General objective

At the end of this lecture, a student should have knowledge on meeting basic client nutritional needs.

Specific Objectives
At the end of this lecture, a student should be able to;
Define nutrition and nutritional status State four (4) methods that can be used in assessment of nutritional status Describe in detail the four (4) approaches used to assess the nutritional status

Contd
Outline

factors influencing diet requirements and intake Explain general guidelines on food preparation and serving

Introduction
0 Nutrition (also called nourishment) is

the provision, to cells and organisms of the materials necessary in the form of food to support life (Williams S.R., 1995). 0 Nutrition concerns the food people eat and how their bodies use it.

Contd
0 Nutritional status is the balance between

the intake of nutrients by an organism and the expenditure of these in the processes of growth, reproduction, and health maintenance (Williams S.R., 1995).

Assessment of Nutritional status

0 Nutritional assessment of the client is an integral part

of the total health assessment because food and fluid are the basic biologic needs (Wilson and Giddens, 2005). 0 Commonly summarized by the mnemonic "ABCD," which stands for Anthropometric measurement, Biochemical or laboratory tests, Clinical indicators, and Dietary assessment.

Anthropometric method
0 Anthropometry is a measurement system of size and makeup of the body (Potter and Perry, 2005).
0 Approaches are usually non-invasive and generally assess the size or body composition of an individual. 0 For adults, body wt and ht are used to evaluate

overall nutritional status and to classify individuals as at healthy or non-healthy weights

Contd
0 The most recent classification is to use Body Mass Index (BMI, in kg/m2).
0 BMI, regardless of population, is normal at

18.5 to 25.0 kg/m2, overweight at 25.0 to 29.9 kg/m2, and obese at over 30.0 kg/m2. 0 In general BMI greater than 30 is assumed to be due to excessive adiposity.

Contd
0 In children, growth charts, have been developed to allow

clinicians to assess weight-and height-for-age, as well as weight-for-height. 0 For children, low height-for-age is considered stunting, while low weight-for-height indicates wasting. 0 In addition to wt and ht, measures of Mid Upper Arm Circumference (MUAC)and skin fold measured over the triceps muscle at the mid-arm are used to estimate fat and muscle mass. 0 Anthropometric measures of nutritional status can be compromised by other health conditions eg oedema characteristic of some forms of malnutrition can conceal wasting by increasing body weight.

Stretch time

Biochemical or laboratory tests

0 No single biochemical and laboratory test is diagnostic for malnutrition (Potter and Perry, 2005). 0 The tests provide objective data to nutritional assessment

Contd
0 The tests most commonly used are: Serum proteins- tests include Hb which provide information regarding red blood cells and can provide information on iron and Vit B12 deficiency. Others are blood glucose which reflect carbohydrate

metabolism.

Contd
Urine tests- urinary Cr reflects a persons total muscle mass. The greater the muscle mass the greater the excretion of Cr. Total lymphocyte count- certain nutrient deficiencies and forms of protein-calorie malnutrition can depress the immune system.

Clinical indicators
0 A nurse performs a nutritional screen An assessment performed to identify clients at risk for malnutrition or those undernourished. 0 This is a quick physical examination that

assesses body systems because effects of improper nutrition affect all body systems and can give clues to malnutrition.

Contd
0A

nurse can assess the general appearance for cachexia and apathy, CVS for heart rate and BP, GI system for anorexia, indigestion and constipation. 0 The nurse can also assess the hair, skin, face and neck, lips, gums, teeth, eyes and nails.

Dietary Assessment
0 This is a more specific diet history used to

assess the clients actual and potential needs (Potter and Perry, 2005). 0 Components: Diet
Number of meals per day Food preferences and preparation practices

Components contd
Unpleasant symptoms

Indigestion, heartburn, gas

Allergies Chewing and swallowing

Appetite
Elimination

Factors influencing Diet requirements and Intake

Age Children normally require a lot of carbohydrates, proteins and vitamins for proper growth and repair. For infants for example, breast milk is the ideal food and they require to be fed whenever necessary.

Contd
Religious practices Some religious practices like Rastafarians encourage adoption of vegetarian diets.

Cultural practices Some cultural practices forbid intake of certain foods for example some cultures in Zambia forbid pregnant women to eat eggs.

Contd
Occupation and Physical Activities Nutrients give the energy needed to perform the daily activities of living. The amount of energy used by the body is the energy expenditure and this varies widely from individual to individual. When we do more work, our body requires more energy to keep our bodies healthy Workers like army recruits, builders and athletes need more food that contains more nutrients such as carbohydrates, protein and fats.

Contd
Environments Weather For example on the weather, people are more likely to consume more food during the cold rather than hot weather. People tend to eat more during the cold season.

Contd
Disease Disease states like, burns and malnutrition require a special diet if healing is to take place. Other factors include social and economic status.

Preparation and serving of food to patients

0 Food should be prepared in a hygienic manner to prevent food poisoning. 0 It is important to always prepare food that a patient prefers and enjoys although some

patients may require health education on the type of food to avoid drug interactions and malnutrition.

Contd
0 On serving, food should be attractive in

appearance. 0 Serving food neatly can stimulate the clients appetite. 0 It is good practice to ensure that the client receives and eats their prescribed diet. 0 Cultural and religious aspects of patients should be taken into consideration as well as the level of consciousness.

Take home points

0 Nutrition is the provision, to cells and

organisms of the materials necessary in the form of food to support life whereas Nutritional status is the balance between the intake of nutrients by an organism and the expenditure of these in the processes of growth, reproduction, and health maintenance.

Contd
0 Nutritional assessment of the client is an integral part of the total health assessment because food and fluid are the basic biologic needs. 0 The purpose of the nutritional assessment is to identify patients at risk for malnutrition and those with poor nutritional status. 0 Four main methods exist for nutritional

assessment namely anthropometric, biochemical, clinical indicators and dietary assessment abbreviated as ABCD.

Contd
0 Nutrition

being the basic biologic need, is affected by many factors some of which include age and culture. 0 Finally, when preparing food for the patient, it is best practice to prepare food according to the patients preference and taking into account factors like culture and religion.

Assignment
0 Read and write brief notes on the importance of meeting the client basic nutritional need.

References
0 Potter, A,P and Perry, A,G(2005), Fundamentals of Nursing, 6th Edition, Mosby, USA. 0 Wilson

S.F, Giddens J.F (2005), Health Assessment for Nursing Practice, 3rd edition, Elsevier Mosby, USA 0 Williams S.R (1995), Basic Nutrition and Diet Therapy, 10th edition, Mosby publishers, USA