nutrition care and assessment

what are three ways in which illness and treatment affect nutrition status

reduce food intake, impaired digestion and absorption, altered nutrient metabolism and excretion

role of MD

responsible for meeting all of the pts medical needs; diet order

role of RN

screen pt for nutrition problems, participate in nutrition and dietary assessments, direct pt care, encourage pt to eat, record pt food intake, answer questions

role of RD

provide medical nutrition therapy, nutrition, and dietary assessment, dx problems, develop/implement/evaluate nutrition care plans, menus, dietary counseling

role of RDT

work in partnership with RD, supervising foodservice operations, inventory, quality control

what info helps ID pt with risk for malnutrition

recent weight loss and change in appetite

6 consensus malnutrition characteristics

unintentional weight loss, evidence of inadequate intake, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, reduced hand grip strength

describe nutrition assessment

collection/analysis of health related data, historical, dietary assessment, anthropometric, biochemical, physical examination

describe nutrition diagnosis

PES, unintentional weight loss, excessive /low kcal intake, issues swallowing

describe nutrition intervention

care plan, counseling, change intake, change medications

describe nutrition monitoring/evaluation

determine effectiveness of plan, follow pt progress, adapt changes

what types of data are included in historical information

age, current complaint, past medical problems, ongoing medical treatments, surgical history, family medical history, chronic disease risk, mental/emotional health

24 hour recall

guided interview, multiple pass (quick list, help to remember foods often forgotten), weakness - may not be typical, inaccurate recall, only for one day

food frequency questionnaire

foods and beverages regularly consumed during a specific time period, weakness - relies on memory, special population groups may not have their foods on the list

food record

diary written account of foods and beverages consumed during a specified time period, usually several consecutive days

direct observation

food intakes directly observed and analyzed 0-100%, nurses conduct pt kcal count

what does ht and wt tell us

BMI

what does waist measurement tell us

body fat

what does head circumference tell us

brain development in infants

what does serum protein tell us

protein-energy status, but also liver function, metabolic stress, and inflammation

what does albumin tell us

gauge severity of inflammation/illness, slow to reflect change, not a sensitive indicator

what does transferrin tell us

increases as iron status worsens and vice versa, not reliable for PEM if iron deficiency is also present, decreases with inflammation

what does pre-albumin and retinol-binding proteins tell us

decreases with inflammation/metabolic stress, decrease rapidly during PEM, respond quickly to improved protein intakes, expensive, not routine

red blood cell count in males

4.3-5.7

red blood cell count in females

3.8-5.1

hemoglobin in males

13.5-17.5

hemoglobin in females

12-16

hematocrit in males

39-49%

hematocrit in females

35-45%

mean corpuscular volume

80-100 this helps to distinguish microcytic and macrocytic anemia

MCHC

31-37%

where do signs of malnutrition first appear

where cells are quickly turned over (GI, skin, and hair)

edema

fluid retention, infection, injury, or use of certain meds, impaired circulation, organ dysfunction, diseases of the heart

physical signs of edema

weight gain, facial puffiness, swelling of limbs, abdominal distension, tight fitting shoes

causes of dehydration

vomiting, diarrhea, fever, sweating, excessive urination, blood loss, injuries to skin

symptoms of dehydration

thirst, weight loss, dry skin or mouth, reduced skin tension, dark yellow/amber urine, low urine volume