NUTRITIONAL ASSESSMENT

INTRODUCTION:-
The word nutrition is derived from the word “nutricus” which
means to suckle at the breast. Nutrition is defined as combination of dynamic process by
which the consumed food is utilized for nourishment and structural and functional efficiency
of every cell of the body. It is the science of food and its relationship to health. The term food
refers to anything which nourishes the body. It includes solid, semisolids and liquids which
can be consumed and which help to sustain the body and keep it healthy. Food and nutrition
are different and having different meaning. Food is defined as what one feed on and is a
composite mixture of many nutrient substances ranging from a fraction of a gram in some
cases to hundred of grams in others. Food stuff is defined as anything which can be used for
food. Balanced and sufficient nutritional intake is most essential for children to promote
optimal growth and development to protect and maintain health. To prevent nutritional
deficiency conditions and various illness.

DEFINITION: -
Nutrition is defined as combination of dynamic process by which the
consumed food is utilized for nourishment, structure and functional efficiency of every cell of
body.

CRITERION MEASUREMENT:-
Nutritional assessment will be based on the
anthropometric measurement in different grades of nutrition by using different method of
classification.

1) GOMEZ ‘S CLASSIFICATION (1956) WEIGHT FOR AGE:

weight of child
Weight for age% = *100
. Weight of child of same age (ICMR)

Normal nutritional status 90% to 110%

1st Degree malnutrition 75% to 89%
2nd Degree malnutrition 60% to 74%
3rd Degree malnutrition Under 60%

2) WATERLOW’S CLASSIFICATION (1977) DEFINES TWO GROUPS:

Weight for height(wasting%) = weight of child *100

. Weight of child of same height (ICMR)

Height for age (shunting%) = height of child *100

Height of normal child of same age
 Nutritional status Shunting Wasting
Normal >95 >90
Mild impairment 87.5-95 80-90
Moderate impairment 80-87.5 70-80
Severe impairment <80 <70

3) MALNUTRITION GRADING BY MID ARM HEAD CIRCUMFERENCE RATIO

BY KANAWATI AND MC LAREN (1970)

Healthy> 0.311, Mild 0.310-0.280, Moderate 0.279-0.250, Severe<0.250

The standards of Indian council of Medical Research (ICMR 1984) have been used for
referral value of all anthropometric measurements.

INTRODUCTION:

My patient Neethu Thomas has been admitted in CKS hospital

on 21/5/2024 at 11:30 am with complaints of dysuria, weight gain and edema.

BIODATA:

Name : - Neethu Thomas

Age : - 31/2yr
Sex : - Female
Religion : - Christian
OPD no. : - 459498
IPD NO. : - 303256
Address : - sector-10,steet-45,block 34, moti nagar, jaipur
Bed no : - 10
DOA : - 21/5/2024
Diagnosis : - Nephrotic syndrome

CHIEF COMPLAINT:
My patient Neethu is admitted in pediatric ward with chief
complaint of dysuria, edema and weight gain.

PAST HISTORY:
She was not having any disease in the past some times but she was
having slight fever, cough and breathlessness 5month ago.

PRESENT HISTORY:
At the time of admission she is suffering from dysuria, edema
and weight gain.
FAMILY HISTORY:
My patient lives in a nuclear family. She lives with her parents and
elder sister.

BIRTH HISTORY:

Mother’s condition: - During antenatal period her mother’s condition

was good.
Mode of delivery: - My patient Arushi was born by normal vaginal
delivery at MMI hospital Jaipur
Birth weight: -At time of birth his weight was 4kg
Congenital malformation: - She was normal healthy child and no any
congenital anomalies at the time of birth.
Dietary pattern: Non vegetarian.
Immunization: She received all type of immunization up to age of
1/2
3 yr.
Developmental history is normal up to the corresponding age.

PHYSICAL EXAMINATION:
Temp. : 1000F
Pulse : 100b/min
Resp : 26breaths/min
BP : 102/70mm of Hg
Skin : Normal
Posture : Normal
Chest : Norma
Lungs : Bilateral air entry
Abdomen : NAD
Dependency level of patient: fully dependent.
Wt : 14kg
Ht : 102cm
Hc : 48cm
Cc : 52cm

1) GOMEZ’S CLASSIFICATION(1956) WEIGHT FOR AGE:

weight of child
Weight for age% = *100
Weight of child of same age (ICMR)

= 14kg *100
14.7

= 95.89%
2) WATERLOW’S CLASSIFICATION (1977) DEFINES TWO GROUPS:
Weight for height(wasting% )= weight of child *100
Weight of child of same height(ICMR)
= 14kg *100
16.7

= 83.83%

Height for age% = height of child *100

Height of normal child of same age

= 102 *100
94.9

= 107.48%

Normal Observed
Head circumference 48cm 48cm
Chest circumference 52cm 52cm

REMARK:
Nutritional status of my child is normal according to Gomes’s and according
to waterlow’s classification wasting is mild impaired.

CLINICAL MANIFESTATION

Growth retardation: Not observed

Muscle vesting with retention of subcutaneous fat: Not observed
Dullness & loss of appetite: Observed in my patient
Pitting edema over per orbital region: Observed in my patient
Thin light colored hair: Not observed
Gross wasting of muscles with subcutaneous tissue: Not observed
Dry skin with prominent loose folds: Not observed
HEALTH EDUCATION:-

PERSONAL HYGIENE:

Advice to maintain personal hygiene like daily bath, hand washing before and after
meal, cutting nails etc

DIET:-

Instructed to take high protein & caloric diet.

Advice to take iron rich diet like gram, spinach, nuts.
Advice to improve dietary habit with locally available, low cost food items for
balanced diet.

MEDICATION:

Advice to take regular medicine if prescribed.

Immunization against vaccine preventable disease.

FOLLOW UP CARE:

Advice for follow up check up and to take medicine in time.

ENVIRONMENTAL SANITATION:

Teaching given on environmental sanitation.

BIBLIOGRAPHY:-

1) Vishwanathan J and Desai A b (1989) “Achar’s Textbook of pediatrics”, 3rd edition,

by orient long man, Pp-315,316.

2) Ghai OP,(1996),”text book of essesstials of pediatric”, by OP ghai, Pp-206,207

3) Datta Parul, (2007), “textbook of pediatric” , 1st ed, Jaypee brothers medical publisher

(p) ltd, Pp189,190,191.

4) Park K. Preventive and social medicine.20th edition .Jabalpur : Banarsidas

Bhunot;2009.p.575-576

5) Lal Sundar.Text book of community health nsg.2nd ed. Chennai: CBS

publisher;2009.p.145-147

6) Narang. Approach to practical pediatric.1st edition .New Delhi : Jaypee

brother;2008.p.58-60

7) Rao B Sridhar, (2003), “Text book of community health nursing”, 1st edition. By
Virendra kumar arya medical publishers, Pp-169-171