nutritional assessment
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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
Maria Carmela L. Domocmat, RN, MSN
SUBJECTIVE DATA
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
• use various nutritional
assessment tools o Checklist for nutritional
screening screening
o Nutrition Screening Checklist
Maria Carmela L. Domocmat, RN, MSN
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)
Maria Carmela L. Domocmat, RN, MSN
OBJECTIVE DATA
Maria Carmela L. Domocmat, RN, MSN
1.Anthropometric measurements
2.Body composition measurements
Maria Carmela L. Domocmat, RN, MSN
Anthropometric measurements
• Height, weight, BMI
• Helps to evaluate the client’s physical growth, development, and nutritional status and nutritional status
Maria Carmela L. Domocmat, RN, MSN
Height
o Normal findings:� within range for age, ethnic and
genetic heritage
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
Weight
o determine ideal body weight
(IBW) and percentage of IBW
Maria Carmela L. Domocmat, RN, MSN
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.
Maria Carmela L. Domocmat, RN, MSN
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.
Maria Carmela L. Domocmat, RN, MSN
o calculate &age of IBW:
• actual weight x 100 = %IBW
IBW
Maria Carmela L. Domocmat, RN, MSN
o Normal findings:� body weight is within 10% of ideal
range
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
o Abnormal findings:� weight exceeding 10% of IBW range -
considered overweight
� 20% - obesity � 20% - obesity
Maria Carmela L. Domocmat, RN, MSN
BMI
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
o But not diagnostic of client’s
health status � Does not differentiate bet fat or
muscle tissue muscle tissue
Maria Carmela L. Domocmat, RN, MSN
� 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)
Maria Carmela L. Domocmat, RN, MSN
• May not accurately reflect body fat in adults, who are shorter than 5 feet
Maria Carmela L. Domocmat, RN, MSN
• Further assessments using measurements that determine body fat composition shld be performed – to determine health status and assoc risk factors risk factors
Maria Carmela L. Domocmat, RN, MSN
o formula:
• kg/m 2 = BMI
o Normal findings:� 18.5 – 24.9 � 18.5 – 24.9
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
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
•
Maria Carmela L. Domocmat, RN, MSN
BODY COMPOSITION MEASUREMENTS
Maria Carmela L. Domocmat, RN, MSN
Body composition measurements
o Useful in determining location
of body fat
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Fat Distribution
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
measurement
Body composition measurements
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
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
Waist circumference
� Normal findings:• F: less than 35 inches
• M: less than 40 inches
Maria Carmela L. Domocmat, RN, MSN
Waist circumference
� Abnormal findings:• Increased measurement may indicate
increased risk for disorders such
as DM, HTN, Hyperlipidemia, as DM, HTN, Hyperlipidemia,
cardiovascular dse
Maria Carmela L. Domocmat, RN, MSN
Waist circumference
• May not be accurate in adults who are shorter than 5 feet
Maria Carmela L. Domocmat, RN, MSN
Body composition measurements
o Waist -to -hip ratio measurement
� used to help determine obesity.
� The distribution of fat is
evaluated by dividing waist size
by hip size.
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
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.
Maria Carmela L. Domocmat, RN, MSN
Waist -to -hip ratio measurement
� Normal findings:• Male: ratio ‹1.0
• Female: ratio of ‹0.8
Maria Carmela L. Domocmat, RN, MSN
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.
Maria Carmela L. Domocmat, RN, MSN
Body composition measurements
o Mid -arm circumference
o Helps to assess skeletal muscle
massmass
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
Mid -arm circumference
� record both the MAC ad SR# • Ex: 25 cm, 88% of standard.
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
Body composition measurements
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.
Maria Carmela L. Domocmat, RN, MSN
Skinfold calipers
• areas: arm; suprailiac region of abd ; or subscapular area
Maria Carmela L. Domocmat, RN, MSN
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.
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Triceps skin -fold thickness
• Abnormal finding: greater than 120% = obesity
Maria Carmela L. Domocmat, RN, MSN
Body composition measurements
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)]
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
• Note: when evaluating anthropometric data, base conclusions on a data cluster, not on individual findings
Maria Carmela L. Domocmat, RN, MSN
HYDRATION
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN
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
Maria Carmela L. Domocmat, RN, MSN