Assessing Nutritional Status

• nutrition


  process by which substances in food are transformed into body tissues and provide energy for the full range of physical and mental activities that make up human life
• Nutritional status


  results from the relationship or balance between nutrient intake and the body's requirements, and the body's ability to digest, absorb, and usethe nutrients
• Optimal Nutritional Status


  The most beneficial nutritional status requires a balance of nutrient intake to meet daily metabolic demands
• 2 types of malnutrition

  undernutrition and overnutrition
• undernutrition


  results from inadequate nutrient intake or nutritional reserves being depleted
• overnutrition


  when the intake of nutrients exceeds the metabolic needsof the body to maintain normal growth, development, and metabolism
• overweight


  10% over ideal body weight (IBW)
• obese


  20% over IBW
• Optimal Hydration


  maintains the hydration of al body systems and organs, affecting every bodily function; maintains urination, bowel elimi- nation, sweating temperature regulation, toxin elimination (affecting liver function), metabolism, enzyme production, nutrient absorption, immune system efficiency, calorie burning efficiency, and health of skin, hair, and nails
• usual recommendation of water consumption

  8 glasses of water, each 8 oz, per day
• best absorption can be taken from

  water in plants
• Dehydration


  after dangerous excess or deficit of various serum electrolyte levels has occurred
• overhydration


  not a problem because the body is effective in maintaining a correct fluid balance; it does this by shifting fluidsin and outofphysiologic third spaces, such as extracellular tissues, the pleural and pericardial spaces, the tongue and the eyeball, and by excreting Auid in the urine, stool, and through respiration and perspiration.
• most common pathogens

  norovirus, Salmonella, Clostridium perfringens, and Campylobacter
• Nutritional assessment


  composedof nutritional screening and a comprehensive nutritional assessment that includes collection of subjective data through a health history interview; collection of objective data, including anthropometric measurements, used to evaluate the client's physical growth, development, and nutritional status; and laboratory tests
• Use Assessment Tool 13-1, Client's 24-Hour Diet Recall.

  Using a 24-hour food recall is an efficient and easy method of identifying a client's intake. However, this tool can only be used with a person who is able to remember all types and quantities of foods and beverages ingested in a 24-hour period.
• physical examination includes


  observing body build, measuring weight and height, taking anthropometric measurements, and assessing hydration
• equipment needed for physical examination


  • Balance beam scale with height attachment or digital scale and height measuring device

  • Metric measuring tape

  • Marking pencil

  • Skin fold calipers
• General Routine Screening

  Assess client's 24-hour intake, nutritional intake, and risk factors for overnutrition or undernutrition, dehydration, or over hydration.

  • Observe client's general nutritional status and appearance.

  • Observe body build as well as muscle massand fat distribution.

  • Measure height and weight.

  • Determine IBW and percentage of IBW.

  • Measure BMI.

  • Observe for changes in hydration:

  • MeasureIand0.

  • Assess skin turgor and moisture.

  • Check for edema.

  • Check venous filling neck veins.

  • Check condition of tongue.

  • Check condition of eyeballs and surrounding skin.

  • Auscultate lung sounds.
• Focused Specialty Assessment

  • Determine waist circumference.

  • Determine waist-to-hip ratio.

  • Measure MAC.

  • Measure TSF.

  • Calculate MAMC (Table 13-1).
• standard reference for Adult MAMC (cm)

  men: 25.3

  women: 23.2
• 90% of standard reference moderately malnourished for Adult MAMC (cm)

  men: 22.8

  women: 20.9
• 60% of standard reference severely malnourished for Adult MAMC (cm)

  men: 15.2

  women: 13.9
• ectomorph


  • small "delicate" frame and bone structure

  • flat chest

  • small shoulders

  • thin

  • lean muscle mass

  • finds it hard to gain weight

  • fast metabolism
• mesomorph


  • athletic

  • generally hard body

  • well-defined muscles

  • rectangular-shaped body

  • strong

  • gains muscle easily

  • gains fat more easily than ectomorphs
• endomorph


  • soft and round body

  • gains muscle and fat very easily

  • is generally short

  • "stocky" build

  • round physique

  • finds it hard to lose fat

  • slow metabolism

  • muscles not so well-defined
• how to measure height

  using the L-shaped measuring attachment on the balance scale. Instruct the client to stand shoeless on the balance scale platform with heels together and back straight, and to look straight ahead. Raise the attachment above the client's head. Then lower it to the top of the client's head.
• if the client cannot stand when measuring height,

  measure the arm span to estimate height. Have the client stretch one arm straight out sideways. Measure from the tip of one middle finger to the tip of the nose. Multiply by two and record the arm span height.
• how to measure weight

  Level the balance beam scale at zero before weighing the client. Do this by moving the weights on the scale to zero and adjusting the knob by tuming it until the balance beam is level. Ask the client to remove shoes and heavy outer clothing and to stand on the scale. Adjust the weights to the right and left until the balance beam is level again. Record weight in kg.
• if you are weighing a client at home

  you may have to use an electronic scale with an automatically adjusting true zero
• Determine ideal body weight (IBW) and percentage of IBW. Use this formula to calculate the client's IBW

  Female: 100 lb for 5 ft + 5 lb for each inch over 5 ft+/- 10% for small or large frame

  Male: 106 lb for 5ft +6 lb for each inch over 5 ft +/- 10% for small or large frame
• formula in calculating the client's percentage of IBW

  Actual weight/IBW * 100= %IBW
• how to measure body mass index (BMI)

  weight in kilograms divided by the square height in meters

  Weight in kilograms/Height in meters2= BMI

  Weight in pounds/Height in inches * 703= BMI
• most commonly used screening method

  BMI
• BMI


  calculated based on height and weight regardless of gender. It is a practical measure for estimating total body fat
• underweight in children


  Less than the 5th percentile
• underweight in adults


  less than 18.5 kg/m2
• normal weight in children

  5th percentile to less than the 85th percentile
• normal weight in adults


  18.5-24.9 kg/m2
• overweight in children


  85th to less than the 95th percentile