nutritional assessment

NUTRITIONAL ASSESSMENT

Maria Carmela L. Domocmat, RN, MSN

Purposes

• Provides insight into the client’s

overall physical health

• Helps identify risk factors for

obesity and to promote healthobesity and to promote health

• Help identify nutritional deficits

• Hydration s an important indicator

of the client’s general health

status


SUBJECTIVE DATA


General nutritional status interview

• Dietary habits

• Average daily intake of food

and fluids

• types and quantities consume• types and quantities consume

• where and when food is eaten

• any conditions or diseases that

affect intake or absorption


• use various nutritional

assessment tools o Checklist for nutritional

screening screening

o Nutrition Screening Checklist


Nutrition Screening ChecklistI have an illness or condition that made me change the kind and/or amount of food I eat

Yes (2 pts)_____

I eat fewer than 2 meals per day Yes (2 pts)_____

I eat few fruits or vegetables, or milk products Yes (2 pts)_____

I have 3 or more drinks of beer, liquor, or wine almost everyday Yes (2 pts)_____

I have tooth or mouth problems that make it hard for me to eat Yes (2 pts)_____

I don’t always have enough money to buy the food I need Yes (2 pts)_____

I eat alone most of the time Yes (2 pts)_____I take 3 or more different prescribed or over-the-counter drugs each day

Yes (2 pts)_____

without wanting to, I have lost or gained 10 pounds in the last 6 months

Yes (2 pts)_____

I am not always physically able to shop, cook, and/or feed myself Yes (2 pts)_____

Instruction: Check “yes” for each condition that applies, then total the nutritional score. For total scores of 3-5 points (moderate risk) or ≥ 6 points (high risk), further evaluation is needed (especially for elderly)


OBJECTIVE DATA


1.Anthropometric measurements

2.Body composition measurements


Anthropometric measurements

• Height, weight, BMI

• Helps to evaluate the client’s physical growth, development, and nutritional status and nutritional status


Height

o Normal findings:� within range for age, ethnic and

genetic heritage


Height

o Abnormal findings:� extreme shortness is seen

achondroplastic dwarfism and

Turner’s syndrome Turner’s syndrome

� extreme tallness – gigantism

(excessive secretion of GH) and

Marfan’s syndrome


Weight

o determine ideal body weight

(IBW) and percentage of IBW


Weight

o Method for determining desired

weight.� Females assume 100 pounds for the

first 5 feet (60 inches) and add 5 first 5 feet (60 inches) and add 5

pounds for each inch over 60.


Weight

o Method for determining desired

weight.� Males assume 106 pounds for the

first 5 feet (60 inches) and add 6 first 5 feet (60 inches) and add 6

pounds for each inch over 60.


o calculate &age of IBW:

• actual weight x 100 = %IBW

IBW


o Normal findings:� body weight is within 10% of ideal

range


o Abnormal findings:� current weight that is 10 -20%

below IBW – indicates a lean

client and possibly mild client and possibly mild

malnutrition • if 20-30% - indicates moderate

malnutrition

• more than 30% - severe malnutrition


o Abnormal findings:� weight exceeding 10% of IBW range -

considered overweight

� 20% - obesity � 20% - obesity


BMI


BMI

o Calculated based on ht and wt

regardless of gender

o A practical measure for

estimating total body fat estimating total body fat

o Calculated as wt in kg and

divided by the square in ht in

meters

o Simple, quick, inexpensive


o But not diagnostic of client’s

health status � Does not differentiate bet fat or

muscle tissue muscle tissue


� Inaccurately high or low findings

can result for individuals who are

particularly muscular or elderly

who tend to lose muscle mass who tend to lose muscle mass

� Inaccurate if client is retaining

fluid (e.g., edema, ascites,

pregnant)


• May not accurately reflect body fat in adults, who are shorter than 5 feet


• Further assessments using measurements that determine body fat composition shld be performed – to determine health status and assoc risk factors risk factors


o formula:

• kg/m 2 = BMI

o Normal findings:� 18.5 – 24.9 � 18.5 – 24.9


o Abnormal findings:� ‹18.5 = underwt

� 25-29.9 = overwt ; increases risk

for health problems for health problems

� 30 or greater = obese; igher risk

for diabetes and cardiovascular

dse

•


BODY COMPOSITION MEASUREMENTS


Body composition measurements

o Useful in determining location

of body fat


Fat Distribution


Fat Distribution

• Pear-shaped body has a lower risk for disease

than does apple-shaped body.

