Download Assessment of Nutritional Status

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