NUTRITIONAL ASSESSMENT Weight-for-height is an index use for assessing wasting

(acute malnutrition)
Signs of Good Nutrition
-most curate indicator of present or current state of
1. alert; responsive general appearance
nutrition.
2. Shiny, lustrous hair, healthy scalp
3. No enlargement in neck glands
4. Smooth slightly moist, good skin, face & neck
color: reddish pink mucous membrane
5. Bright, clear eyes, no fatigue circles
6. Moist lips w/ good color, no cracks at corner
7. Pink color tongue, firm, no swelling or bleeding
8. Straight no crowding, clean teeth, no
discoloration, well-shaped jaw
9. Smooth, good color, moist skin
10. Flat abdomen, no bloating
11. No tenderness weakness of legs & feet, and
swelling
12. No skeletal malformation
13. Normal height & weight age & body build
14. erect posture, arms & legs straight, and in,
chest out
15. Well-developed firm muscles
16. Nervous control: good attention span for age
17. Cheerful disposition: doesn't cry easily, not
irritable nor restless
18. Good appetite & digestion; regular bowel &
urination
19. Gen. Vitality; energetic, vigorous, doesn't get
tired easily
20. Sleeps well at night

Nutritional assessment can be done using the

ABCD method:

A. Anthropometric Measurement
B. Biochemical or Biophysical methods
C. Clinical methods
D. Dietary Methods

A. Anthropometric measurement

is the measurement of variations of the physical

dimensions and gross composition of the human body
at different age levels and degree of nutrition

1. Height and weight (for infant length and to include

head circumference)

• Head circumference s useful in assessing 2. Body Composition

chronic nutritional problems in children under
a. measurement of fat mass (fatness)
2years old.
The body mass index (BMI) or Quetelet
Weight-for-age -is an index used in growth monitoring
index is a value derived from the mass
for assessing children who maybe underweight
(weight) and height of a person. The
 -a sensitive indicator of current BMI is defined as the body mass divided
nutritional status by the square of the body height, and is
universally expressed in units of kg/m2,
Height-for-age-is an index for assessing stunting
resulting from mass in kilograms and
• -less sensitive to change in growth rate. height in meters.
Calculating a patient's BMI an accurate way to measure fat-free mass is to measure
the mid upper arm circumference (MUAC)
BMI = weight in kg

height in m2

PRACTICE

Gina is 1.6 metres tall and weighs 70 kilograms

70 = 70 = 27.34 = 27

1.6 x 1.6 2.56

C. skinfold thickness

this test estimate the percentage of body fat by

measuring skinfold thickness at specific locations on the
body.

The seven (7) locations on the body

1. Triceps - The back of the upper arm

2. Pectoral - The mid-chest, just forward
of the armpit
3. Subscapular - Beneath the edge of the
shoulder blade 4. Midaxilla - Midline of
the side of the torso
4. Abdomen - Next to the belly button
5. Suprailiac - Just above the iliac crest of
the hip bone
6. Quadriceps - Middle of the upper thigh

b. measurement of fat-free mass (muscle mass)

• it is also very simple to use in screening a large

number of people. Therefore, use as a B. Biochemical Method
screening tool for community based nutrition
programmes such as outpatient therapeutic • Based on laboratory analyses of blood & urine
program (OTP). • Objective results
• is the only anthropometric measure to • Useful for diagnoses & therapy
assessing nutritional status among pregnant • Laboratory test base on blood and urine can be
woman. important indicators of nutritional status.
• also used for screening target children and limitations of biochemical method
pregnant women for severe acute malnutrition
(SAM) and moderate acute malnutrition • Skilled personnel
(MAM). • Expensive Analytical equipment
• Can't be applied on large scale
• No single test to evaluate short-term response
to medical nutritional therapy
• Lab test to be conducted several times over a
certain period
• Used in conjunction w/ the other methods
BIOCHEMICAL ANALYSES -protein energy nutrition,
vitamin and mineral status, fluid and electrolyte
balances, and organ function.