• this is measured by Waist-to-hip ratio

measurement


measurement


o Waist circumference� Most common measurement used to

determine extent of abd visceral

fat in relation to body fat fat in relation to body fat


Waist circumference

� Visceral fat• excess fat within the abd cavity

• assoc with higher health risks than

subq fat

•• may be an independent predictor of

health risks even when BMI is not

markedly increased


Waist circumference

� Normal findings:• F: less than 35 inches

• M: less than 40 inches


Waist circumference

� Abnormal findings:• Increased measurement may indicate

increased risk for disorders such

as DM, HTN, Hyperlipidemia, as DM, HTN, Hyperlipidemia,

cardiovascular dse


Waist circumference

• May not be accurate in adults who are shorter than 5 feet



o Waist -to -hip ratio measurement

� used to help determine obesity.

� The distribution of fat is

evaluated by dividing waist size

by hip size.


Waist - to - hip ratio measurement

� Ex: • 30-inch waist and 40 -inch hips

would have a ratio of .75

• 41- inch waist and 39 - inch hips • 41- inch waist and 39 - inch hips

would have a ratio of 1.05.


Waist -to -hip ratio measurement

� Normal findings:• Male: ratio ‹1.0

• Female: ratio of ‹0.8


Waist -to -hip ratio measurement

� Abnormal findings:• Male: ratio ›1.0

• Female: ratio ›0.8

• increased risk of diseases • increased risk of diseases

• The higher the ratio, the higher

the risk of heart disease and

other obesity -related disorders.



o Mid -arm circumference

o Helps to assess skeletal muscle

massmass


Mid -arm circumference

� procedure • extend hand dangle nondominant arm

freely next to the body

• locate arm’s midpoint (halfway bet • locate arm’s midpoint (halfway bet

top of acromion process and

olecranon process)

• measure in cm

• to calculate % = MAC/SR


Mid -arm circumference

� record both the MAC ad SR# • Ex: 25 cm, 88% of standard.


MAC standard reference

Adult

MAC (cm)

standard

reference

(SR)

90% SR-

moderately

malnourish

ed

60% SR-

severely

malnourish

ed

M 29.3 26.3 17.6

F 28.5 25.7 17.1



o Triceps skin -fold thickness

o Helps to evaluate subq fat stores

o measure, in millimeters, the o measure, in millimeters, the

amount of skin and body fat.


Skinfold calipers

• areas: arm; suprailiac region of abd ; or subscapular area


Skinfold calipers

• Male: measure at mid -chest , abdominal (1 inch to the side of the belly button), & top of mid - thighmid - thigh

• Female: measure at the mid -triceps, suprailiac (outside abdominal, about 2 inches forward of your love handles), & mid -thigh if you're a woman.


Triceps skin -fold thickness

� Arm = grasp skinfold and subq

fat bet thumb and forefinger,

midway bet acromion process and

tip of elbowtip of elbow

� pull skin away from muscle

� apply calipers

� repeat 3 times record in mm


TSF standard reference

Adult

TSF (mm)

standard

referenc

e (SR)

90% SR-

moderatel

y

malnouris

hed

60% SR-

severely

malnouris

hed

hed

M 12.5 11.3 7.5

F 16.5 14.9 9.9


Triceps skin -fold thickness

• Abnormal finding: greater than 120% = obesity



o Mid -arm muscle circumference

o Evaluate muscle reserve stores

o Fla : MAMC = MAC (cm) – [0.314 x o Fla : MAMC = MAC (cm) – [0.314 x

TSF (mm)]


Mid -arm muscle circumference

Adult

MAC

(cm)

standar

d

referen

90% SR-

moderate

ly

60% SR-

severely

malnouri

ce (SR) malnouri

shed

shed

M 25.3 22.8 15.2

F 23.2 20.9 13.9


Mid -arm muscle circumference

� to calculate % = 20.29/23.2 =

87%

� record MAC and TSF and SR #• ex: MAMC = 25 - [0.314 x 15] = • ex: MAMC = 25 - [0.314 x 15] =

20.29; 87% of standard


• Note: when evaluating anthropometric data, base conclusions on a data cluster, not on individual findings


HYDRATION


Hydration

o Measure I &O

o Weight clients

o Check skin turgor

o Check for pitting edemao Check for pitting edema

o Observe skin for moisture

o Assess venous filing

o Observe neck veins


Hydration

o Inspect tongue’s condition

gently palpate eyeball

o Observe eye position and

surrounding coloration surrounding coloration

o Auscultate lung sounds

o Take BP on different positions


nutritional assessment

Health & Medicine

abnormal findings

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shaped body

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determining

weighto method

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