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Assessment of Nutritional Status Sara Mitchell, RN, Ph.D., CPNP November 3, 2006 Nutritional facts The prevalence of obesity has ________in the past 10 year by more that ____ About 97 million adult Americans are overweight or obese More than _______________are overweight Nutritional facts Five of the leading causes of death in this country all diet related 1. 2. 3. 4. 5. Nutritional facts Over the past 30 years portions sizes have increased dramatically. The standard plate size was once 10inches but is now 12 inches Food nourishes the body to: Provide _______for necessary activities Provide for the _______& ________of body tissue _________body processes The Macronutrients Carbohydrates Protein Fat The Micronutrients Vitamins Minerals Electrolytes Resting energy expenditure (REE) Uses the largest proportion of total energy expenditure by the body Physical activity Constitutes the second largest proportion of total energy expenditure by the body Physiologic categories associated with weight loss Category Decreased caloric intake Maldigestion/malabsorption Impaired metabolism/increased requirements Increased losses/excretion Symptoms Diseases Loss of appetite o early satiety Change in taste/dry or sore mouth & tongue Difficulty chewing or swallowing Nausea or vomiting Self imposed diet Social isolation/depression Dysmobility Gingivitis/poor dentition Gastroparesis Obstruction Eating disorder Malignancy Diarrhea Fatty, malodorous stools Change in bowel habits Food particles in stool Pancreatic insufficiency Crohn’s disease Short bowel syndrome Lactose intolerance Celiac disease Fever Increased or decreased appetitie AIDS Pneumonia/sepsis Major surgery or trauma Hyperthyroidism Chronic liver, renal, or pulmonary disease Draining fistulas or open wounds Diarrhea Increased urination Excessive vomiting Burns Occult GI bleeding Hemodialysis Diabetes (glucosuria) Swartz, M.H. (2006) Textbook of Physical Diagnosis and History Examination (8 th ed.) Saunders: Philadelphia, PA Commonly Used Herbs and Their Side Effects Herb Common Use Side Effects & Interactions Echinacea Treatment and prevention of URI’s Rash, pruritus, dizziness St. John’s wort Treatment of mild to moderate depression GI upset, photosensitivity Gingko biloba Treatment of dementia Mid GI distress, headache, possible anticoagulant effects Garlic Treatment of hypertension; hypercholesterolemia; atherosclerosis GI upset, gas, reflux, nausea, allergic reaction, antiplatelet effects Saw palmetto Treatment of benign prostatic hyperplasia Uncommon Ginseng General health promotion High does may cause diarrhea, hypertension; insomnia; nervousness. Siberian ginseng may alter digoxin level Goldenseal Treatment of URI’s Diarrhea, hypertension, vasoconstriction Aloe Topical application for dermatitis, herpes May delay wound healing after topical application; diarrhea and hypokalemia with oral use Valerian Treatment of insomnia, anxiety Fatigue, tremor, headache Swartz, M.H. (2006) Textbook of Physical Diagnosis and History Examination (8th ed.) Saunders : Philadelphia, PA Drugs Commonly associated with weight gain Antidepressants Lithium Antipsychotics Insulin Sulfonylureas thiazolidinediones Phenothiazines butyrophenones Anticonvulsants Valporic acid Carbamazepin Antidiabetics Steroid hormones Corticosteroid derivatives Megestrol acetate Estrogen Questions to guide nutritional assessment Does nutrition contribute to the cause, severity, or treatment of the illness? How has the illness affected the patient’s diet and nutritional status? Does the patient see a relationship between diet and disease? Was the patient ever advised to follow a special diet or use other nutritional therapy? Components of a nutritional assessment Nutritional health History Dietary Assessment Anthropometric measurements Biochemical & laboratory assessment Physical examination Obesity-Focused History 1. 2. 3. Red Flags suggesting an eating disorder Weight preoccupation Poor-self-esteem, perfectionist personality Chronic medical illness Family history of eating disorders Use of appetite suppression and/or laxitives Cultural pressure for thinness or outstanding performance Athlete driven to excel Food cravings, restrictions Compulsive/binge eating Difficulties with communication Special groups of people Infants & Children Adolescents Pregnant Women Older Adults Food practices of some ethnic groups 1. 2. 3. 4. “Hot” & “Cold” foods from a cultural perspective Depending on the “hot” and “cold” nature of the illness, some foods may be avoided. Body Mass Index BMI = weight (kg)/height (meters)2 or BMI = weight (pounds)/height (inches)2 x 703 Obesity defined as a BMI of 25 kg/m2 or higher Waist-to-Hip Ratio Waist-to-hip ratio = Waist circumference ___________________________________________________________ Hip circumference A waist-to-hip ratio of 1 or greater in men or .8 or greater in women is indicative of android (upper body obesity) and increasing risk for obesity-related diseases and early mortality