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MOUNT CARMEL COLLEGE OF NURSING
Assessment Guide: Nutritional Status
Assessment
I.
Appearance
Age
Long-standing eating habits may be a factor
in the appearance of a patient who looks
older/younger than his chronological years.
Sex
Height, weight and sex are used to evaluate
condition of normal, over or
weight. Weight status is an indication of
nutritional status. Overweight is a
contributing factor to most illness, e.g.
diabetes, heart diseases. Look at high fat
intake; total calories; exercise patterns.
Suggested weight chart is based on the BMI.
Waist measure is another tool to use for
weight assessment. Risk is associated with
waist measurement greater than 35 inches
for women; 40 for men.
Height
Weight (Compare to weight chart)
Body Mass Index
Skin-tugor, coloring
Eyes and Hair
General alertness/level of
consciousness
II.
Significance
General appearance, including skin coloring,
skin tugor, eyes and hair may be indicators
of nutrition and/or hydration status.
General alertness – level of consciousness
will determine extent of teaching possible or
need for special feeding help.
Nutritional Adequacy of Food Intake
At home – nutrition history
Evaluation of the patient’s nutrition history
It is the best way to determine usual eating
habits which contribute to present nutritional
status.
In hospital
observation of meal intake
Types and amount of foods
actually eaten in the hospital may be
indicators of nutritional status.
Food Allergies/Intolerance
Food allergies may contribute to present
nutritional status and must be considered in
teaching, feeding the patient.
Previous diet restrictions
Previous diet restrictions and the extent of
knowledge about the diet must be assessed
in order to plan appropriate teaching.
-2Alcohol intake
III.
Alcohol intake contributes empty calories in
the diet and may interfere with adequate
nutritional intake and the metabolism of
certain nutrients.
Sociological and Physical Factors Affecting Food Intake
Social and emotional
Degree of socialization influences eating
pattern.
Loneliness decreases appetite and general
interest in eating.
Explore with patient possible ways to
increase degree of socialization – e.g.,
Congregate Meal Program; friends, family.
Emotional status influences food choices
and quantity eaten. May increase or decrease
quantity eaten. Must be resolved before diet
restrictions can be followed.
Eating-related behavior may be of
importance, especially in working with the
overweight, e.g. eating when angry, eating
when lonely, sampling when cooking.
Job related
Job related factors such as type of work,
hours of work, availability of foods
(cafeteria or vending machine) influences
food eaten.
Ethnic and religious
Ethnic and religious and cultural preferences
or restrictions influence foods eaten.
Economic
Economics plays an important role in food
choices especially with those on low
income. Food Stamps can increase amount
of money for food and should be suggested
to those likely to qualify. Storage and
cooking facilities influence food choices.
Physical handicaps
Limitation in available transportation and
physical handicaps including degree of
ambulation affect shopping habits and
preparation of food as well as eating habits.
Investigation of help available for these
purposes should be pursued. Possibility of
“Meals on Wheels.”
-3Pain
Shortness of breath
Condition of mouth teeth-dentures
IV.
Pain will decrease appetite and shortness of
breath will interfere with preparation of
foods as well as eating. Consider the use of
pain medication and rest periods prior to
eating.
Missing teeth or dentures should be
considered. Not having teeth does not
necessarily limit selection of foods. Some
people “gum” very well.
tongue, mucous membrane
Presence of lesions in the mouth, dry
mucous membranes, swollen, infected gums
and coated tongue all decrease appetite for
foods.
Swallowing ability
Swallowing ability must be considered in
choices of foods and their consistency.
Thickeners may be needed. Swallowing
Evaluation by Speech Therapy may be
needed
Constipation
Constipation problems influence food
choices and eating habits. Explore with
patient ways of increasing fiber and fluid
intake.
Diarrhea
Diarrhea means that nutrients are being lost.
Cause needs to be identified. Fluid
replacement is especially important. Fiber
can be a factor here too. Yogurt with active
cultures may be helpful.
Digestion
Presence of conditions which
impair digestive ability
Loss of important G.I. secretions (HCL –
enzymes) will interfere with degree of
digestion.
Loss of part of the G.I. tract (gastrectomy,
ileostomy) will influence completeness of
digestion and absorption. Consider which
nutrients are most affected in specific
situations.
Medications which interfere
with digestion.
Many medications have G.I. disturbing side
effects.
-4Anorexia, nausea and vomiting
Presence of anorexia, nausea and vomiting
will limit availability of foods for digestion.
Foods must be digested in order for nutrients
to be absorbed.
V.
Absorption
Presence of conditions which impair
absorption
Loss of part of the absorptive surface of the
G.I. tract will limit absorption – (Crohn’s
disease, short-bowel syndrome).
Increased speed of passage of contents of
G.I. tract will decrease absorption
(ileostomy, diarrhea).
Medications which interfere with
absorption
Some medications interfere with absorption
and others destroy normal intestinal flora
which aid in digestion and absorption.
