Nutrional assessment & malnutrition

Applied Nutrition for BScN
9/2/2021 Clinical Instructor: Sir Jerry Zahid GFNC 1

Objectives
• At the end of this lecture the students will be able to:
1. Define Nutritional Assessment
2. Explain & measure the components Of The Nutritional Assessment
3. Identify the nursing diagnosis
4. Explain the preventive measure to maintain healthy status
5. Malnutrition & its types

Nutritional Assessment
• Nutritional assessment is the systematic process of collecting and interpreting
information in order to make decisions about the nature and cause of nutrition
related health issues that affect an individual.
(British Dietetic Association (BDA), 2012)
• Nutritional assessment is the interpretation of anthropometric, biochemical
(laboratory), clinical and dietary data to determine whether a person or groups
of people are well nourished or malnourished (over-nourished or under-
nourished).

Components Of The Nutritional Assessment
• The four primary components of the nutritional assessment are
summarized by the mnemonic ABCD:
• A- Anthropometric measurements
• B- Biochemical parameters
• C- Clinical Methods
• D- Dietary Methods

A: Anthropometry / Anthropometric measurements
• Anthropometry allows for an assessment of the different component
parts of the human body. Body composition refers to the anatomical
makeup of the body in terms of bone, muscle, water and fat.
• Other visual signs may indicate recent weight loss such as loose
jewellery, baggy clothes, extra notch in belt, ill-fitting dentures, loose
or thin looking skin, and prominent bony features.

B: Biochemistry / Biophysical Methods
• The blood tests conducted within a nutrition assessment are
interpreted in conjunction with a clinical examination; previous
medical history; and current medications. Biochemistry tests measure
levels of chemical substances present in the blood. Functional tests
measure the function of vital organs such as the kidneys or liver.

C: Clinical Methods
• A person’s disease state may increase the risk of malnutrition due to increased
energy requirements; reduced energy intake; or increased nutritional losses.
Examples of diseases/conditions where this may occur include:
• Cancer
• Chronic Obstructive Pulmonary Disease
• Heart failure
• Gastrointestinal disorders such as Crohns disease, liver disease, coeliac disease
• Neurological conditions such as stroke, Motor Neurone Disease, Parkinsons
Disease, multiple sclerosis, dementia
• Burns, surgery or trauma
• Mental health conditions (such as depression)

C: Clinical Methods continue…
• Symptoms that may impact on a person’s nutritional status either through
reducing nutritional intake or increasing nutritional losses include:
• altered bowel movements e.g. diarrhoea, constipation
• upper gastrointestinal upset e.g. reflux, bloating, nausea, and vomiting.
• early satiety
• dysphagia
• lethargy

D Dietary
• Energy requirements
• Estimate Basal Metabolic Rate (BMR) using Henry Equations (2005) based on age,
gender and weight (Henry, 2005) or estimate requirements for stable patients
using 25-35kcal/kg (NICE 2006).
• Add factor when patient is metabolically stressed
• Add factor for activity and diet induced thermogenesis
• If aiming for weight gain, add 400-600 kcal/day. Only add this for patients who are
metabolically stable (i.e. not acutely unwell).

Nursing Diagnosis
• Imbalance nutrition less than body requirement
• Muscle weakness
• Activity intolerance
• Impaired electrolyte and fluid balance
• Impaired skin integrity
• Fatigue
• Risk for infection
• Risk for injury

Preventive measures
• Estimate of haemoglobin level to asses the severity of anemia
• Blood transfusion in severe cases of anemia
• Iron & folic acid supplements
• Iron rich food or food fortification with iron
• Modify dietary habits
• Control of parasites & infections such as UTI, Rubella, Syphillis
• Improving health & nutrition through education & awareness
• Improve sanitation methods
• Avoid smoking 9/2/2021
Clinical Instructor: Sir Jerry Zahid GFNC 16

Malnutrition
• Malnutrition is defined as improper or ill balanced nutrition.
• Malnutrition refers to getting too little or too much of certain nutrients.
• It can lead to serious health issues, including stunted growth, eye problems,
diabetes and heart disease.
• It’s the largest contributor to disease across the globe.
• Some populations have a high risk of developing certain types of malnutrition
depending on their environment, lifestyle and resources.
• Two types of malnutrition are: 1.Undernutrition 2. Overnutrition

1. Undernutrition
• It is a condition in which
consumption is lesser than required
dietary allowances. It leads to low
weight-for-height (wasting), height-
for-age (stunting) and weight-for-
age (underweight).
• Its signs & symptoms can be:
• Weight loss
• Loss of fat and muscle mass
• Hollow cheeks and sunken eyes
• A swollen stomach
• Dry hair and skin
• Delayed wound healing
• Fatigue
• Difficulty concentrating
• Irritability
• Depression and anxiety

Undernutrion causes:
• Kwashiorkor, a severe protein deficiency, causes fluid retention and a protruding abdomen.
• Marasmus, which results from severe calorie deficiency, leads to wasting and significant fat
and muscle loss.
• Vitamin A deficiency causes Dry eyes, night blindness & decreased immunity.
• Zinc reduction causes Anorexia, stunted growth, delayed healing of wounds, hair loss
(Alopecia), diarrhea.
• Iron deficiency causes Impaired brain function, issues with regulating body temperature,
stomach problems.
• Iodine Deficiency causes Enlarged thyroid glands (goiters), decreased production of thyroid
hormone, growth and development issues

Undernutrition of micronutrients
• This occurs when your diet is out of balance, and it can happen whether or
not you’re getting enough calories. Iron and calcium are often insufficient
in the typical diet. In some cases, the deficiency is due to a disease, such as
pernicious anemia that results in a lack of vitamin B-12. Symptoms usually
don’t occur immediately, but problems arise over time. Micronutrient
deficiencies can be treated by correcting the diet. Adding dietary
supplements or treating any underlying disorders.

Deficiency Of Essential Fatty Acid Causes
• Adverse effect on reproductive system & lactation
• Leads to growth retardation
• Affects energy production
• Water imbalance
• Affects integrity of cell membrane
• Permanent learning defects
• Phrynoderma or Toad Skin is a skin disorder & distinctive form of follicular
hyperkeratosis improved by consumption of essential fatty acids along with
vitamin A, B Complex.

Overnutrition
• It happens when you consume too much energy. Over time it causes
you to gain weight unless you increase your physical activity. It
doesn’t matter if those extra calories come from fat, carbohydrates or
proteins, because your body can take whatever it doesn’t need and
store it as fat. Being overweight or obese is a risk factor for
cardiovascular disease (Hypercholesterolemia), some types of cancer
and type 2 diabetes.

• Treating this kind of overnutrition requires dietary adjustments to
reduce overall calories and improve the balance of the diet to include
more fruits and vegetables, whole grains, calcium sources and
healthful protein sources with a few fats. At the same time, it helps to
increase physical activity and avoid junk foods, which are foods that
are high in calories but have little nutritional value. Sometimes,
medical disorders such as hypothyroidism make it harder to lose excess
weight.

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