Food Diary And Nutritional Self Assessment
Based on Maslow’s hierarchy of needs, food and nutrition rank on the same level as air in the basic necessities of life. Obviously, death eventually occurs without food. But unlike air, food does so much more than simply sustain life. Food is loaded with personal, social, and cultural meanings that defi ne our food values, beliefs, and customs. That food nour- ishes the mind as well as the body broadens nutrition to an art as well as a science. Nutrition is not simply a matter of food or no food but rather a question of what kind, how much, how often, and why. Merging want with need and pleasure with health are keys to feeding the body, mind, and soul.
Although the dietitian is the nutrition and food expert, nurses play a vital role in nutri- tion care. Nurses may be responsible for screening hospitalized patients to identify patients at nutritional risk. They often serve as the liaison between the dietitian and physician as well as with other members of the health-care team. Nurses have far more contact with the patient and family and are often available as a nutrition resource when dietitians are not, such as during the evening, on weekends, and during discharge instructions. In home care and wellness settings, dietitians may be available only on a consultative basis. Nurses may reinforce nutrition counseling provided by the dietitian and may be responsible for basic nutrition education in hospitalized clients with low to mild nutritional risk. Nurses are inti- mately involved in all aspects of nutritional care.
This chapter discusses nutrition within the context of nursing, including nutrition screening and how nutrition can be integrated into the nursing care process.
Nutrition screening is a quick look at a few variables to identify individuals who are mal- nourished or who are at risk for malnutrition so that an in-depth nutrition assessment can follow. Screening tools should be simple, reliable, valid, applicable to most patients or clients in the group, and use data that is readily available (Academy of Nutrition and Dietetics, 2012). For instance, a community-based senior center may use a nutrition screen that focuses mostly on intake risks common to that population, such as whether the client eats alone most of the time and/or has physical limitations that impair the abil- ity to buy or cook food (Fig. 1.1). In contrast, common screening parameters in acute care settings include unintentional weight loss, appetite, body mass index (BMI), and disease severity. Advanced age, dementia, and other factors may be considered. There is no universally agreed upon tool that is valid and reliable at identifying risk of malnutrition in all populations at all times.
The Joint Commission, a nonprofi t organization that sets health-care standards and accredits health-care facilities that meet those standards, specifi es that nutrition screening be conducted within 24 hours after admission to a hospital or other health-care facility—even on weekends and holidays. The Joint Commission allows facilities to determine screening criteria and how risk is defi ned. For instance, a hospital may use serum creatinine level as a screening criterion, with a level greater than 2.5 mg/dL defi ned as “high risk” because the majority of their patients are elderly and the prevalence of chronic renal problems is high. The Joint Commission also leaves the decision of who performs the screening up to indi- vidual facilities. Because the standard applies 24 hours a day, 7 days a week, staff nurses are often responsible for completing the screen as part of the admission process. Clients who “pass” the initial screen are rescreened after a specifi ed amount of time to determine if their status has changed.
Nutritional Screen: a quick look at a few variables to judge a client’s relative risk for nutritional problems. Can be custom de- signed for a particular population (e.g., preg- nant women) or for a specific disorder (e.g., cardiac disease). Malnutrition: literally “bad nutrition” or any nutritional imbalance including overnutrition. In practice, malnutrition usually means undernu- trition or an inadequate intake of protein and/or calories that causes loss of fat stores and/or muscle wasting.
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4 U N I T 1 Principles of Nutrition
NUTRITION CARE PROCESS
Clients considered to be at moderate or high risk for malnutrition through screening are usually referred to a dietitian for a comprehensive nutritional assessment to identify spe- cifi c risks or confi rm the existence of malnutrition. Nutritional assessment is more accu- rately called the nutrition care process, which includes four steps (Fig. 1.2). While nurses use the same problem-solving model to develop nursing or multidisciplinary care plans that
I have an illness or condition that made me change the kind and/or amount of food I eat.
I eat fewer than two meals per day.
I eat few fruits or vegetables, or milk products.
I have three or more drinks of beer, liquor or wine almost every day.
I have tooth or mouth problems that make it hard for me to eat.
I don’t always have enough money to buy the food I need.
I eat alone most of the time.
I take three or more different prescribed or over-the-counter drugs a day.
Without wanting to, I have lost or gained 10 pounds in the last six months.
I am not always physically able to shop, cook and/or feed myself
Dietitians may obtain much of their preliminary information about the patient from the nursing history and physical examination, such as height and weight; skin integrity; usual diet prior to admission; difficulty chewing, swallowing, or self-feeding; chief com- plaint; medications, supplements, and over-the-counter drugs used prior to admission; and living situation. Dietitians may request laboratory tests to assess vitamin levels when micronutrient deficiencies are suspected.
■ Dietitians interview patients and/or families to obtain a nutrition history, which may include information on current dietary habits; recent changes in intake or appetite; intake of snacks; alcohol consumption; food allergies and intolerances; ethnic, cultural, or religious diet influ- ences; nutrition knowledge and beliefs; and use of supplements. A nutrition history can help differentiate nutrition problems caused by inadequate intake from those caused by disease.
■ Dietitians usually calculate estimated calorie and protein requirements based on the assessment data and determine whether the diet ordered is adequate and appropriate for the individual.
■ Dietitians determine nutrition diagnoses that define the nutritional problem, etiology, and signs and symptoms. While a nursing diagnosis statement may begin with “Altered nutrition: eating less than the body needs,” a nutrition diagnosis would be more specific, such as “Inadequate protein–energy intake.”
■ Dietitians may also determine the appropriate malnutrition diagnosis code for the patient for hospital reimbursement purposes.
■ Nutrition interventions may include requesting a diet order change, requesting additional laboratory tests to monitor nutritional repletion, and performing nutrition counseling or education.
Also check: Transition To The Nursing Profession