Nursing 105

Essentials of Nursing Study Guide

©2018 Achieve Page 26 of 160 1.5 Nutritional Assessment Nutritional assessments for nurses include screening two types of data. • Subjective Data: Subjective data asks clients to recall all food and beverages consumed in a typical 24-hour period. A food frequency record is a checklist which indicates how often food groups or specific foods are eaten. A food diary is a detailed record of measured amounts of all food and fluids during a specified time. A diet history is an extensive interview by a dietician ornutritionist • Objective Data : Objective data includes body mass index measurements and skin fold measurements. Laboratory tests include serum proteins, urinary tests, and total lymphocyte count. Effective nutrition screening can be used to efficiently identify patients that may benefit from a more extensive formal nutrition assessment. It may be particularly important to vigorously screen elderly patients because the elderly may experience eating or swallowing difficulties, adverse drug-nutrient interactions, alcohol abuse, depression, reduced appetite, functional disabilities, impaired taste and smell, and effects of polypharmacy. The goals of a formal nutrition assessment are to identify patients who are malnourished or who are at risk for malnutrition. Nutritional assessment is also used to collect the information necessary to create a nutrition care plan and to monitor the adequacy of nutrition therapy. The Prognostic Nutrition Index (PNI), Prognostic Inflammatory and Nutritional Index (PINI), and Nutritional Risk Index (NRI) all reliably predict morbidity in perioperativepatients. The only clinical method that has been validated as reproducible and that evaluates nutrition status (and severity of illness) by encompassing patient history and physical parameters is the subjective global assessment (SGA). The SGA has been found to be a good predictor of complications in patients undergoing gastrointestinal surgery, liver transplantation, and dialysis. Patient History and Physical Examination A physical exam should include the following: • Clinical examination: findings include general patient appearance, presence of edema, ascites, cachexia, obesity, skin change, dry mucous membranes, petecchiae or ecchymosis, poorly healing wounds, glossitis, stomatitis, and cheilosis • Examination of patient musculoskeletal system: noting asymmetry, examining temporalis muscles, deltoids, suprascapular, and infrascapular muscles, bulk and tone of biceps, triceps, quadriceps, and interosseus muscles of the hand • Examination for loss of body: subcutaneous fat, muscle wasting, nature and severity of underlying disease, any noticeable changes in hair-bearing areas, oral mucosa, gravity dependent areas, peripheral sensation of hands and feet, triceps skin fold to determine fat stores, and mid-arm circumference to measure muscle