Serum proteins-protein energy status

Albumin-most abundant serum protein gauge severity

of illness

Transferrin-iron-transport protein-iron status, PEM

Pre-albumin and Retinol-binding protein decrease

rapidly during PEM and respond quickly to improved
protein intakes

C. Clinical Method

• Provide information about the individual's

medical history, including acute and chronic
illness and diagnostic procedures, therapies or
treatments that may increase nutrient needs or
induce malabsorption.
• Simplest & practical method of ascertaining
nutritional status
• Medical- history & physical examination
3. Three, five, seven days records (Food Diary)
• check signs of deficiency at specific places on
body or asking patient for any symptom • Prepared by client for the next day's intake.
suggesting nutrient deficiency from the patient. • covers days when informant has different meal
patterns over the weekend
Physical Examination
• Week's record for patient requiring to stabilize
a) Clinical Signs of Malnutrition-hair, skin, eyes, dietary regimen, if under nutritional therapy
lips, nails, mouth and gums obesity, food allergies or uncontrolled DM)
b) Hydration Status- fluid imbalances- fluid • Reliable but difficult to maintain
retention/dehydration
4. WEIGHED FOOD RECORD OBSERVATION OF FOOD
c) Functional Assessment-hand-grip strength=
INTAKE) .
wasting (loss of muscle tissue)
• More involved method
D. Dietary Data
• Food consumed over a defined period is
• During the nutrition interview the practitioners weighed.
may ask what the individual ate during the • Samples be saved individually composite-
previous 24hrs. nutrient analysis
• Nutritional intake measured through:
Limitations:
1.24 hour recall.
• Tendency of subject to change usual pattern
• -determine overall usual eating pattern (simplify weighing/impress investigator).
• Ask client recall actual intake for the past 24 hr. • motivated & willing participants
• expensive ,
Limitations: Depends on memory of informant. Ability • For metabolic balance studies or controlled lab
to estimate serving portions experiments
• Best followed by food frequency questionnaire Malnutrition Universal Screening Tool
2. Food frequency questionnaire 'MUST' is a five-step screening tool to identify adults,
• List of specific food items to record intakes over who are malnourished, at risk of malnutrition
a given period (frequency per day, week, (undernutrition), or obese. It also includes management
month) guidelines which can be used to develop a care plan.

It is for use in hospitals, community and other care

settings and can be used by all care workers.
 * SGA fulfils the requirements of a desirable system of
nutritional assessment by:

• Identifying malnutrition
• Distinguishing malnutrition from a disease state
• Predicting outcome
• Identifying patients in whom nutritional therapy
can alter outcome

CALCULATING AND INTERPRETING THE % DEVIATION

FROM USUAL BODY WEIGHT AND % WEIGHT LOSS
Subjective Global Assessment CALCULATING % CALCULATING %WEIGHT
USUAL BODY WEIGHT LOSS
• . is a simple bedside method of assessing the % USUAL BODY WEIGHT %WEIGHT LOSS=
risk of malnutrition and identifying those who Current weight x100 U.W -Current weight x100
would benefit from nutritional support. Usual body weight U.W
• is a proven nutritional assessment tool that has
been found to be highly predictive of nutrition- Mild malnutrition 85- USUAL WEIGHT =U.W
associated complications. 90% Severe weight loss
Moderate m. 75-84% >5% over 1month
Severe m. less than 74% >7.5% over 3 months
>10% over 6 months
 GERIACTRIC NUTRITIONAL RISK INDEX -simple
method to assess nutritional condition, which
utilizes only three objective parameters of body
weight, height and serum albumin. useful tool
for the assessment of nutritional status, not
only for elderly patients but also for chronic
haemodialysis patients.

is a simple but useful tool to assess nutritional status in

chronic haemodialysis patients. Our study demonstrates
Mini Nutritional Assessment that lower GNRI is a significant predictor for mortality in
• is a validated nutrition screening and these patients.
assessment tool that can identify geriatric Nutrition Care Process
patients age 65 and above who are
malnourished or at risk of malnutrition. • is a systematic approach to providing high-
• the most well validated nutrition screening quality n6utrition care.
• the process provides a framework for the RDN
to individualize care, taking into account the
patient/client's needs and values and using the
best evidence available to make decisions.
p • Feeding self-care deficit
• Imbalanced nutrition less than body
requirements
• Imbalanced nutrition: more than body
requirements
• Impaired dentition
• Impaired oral mucous membrane
• Impaired physical mobility
• Impaired swallowing
• Insufficient breast milk
• Nausea
• Readiness for enhanced nutrition
• Risk for aspiration Risk for deficient fluid
volume
• Risk for unstable glucose level

3. Nutrition Intervention

• -selects the nutrition intervention that will be

directed to the root cause of the nutrition
problem and aim in alleviating the signs and
symptoms of the diagnosis
• -nutrition care can be planned and
implemented.
• -counseling, education
• -consider=food habits, lifestyle, other personal
1. Nutrition Assessment factors
The RND collects and documents information such as: • -goals stated
food or nutrition related history, biochemical data, • Ex. overweight person with diabetes-improve
medical record, physical examination, laboratory blood glucose & weight
analyses, medical procedures, an interview with the - change dietary behavior
patient or caregiver, consultation 4. Nutrition Monitoring and Evaluation
2. Nutrition Diagnosis • -achieved the goals
• -Data collected during the nutrition assessment • -making progress towards the planned goals
guides in selection of appropriate nutrition • -effectiveness of plan of care
diagnosis. • -adjustment of goals Exchange in medical
• Each nutrition problem = separate diagnosis treatment or new medication- alter tolerance to
• -formatted to include the specific nutrition food
problem, the etiology or cause, and signs and
symptoms

• Ex. "Unintentional weight loss (the problem)

related to insufficient kcaloric intake (the
etiology or cause) as evidenced by a 10-pound
weight loss [8 percent of body weight in the
past few months (the sign or symptom)."
• -can change during the course of an illness

Nursing Diagnoses with Nutritional Implications

• Chronic confusion
• Chronic pain
• Constipation
• Diarrhea
• Disturbed body image