Nutrients must be fully absorbed in order to
to available for body utilization.
VI.
Factors Which Alter Nutrient Needs
Increase of metabolism
Increase in need for calories and other
nutrients is present in stress, fever,
infections, wound healing, cancer, burns,
etc.
State of hydration
Replacement of losses in fluids and nutrients
must be considered in situations such as
prolonged diarrhea, burns, hemorrhage,
extensive drainage, malnutrition.
Medications affecting nutrient
needs
Many medications have nutrient interactions
and influence nutrient metabolism.
Altered metabolism
Some conditions, such as diabetes, thyroid
and parathyroid problems alter normal
metabolism of nutrients.
Age
Consider the difference in needs for the
infant, child, teen and for pregnancy and
lactation.
-5VII.
Lab Values Pertinent to Nutrition
Hgb
Low hemoglobin indicates a need for ironrich foods, along with protein. Note factors
that favor/hinder iron absorption.
Serum albumin, pre-albumin
total iron-binding capacity,
transferrin, creatinine
Low serum albumin, pre-albumin and
T.I.B.C. or transferrin may indicate poor
protein status as a result of malnutrition.
High creatinine levels indicate body protein
being broken down – negative nitrogen
balance.
Cholesterol, HDL/LDL ration
Cholesterol and HDL/LDL ratio are
indicators of lipid status and the possible
need for diet altered in total fat, saturated
fatty acids, and cholesterol.
Fasting Blood Sugar (FBS)
Blood glucose levels
High glucose and Fasting Blood Glucose
may indicate altered carbohydrate
metabolism, possible diabetes or
pre-diabetes.
Hg A1c
Hemoglobin A1c indicates degree of blood
sugar control over time.
Total Lymphocytes
Must be calculated from total W.B.C., using
the percent of lymphocytes indicated on the
Differential Test or use Lymph Absolute on
lab sheet. Low levels may indicate poor
immune status – an indicator of
malnutrition.
K and Na
Low potassium levels may relate to general
poor nutrient status, or excessive losses
since K is found in most foods.
High sodium levels may indicate need for
sodium restriction.
NOTE: No one lab value indicates malnutrition. Several low or marginal values are used as
indicators of poor nutritional status.
Blood calcium levels are maintained at the expense of the bone – therefore calcium is not
an indicator of nutritional status.
-6VII.
Medications Affecting Nutritional Status
Diuretics
Diuretics (depending on type) cause
increased retention or loss of sodium or
potassium. Dietary need for these minerals
may be affected.
Iron Medications
Iron medications may cause constipation
and/or GI upset. Better tolerated in
combination with vitamins.
Multivitamins
Multivitamins may be used to supplement
diet. Therapeutic preparations should taken
only on doctor’s order. Does the preparation
taken by the patient actually contain the
nutrients you have found to be low in the
patient’s dietary intake? Caution patient
about danger of high levels of vitamins and
minerals taken as supplements.
Herbal Products
Concern about these products. No
requirement that they are safe or effective!!
“Natural” does not always mean better or
safe!
Others
There are many drug-nutrient interactions.
Most medications have some effect on the
G. I. tract. Note this when looking up drugs
that your patient is receiving.
IX.
Additional Source of Nutrients
Standard IV’s
If patient is receiving I.V. – what nutrients
are provided? How many calories per day?
How does this compare with his actual
needs?
Total Parenteral Nutrition Amino Acids with Dextrose
Fatty Acids
If patient receiving T.P.N. – what is the
order? What nutrients are provided? How
many calories per day? How does this
compare to actual needs?
Tube feeding
If patient receiving tube feeding – which
one? How does the amount being given the
patient in 24 hours compare to actual calorie
needs (and to amount needed for 100%
RDI/RDA according to label on can)? What
is the osmolality of feeding? Does the
patient tolerate the tube feeding?
-7-
Nutritional supplements
X.
If patient receiving nutritional supplements,
Which? Does it provide the nutrients the
patient is not receiving in his usual intake?
Does it take away appetite for the usual
meals?
Other Pertinent Information: Based on Learned Concepts
Family history of diabetes
Is there a family history of diabetes which
would be important to note in an individual
who is already obese and perhaps has a high
FBS?
If patient has diabetes, he/she needs to be on
a diabetic diet. Patient needs to be referred
to a diabetes educator and/or registered
dietitian.
Family history of heart disease
Is there a family history of heart disease
which would be important to note in
situation where patient is obese and has high
serum cholesterol and high fat intake?
Refer to a registered dietitian for help.
Osteoporosis
Is the patient aware of the importance of
calcium intake and exercise on the
development of osteoporosis?
Cancer
Note weight status; appetite. Encourage
patient to eat as part of his/her treatment,
regardless of appetite.
Hypertension
Refer to dietitian. Consider the effect of
obesity, sodium, possibly calcium and
potassium on blood pressure.
Rev: 12/10