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42 Cards in this Set
- Front
- Back
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Health Problems
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-Alter Nutrition Needs
-Lead to Malnutrition |
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Hospitalized Patients
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-40-60% with acute illness are malnourished
-Nutrition status can decline quickly (3 weeks) |
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Poor nutrition status
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can affect disease procession
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Illness and nutrition
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Reduced Food Intake
Interferes with absorption and digestion alters metabolism & excretion dietary restrictions, emotional upset unable to make own food |
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Registered Dietitians
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–Provide medical nutrition therapy (MNT)
–Nutrition care plans –Plan and approve menus –Provide education |
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Dietetic Technician
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–Assist the RD
–Nutrition screening –Menu/food issues |
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MD/PA/NP
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–Prescribe diet orders
–Nutrition support orders |
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Nursing Team
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–Screen patients
–Participate in nutrition assessments –Provide direct nutrition care |
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Other team members
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Pharmacists, SLP, OT, PT, RT, SW
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Nutrition screening
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–Identifies persons at risk for nutrition problems
–Should be done 24 hours after admission per JCAHO –Quick |
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Screening/data collection
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–Medical diagnosis
–Medical record –Physical measurements –Lab reports –Brief diet history |
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Nutrition Screen
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•Recent weight changes
•Food intake changes allergies/intolerances •Chronic bowel issues •Swallowing/chewing difficulties •Skin/wound issues •Chronic disease--DM, Renal, Cancer, GI, CVD, Lung |
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The Nutrition Care Process
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–Nutrition assessment
–Nutrition diagnosis –Nutrition intervention –Nutrition monitoring & evaluation |
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The Nursing Process
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–Assessment
–Nursing diagnosis –Outcome identification & planning –Implementation –Evaluation |
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Assessment
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–Medical, social, & dietary histories
–Anthropometric data –Biochemical analysis –Physical exam |
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Nutrition Diagnosis
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–Actual or potential
–Problem, etiology, signs and symptoms (PES statement) –Not used by all RD’s |
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Intervention
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–Nutritional changes
–Nutrition education –Medication changes |
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Monitoring & evaluation
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–May need to modify the plan
–Must be flexible |
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Medical history
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–Age
–Gender –Weight –Prescription drugs –OTC medications –Dietary supplements –Type of illness |
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Social history
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–Cultural
–Financial issues –Who prepares and shops for food –Living situation |
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Diet history
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–Food intake
–Meal patterns |
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24-hour recall
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–All foods & beverages
–Time of day eaten –Amounts consumed –Food preparation –Typical day? |
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Food record
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–Recorded over several days
–Recorded as consumed –Does not rely on memory |
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Direct observation
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–Calorie Counts
–Meal Rounds –Documentation to initiate nutrition support |
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Estimated Calorie need for adult
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20-45 kcals /kg IBW or ABW
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Estimated Calorie need for child
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45-100 kcals/kg
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Estimated Protein normal needs
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.8 g/kg IBW
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Estimated Protein stressed needs
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1-2 g/kg IBW or ABW
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Assessment tools: Anthropometrics
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•Height: Adults
•Length infants to 24 months •Weight- BMI usual or ideal body weight •Head circumference •Waist circumference or skin fold measure |
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Estimating Ideal body Weight (IBW)
Male |
106 lbs for first 5’ of height + 6 lbs for each inch over 5’
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Estimating Ideal body Weight (IBW)
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100 lbs for first 5’ in height + 5 lbs for each inch over 5’
For small frames:deduct 10% For large frames:add 10% |
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Calculating %UBW
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•Actual wt = 120#
•Usual wt = 155# 120/155 x 100 = 77% UBW |
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Calculating %IBW
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•Actual wt = 100 kg
•IBW = 60 kg 100/60 x 100 = 167 % IBW |
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Adjusted Body Weight (ABW) for Obesity
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Adjusted Body Weight =
{(actual body weight -IBW) X .25} + IBW |
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Assessment tools:Biochemical Analysis
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•Provides information about
–Protein-energy nutrition –Vitamin & mineral status –Fluid & electrolyte balance –Organ functioning •Analysis of blood & urine samples |
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Plasma Protein
Albumin |
–Most abundant
–Slow to reflect changes in status –3 week half-life |
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Transferrin
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–Transports iron
–Indicates PEM & iron status –Slow to detect changes in status –8 -10 day half-life |
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Prealbumin
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–Also called transthyretin
–Responds quickly to changes in protein status –2 day half-life |
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C-Reactive Protein
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–Indicator of inflammation
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Fluid Retention--edema
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–Weight gain
–Facial puffiness –Swelling limbs –Abdominal distention –Tight-fitting shoes Diseases of heart, kidney, liver, lungs |
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Dehydration --symptoms
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–Thirst ?
–Dry skin or mouth –Reduced skin tension –Dark yellow or amber urine with low volume Fever, vomiting, diarrhea, burns |
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Subjective Global Assessment
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•Tool to integrate assessment data
–Combines medical information with results of physical examination –Often used in long-term care –Score or rating given |
