Nutritional Assessment

Nutritional assessment is focused on:

The amount of food and fluids consumed in relation to metabolic needs.

The degree to which the body demonstrates that the ingested nutrients are adequately used.

Consider the entire nutritional pattern

The fact that a person’s nutritional intake is 2200 kcal/day does not in itself provide information about the physiologic status of nutrition.

Wound healing Increased exercise Poor nutrition

Factors to Assess in Evaluating Nutrition and Metabolism:

General appearance Pattern of food and fluid intake Understanding of a balanced diet Cultural and psychosocial factors affecting

diet Metabolic state Physiologic alterations associated with

nutritional dysfunction Physical indicators of malnutrition

The Health History

General information about food and fluid consumption

Food and fluid intake data Activity level Psychosocial, cultural, and personal

influences on consumption The person’s knowledge of nutrition Pertinent physiologic alterations

General Information

How the patient perceives his weight Impaired nutrient ingestion Whether the patient is following a

special diet

Food and Fluid Intake

Ask for a food recall Types of food Amounts of food Where eaten Why eaten

Activity Level

Important because it influences nutritional requirementsExercise patterns—frequency and

intensityOccupation—sedentary (office worker)

or active (construction worker)

Psychosocial/Cultural/Personal Influences

Personal preference Economic factors Ethnic background Religious beliefs (e.g. kosher diet) Nonreligious beliefs (e.g. vegetarian)

Nutrition Knowledge

Assessing the patient’s knowledge of nutrition is helpful because malnutrition may be related to a lack of awareness about food nutrient values.Fad dietsFood preparation

Physiologic Alterations

Many diseases interfere with the basic nutritional process of ingestion, digestion, absorption, transport, and metabolism.

Drugs can alter nutritional and metabolic states.

The Physical Examination

Goals: To determine the status of the

nutritional processes of ingestion, digestion, absorption, transport, and metabolism.

To identify signs of altered nutrition.

The Physical Examination

General inspection Anthropometric assessment Examination of the skin, hair, and

nails Examination of the oral cavity Examination of the abdomen Examination of the thyroid gland

General Inspection

Subcutaneous fat distribution Skeletal muscle mass Skin integrity

Body Composition Assessment

Used to evaluate nutritional status. Include hydrostatic weighing,

anthropomorphic assessment, BMI, and skin fold measurements.

Skin, Hair, and Nails

Skin: jaundice (liver disease) Hair: loss (protein deficiency) Nails: spooning (iron deficiency

anemia)

Examination of the Oral Cavity

Oral mucosa Tongue and taste buds Teeth Palate Oropharynx

Abdominal Assessment

GI motility (bowel sounds) Peritoneum Vasculature

Thyroid Gland

The primary function of the thyroid gland is to regulate the metabolic rate.

Questions?