nhhc chapter 13 powerpoint
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Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Careand Assessment
Chapter 13
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition in Health Care
• Correcting nutritional problems– May improve outcomes of medical treatments
and help to prevent complications• Poor nutrition status
– Weakens immune function– Compromises a person’s healing ability
• What are ways in which illness can affect nutrition status? (Figure 13-1)
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition in Health Care (cont’d.)
• Illnesses and their treatments may lead to malnutrition– Causing a reduction in food intake– Interfering with digestion and absorption– Altering nutrient metabolism and excretion
• Dietary changes for acute illness– Temporary; can be tailored to individual’s
preferences and lifestyle
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition in Health Care (cont’d.)
• Dietary changes for chronic illness– May require long-term adjustments in diet and
lifestyle• Challenges to nutritional status
– Health care costs: drain of financial resources– Insufficient space and equipment– Lack of strength and energy– Emotional health
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition in Health Care (cont’d.)
• Responsibility for nutrition care– What are critical (clinical) pathways?– Physicians
• Responsible for meeting all of a patient’s medical needs: diet orders
– Nurses• Screen patients for nutrition problems• Participate in nutrition and dietary assessments• Members of nutrition support teams
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition in Health Care (cont’d.)
• Responsibility for nutrition care– Registered dietitians
• Provide medical nutrition therapy• What are specific examples of their involvement?
– Registered dietetic technicians• Work in partnership with registered dietitians• Other roles may include supervising foodservice
operations, inventory, quality control, etc.
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition in Health Care (cont’d.)
• Responsibility for nutrition care– Other health care professionals
• Pharmacists, physical therapists, occupational therapists, speech therapists, nursing assistants, home health care aides, and social workers
• Nutrition screening– Identifies patients who are malnourished or at
risk for malnutrition
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition in Health Care (cont’d.)
• Nutritional screening– Subjective Global Assessment (Table 13-2)
• Nursing diagnoses– Clinical judgments about actual or potential
health problems that provide: basis for selecting appropriate nursing interventions
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition in Health Care (cont’d.)
• Nutrition care process– Systematic approach to medical nutrition
therapy implemented by registered dietitians• Nutrition assessment: collection and analysis of
health-related data• Nutrition diagnosis: what is included in a diagnosis?• Nutrition intervention: appropriate plan• Nutrition monitoring and evaluation: determine
effectiveness
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment
• Historical information– Sources
• Medical record• Interviewing the patient of caregiver
– Medical history– Medication and supplement history– Personal and social history– Food and nutrition history: diet history
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Dietary assessment– Methods for obtaining food intake data (Table
13-6)– The 24-hour dietary recall
• Guided interview• Foods and beverages consumed during the
previous day• What is involved in the multiple-pass method?
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Dietary assessment– Food frequency questionnaire (Figure 13-3)
• Foods and beverages regularly consumed during a specific time period
• May collect qualitative only or semiquantitative information
• What are limitations of this tool?
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Dietary assessment– Food record
• Written account of foods and beverages consumed during a specified time period, usually several consecutive days
– Direct observation• Food intakes directly observed and analyzed• Nurses: conduct patients’ kcalorie counts
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Anthropometric data– Related to physical measurements of the
human body• Can reveal nutritional problems: overnutrition or
protein-energy malnutrition (PEM)– “How To” Measure Length and Height
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Anthropometric data– Body weight
• May reflect changes in body water due to illness• Involuntary weight loss: can be a sign of PEM• “How To” Measure Weight
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Anthropometric data– Head circumference
• Children up to three years old: assess brain growth and malnutrition
• Premature and small-for-gestational-age infants: track brain development
– Circumferences of waist and limbs• Waist: body fat evaluation• Limbs: muscle mass determination
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Anthropometric assessment– Infants and children
• Evaluate growth: periodic measurements of height (length), weight, and head circumference: plotted on growth charts
– Adults• Evaluate the nutritional risks associated with
illness: clinicians monitor both the total reduction in body weight and the rate of weight loss over time
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Anthropometric assessment– Adults
• In addition to body weight, why are skinfold and limb circumference measurements important in a nutrition assessment?
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Biochemical analyses– Information about protein-energy nutrition,
vitamin and mineral status, fluid and electrolyte balances, and organ function
– Typically blood and urine samples– Repeated measures
• Indicate improving or worsening condition– Routine laboratory tests (Table 13-9)
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Biochemical analyses– Serum proteins: protein-energy status– Albumin: gauge severity of illness– Transferrin: what is the correlation between
iron status and transferrin levels?– Prealbumin and retinol-binding protein
• Decrease rapidly during PEM • Respond quickly to improved protein intakes
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Physical examination– Interpreting physical signs of malnutrition
• Requires skill and clinical judgment– Clinical signs of malnutrition (Table 13-10)
• Where do signs of malnutrition most commonly appear on the body?
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Physical examination– Hydration status
• Fluid retention (edema)• Dehydration
– Functional assessment• Nutrient deficiencies sometimes impair
physiological functions: tests or procedures may be conducted to aid evaluation
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Assessment (cont’d.)
• Physical examination– Functional assessment
• Examples: skin’s response to antigens; hand-grip strength; and exercise tolerance
• Case Study – Nutrition Screening and Assessment