnutrition is profound.
• All of the information should then be evaluated in context to avoid
making judgments based on one or two isolated signs or symptoms.
 Body systems with signs or symptoms and the
implications for each.
Body System or Region Sign or Symptom Implications

General 1. Weakness and fatigue 1. Anemia or electrolyte

imbalance

2. Weight loss 2. Decreased calorie intake,

increased calorie use, or
inadequate nutrient intake or
absorption
 Body systems with signs or symptoms and the
implications for each.
Body System or Region Sign or Symptom Implications
Skin, hair, and nails 1. Dry, flaky skin 1. Vitamin A, vitamin B-complex, or
linoleic acid deficiency
2. Dry skin with poor turgor 2. Dehydration

3. Rough, scaly skin with bumps 3. Vitamin A deficiency

4. Petechiae or ecchymoses 4. Vitamin K deficiency

5. Sore that won’t heal 5. Protein, vitamin C, or zinc

deficiency
6. Thinning, dry hair 6. Protein deficiency

7. Spoon-shaped, brittle, or ridged 7. Iron deficiency

nails
 Body systems with signs or symptoms and the
implications for each.

Body System or Region Sign or Symptom Implications

Eyes Night blindness; corneal Vitamin A deficiency

swelling, softening, or
dryness; Bitot’s spots

Red conjunctiva Riboflavin deficiency

Corneal swelling, Bitot’s spot
 Body systems with signs or symptoms and the
implications for each.

Body System or Region Sign or Symptom Implications

Throat and mouth 1. Cracks at the corner of mouth 1. Riboflavin or niacin deficiency

2. Magenta tongue 2. Riboflavin deficiency

3. Beefy, red tongue 3. Vitamin B12 deficiency

4. Soft, spongy, bleeding gums 4. Vitamin C deficiency

5. Swollen neck (goiter) 5. Iodine deficiency

Cheilosis

• A deficiency of riboflavin can

result in cheilosis, a condition
characterized by sores on the
lips and cracks at the corners of
the mouth.
Beefy red tongue and magenta tongue
 Body systems with signs or symptoms and the
implications for each.

Body System or Region Sign or Symptom Implications

Cardiovascular Edema Protein deficiency

Tachycardia, Fluid volume deficit

hypotension
 Body systems with signs or symptoms and the
implications for each.
Body System or Region Sign or Symptom Implications
GI Ascites Protein deficiency
Musculoskeletal Bone pain and bow leg Vitamin D or calcium deficiency

Muscle wasting Protein, carbohydrate, and fat

deficiency
 Body systems with signs or symptoms and the
implications for each.

Body System or Region Sign or Symptom Implications

Neurological Altered mental status Dehydration and thiamine or vitamin
B12 deficiency

Paresthesia Vitamin B12, pyridoxine, or thiamine

deficiency
 Laboratory Values That Reflect Malnutrition
Laboratory Value Normal Range Abnormal Range Implication
Fasting blood sugar (FBS) Adult: 65–99 mg/dL Pre-diabetes 100–125
or blood glucose level mg/dL
Critical: less than 40 mg/dL
or more than 400 mg/dL

Hemoglobin Males: 13–18 g/dL Males: ≤12 g/dL Increased with dehydration
Females: 12–16 g/dL Females: ≤11 g/dL or
Polycythemia
Decreased in lack of iron,
protein, B12

Hematocrit Males: 40%–52% Males: ≤39% Decreased with

Females: 36%–48% Females: ≤35% overhydration and
(Hct–Hgb ratio is 1:3]) blood loss, poor dietary
intake of iron, protein.
 Laboratory Values That Reflect Malnutrition
Laboratory Value Normal Range Abnormal Range Implication

Serum albumin 3.5–5.5 g/dL Mild depletion: 2.8–3.5 Increased with dehydration
Moderate depletion: 2.1–2.7 Decreased with
Severe depletion less than 2.1 overhydration,
g/dL malnutrition, liver disease

Transferrin 200–400 mg/dL Mild depletion: 150–199 Increased with pregnancy or

Moderate depletion: 100–149 iron
Severe depletion: less than 100 deficiency
Decreased with chronic
infection or cirrhosis
HISTORY OF PRESENT HEALTH
CONCERN

• What are your height and usual weight?

• Have you lost or gained a considerable amount of weight
recently? How much? Over what period of time?
HISTORY OF PRESENT HEALTH CONCERN

• Are you now or have you been on a diet recently? How did you
decide which diet to follow.
• Can you recall what you ate in the last 24 hours?
• Any recent changes in appetite, taste, or smell? Any recent difficulties
chewing or swallowing?
• Have you had any recent occurrences of vomiting, diarrhea, or
constipation?
PAST HEALTH HISTORY

• Do you have any chronic illnesses?

