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Nutrition in Nursing
Chapter 1
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutritional Screening
• Nutritional screen
– Quick look at a few variables to judge a
client’s relative risk for nutritional problems
– No accepted universal tool
– JCAHO mandates that screen must be done
within 24 hours of admission to the hospital
Nutritional Screening (cont’d)
• Comprehensive nutritional assessment
– Moderate to high risk at screening referred to
dietitian for assessment
– Nutritional care process: 4 steps
o Assessment
o Nutritional diagnosis
o Implementation
o Monitoring and evaluation
• Comprehensive nutritional assessment (cont’d)
– Different from nursing care plan
o Dietitians can get most of information from
nursing admission assessment
o Dietitians interview patients and/or families to
obtain a nutrition history
– Helps to differentiate:
o Nutrition problems caused by inadequate intake
from those caused by illness or its treatments
• Comprehensive nutritional assessment (cont’d)
– Dietitians
o Calculate estimated calorie and protein
requirements based on the assessment data
o Determine nutritional diagnoses that define
the nutritional problem, etiology, and signs
and symptoms
o May also determine the appropriate
malnutrition diagnosis
o
Formulate nutrition interventions
Question
• Nutritional screening helps to differentiate
problems caused by inadequate intake from
those that are caused by:
a. Malnutrition
b. Illness or its treatment
c. Accident or injury
d. Chronic diseases
Answer
b. Illness or its treatment
Rationale: A nutrition history can help
differentiate nutrition problems caused by
inadequate intake from those caused by illness
or its treatments.
Integrating Nutrition
• Assessment
– Data classified as ABCD:
o Anthropometric
o Biochemical
o Clinical
o Dietary data
– Client’s medical-psychosocial history is also
evaluated for its impact on nutritional status
Integrating Nutrition (cont’d)
• Anthropometric data
– Physical measurements of the body
– Body mass index
o “Healthy” or “normal” BMI is defined as 18.5
to 24.9
o Above or below related to health risks
– “Ideal” body weight
– Edema or dehydration skews accurate weight
measurements
– Recent weight change
• Biochemical data
– No single test is both sensitive and
specific for protein-calorie malnutrition
– Biochemical data may help support the
diagnosis of a nutritional problem
• Albumin
– Often used to assess protein status
– Serum levels may be maintained until malnutrition is
in a chronic stage
– Low albumin may indirectly identify patients who may
benefit from nutrition assessment and intervention
• Prealbumin
– Thyroxin-binding protein
– More sensitive indicator of protein status
– More expensive to measure
• Clinical data
– Physical signs and symptoms of malnutrition
observed in the client
– Most signs cannot be considered diagnostic
– Physical signs and symptoms of malnutrition
can vary in intensity among population groups
because of genetic and environmental
differences
– Physical findings occur only with overt
malnutrition
• Dietary data
– Nurse should ask, “Do you avoid any particular
foods?”
– Nurse should not ask, “Are you on a diet?”
• Medical psychosocial history
– May shed light on factors that influence intake,
nutritional requirements, or nutrition counseling
• Medication
– Both prescription and over-the-counter drugs have
the potential to affect and be affected by nutritional
status
– At greatest risk for development of drug-induced
nutrient deficiencies include those who:
o Habitually consume fewer calories and nutrients
than they need
o Have increased nutrient requirements including
infants, adolescents, and pregnant and lactating
women
o Are elderly
o Have chronic illnesses
• At greatest risk for development of drug-induced
nutrient deficiencies include those who (cont’d):
– Take large numbers of drugs (five or more),
whether prescription drugs, over-the-counter
medications, or dietary supplements
– Are receiving long-term drug therapy
– Self-medicate
– Are substance abusers
• Nursing diagnosis
– Provide written documentation of the client’s
status
– Serve as a framework for the plan of care that
follows
• Planning: client outcomes
– Outcomes, or goals, should be measurable,
attainable, specific, and client centered
– Focus on the client, not the health care provider
– Keep in mind that the goal for all clients is to
consume adequate calories and protein using
foods they like and tolerate as appropriate
• Nursing interventions
– Nutrition therapy
o Diet is a four-letter word with negative
connotations
o Usually general suggestions to increase/
decrease, limit/avoid, reduce/encourage, or
modify/maintain aspects of the diet because
exact nutrient requirements are determined
on an individual basis
o Nutrition theory does not always apply to
practice
• Nursing interventions (cont’d)
– Client teaching
o Clients in clinical settings may be more
receptive to nutritional advice
o Hospitalized patients are also prone to
confusion about nutrition messages
• Monitoring and evaluation
– Monitoring precedes evaluation
– Evaluation assesses whether client outcomes
were achieved
Question
• Is the following statement true or false?
Thyroid-binding protein is also called prealbumin.
Answer
False.
Rationale: Prealbumin, also known as
thyroxin-binding protein, is a more sensitive
indicator of protein status than albumin but
not entirely specific for malnutrition; it is
affected by metabolic stress and other medical
conditions.
Physical Signs & Symptoms of
Malnutrition
• Hair is dull, brittle, dry,
or falls out easily
• Swollen glands of neck
and cheeks
• Dry, rough, or spotty
skin
• Poor or delayed wound
healing or sores
• Thin appearance with
lack of subcutaneous fat
• Muscle wasting
• Edema of lower
extremities
• Weakened hand grasp
• Depressed mood
• Abnormal heart
rate/rhythm and BP
• Enlarged liver or spleen
• Loss of balance and
coordination
Nursing Diagnoses With
Nutritional Relevance
• Altered nutrition: more than body requirements
• Altered nutrition: less than body requirements
• Altered nutrition: risk for more than body
requirements
• Constipation
• Diarrhea
• Fluid volume excess
• Fluid volume deficit
Nursing Diagnoses With
Nutritional Relevance (cont’d)
•
•
•
•
•
•
•
•
•
Risk for aspiration
Altered oral mucous membrane
Altered dentition
Impaired skin integrity
Noncompliance
Impaired swallowing
Knowledge deficit
Pain
Nausea
Question
• Mrs. Kirk, age 75, was admitted to the long-term–
care facility because she was found by her children
too weak to care for herself. What assessment data
would influence the nurse to suspect possible
malnutrition?
a. Brittle, dry hair and loss of reflexes
b. Weakened hand grasp and lack of subcutaneous
fat
c. Depressed mood and loss of sensation in
extremities
d. Abnormal BP and thin, wrinkled skin
Answer
b. Weakened hand grasp and lack of subcutaneous
fat
Rationale: See Box 1.4: Physical signs and
symptoms suggestive of malnutrition.

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