• Have you experienced any recent trauma, surgery, or
serious illness?
 • Are any members of your family obese?
FAMILY HISTORY
• Do any members have heart disease or
diabetes?
LIFESTYLE AND HEALTH PRACTICES

• Does your religion or culture have diet restrictions or requirements?

• What current medications/vitamins/supplements are you taking?
• Do you have sufficient income for food?
• Do you follow an exercise regimen?
 PHYSICAL
ASSESSMENT

• Observe body build as well as muscle mass

and fat distribution. Note body type.
• Ectomorph- characterized as skinny, and
usually tall.
• Mesomorph- characterized as hard,
muscular, thick-skinned, and as having good
posture.
• Ebdomorph- characterized as fat, usually
short, and having difficulty losing weigh
Body Build Normal Findings

• Bilateral muscles are firm and well developed. There is equal

distribution of fat with some subcutaneous fat. Body parts are intact
and appear equal without obvious deformities.
Body Build Abnormal
Findings
• A lack of subcutaneous fat with
prominent bones is seen in the
undernourished.
• Abdominal ascites is seen in starvation
and liver disease.
• Abundant fatty tissue is noted in obesity.
PHYSICAL
ASSESSMENT
• Measure height. Measure the client’s height by
using the L-shaped measuring attachment on
the balance scale.
• Height is within range for age, ethnic and
genetic heritage. Children are usually within
the range of parents’ height.
Height Abnormal
Findings

• Extreme shortness is seen in

achondroplastic dwarfism and
Turner’s syndrome. Extreme
tallness is seen in gigantism.
PHYSICAL
ASSESSMENT

• Measure weight. Level the balance beam

scale at zero before weighing the client.
• Weight does not fall within range of
desirable weights for women and men.
BMI

• Measure Body Mass Index (BMI). BMI is calculated based on

height and weight regardless of gender.
BMI

• BMI alone is not diagnostic of a client’s health status. Because BMI

does not differentiate between fat or muscle tissue, inaccurately
high or low findings can result for individuals who are particularly
muscular or the elderly who tend to lose muscle mass
• The results will be erroneous if the individual is retaining fluid as
with edema or ascites or if the client is pregnant
waist circumference
• Determine waist circumference. Have client stand straight with
feet together and arms at sides. Place the measuring tape
snuggly around the midpoint between the lower margin of the
last palpable ribs and the top of the iliac crest, using a stretch‐
resistant tape. yet not compressing the skin Instruct the client to
relax the abdomen and take a normal breath. When the client
exhales, record the waist circumference.
 Waist circumference

• Waist circumference is the most common

measurement used to determine the extent of
abdominal visceral fat in relation to body fat.
• According to a recent study, adding waist
circumference to body mass index (BMI)
increases the predictive ability for health risk
more so than using BMI alone (Meisinger, et
al, 2006)
Waist circumference

• Women with 35 inches or greater

waist circumference or men with
40 inches or greater waist
circumference are at an increased
risk for such disorders as diabetes,
hypertension, abnormal
cholesterol and triglyceride levels,
and cardiovascular disease
Visceral Fat
• abdominal cavity known as visceral fat is
associated with higher health risks than
subcutaneous fat and may be an independent
predictor of health risks even when BMI falls
within the normal range (Weight-control
Information Network, 2004).
• Adults with large visceral fat stores located mainly around the waist
(android obesity) are more likely to develop health related problems
than if the fat is located in the hips or thighs (gynoid obesity).
• These problems include an increased risk of type 2 diabetes,
abnormal cholesterol and triglyceride levels, hypertension, and
cardiovascular disease such as heart attack or stroke.
• The three “vital signs” of obesity are waist circumference, weight,
and body mass index (McDonald, 2007).
• As with BMI, waist circumference guidelines may not be accurate
with adult clients who are shorter than five feet in height (Defining
Overweight and Obesity, 2004).
waist-hip-ratio (WHR)
• is the dimensionless ratio of the circumference of the
waist to that of the hips.
• This is calculated as waist measurement divided by hip
measurement (W ÷ H)
• The WHR has been used as an indicator or measure of
health, and the risk of developing serious health
conditions.
WHR
• According to the World Health
Organization's data gathering
protocol, the waist circumference
should be measured at the midpoint
between the lower margin of the last
palpable ribs and the top of the iliac
crest, using a stretch‐resistant tape.
• Hip circumference should be
measured around the widest portion
of the buttocks.
Normal WHR according to WHO

0.9 OR LESS IN MEN 0.85 OR LESS FOR

WOMEN
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