The Who and What of Nutritional Assessment

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Illnesses can cause malnutrition both indirectly and directly. The illness itself along with symptoms and treatment can be the cause of excess and nutrient deficiency. Some medications, for example, cause anorexia or gastrointestinal discomfort. Meanwhile, an illness like pressure sores can lead to metabolic stress which cause increased protein and energy needs.

Health team workers work together to make sure the nutritional needs are met for patients. These roles can overlap. Physicians are responsible for the patients’ medical needs. The physician is also responsible for prescribing medications, ‘diet orders’ or nutrition prescriptions, and suggesting strategies when the patients status has changed.

The registered dietician is the food and nutrition expert. They are qualified to give ‘nutritional therapy’. They also conduct nutritionary and dietary assessments of their patients. They diagnose the nutrition problems. The registered dietician is also responsible for developing, implementing and evaluating nutrition care plans. They also provide nutrition counseling and education.

The registered dietician technician is responsible for carrying out duties. They help the registered dietician with most tasks listed above.

The nurse works closely with the patients, they assume the responsibility of a dietician when one is not present. The nurses also are responsible for identifying who could benefit from nutrition services. Nurses also screen patients, encourage eating and participate in nutritional assessments.

Historical data can be gathered from an individual. This can include family medical history, history of individual’s supplement and medication intake, personal and social history, and food intake history.

Food intake history can also be called food intake data. This data can be gathered in multiple ways; 24-hour recall, a food frequency questionnaire, food record, and direct observation. a 24-hour recall requires an individual to recount the food they have eaten in the past 24 hours. The assessor takes note of the time, amount and how the food was prepared. A food frequency questionnaire surveys foods consumed during a time period. These foods are organized by food group. The survey taker is required to specify the amount consumed of each food within a time period. A food record is a written account of food consumed over a period of usually a few days. Direct observation can only be conducted in facilities that administer meals to residents daily. Health practitioners use this form of data to measure kcalorie intake.

Anthropometric data includes; height, weight, the circumference of head, and the circumference of limbs. Height measurements are most useful when monitoring a child’s health during growth. Slow or abnormal growth can be a sign of malnutrition in a child. The body weight of an individual can help determine hydration status and BMI. The circumference of the head can help determine brain growth over an individuals growth. The circumference of an individual’s waist and limbs gives an assessor data about the fat and muscle content of the area. These assessments can be split up into adult and child tests. Assessments of infants and children focus on proper growth during childhood. Adult measurements are gathered while in post-acute settings where these measurements can vary depending on nutritional status.

Biochemical data, or lab tests, are used to determine the measurements, in volume, of inner chemical content. These include plasma proteins, albumin, transferrin, prealbumin and retinol-binding protein tests. Plasma protein tests can reflect both protein-energy status and liver functionality. Albumin levels are regularly monitored during illness as the most abundant plasma protein. It is unfortunately slow to give indications of major protein changes. Transferrin is an iron transporting protein, the amount of transferrin in the blood is an indicator of iron in the blood and can give physicians indication if levels are abnormal. Prealbumin and retinol-binding protein tests are more sensitive than albumin tests. Their numbers are affected by zinc concentration, metabolic stress to name a few.

Lastly, there are physical examinations. Although these examinations can give signs of conditions that are nonspecific and not related to nutrition, they can also give rise to conditions that can be eased with nutritional care. These exams include; clinical signs of malnutrition, hydration state, and functional assessments. Clinical signs of malnutrition take place in areas where cell growth is most rapid, such as the hair, nails, skin, and digestive tract. Hydration state of an individual can be determined by blood tests and body weight. This can be caused by fluid retention, which can accompany malnutrition and infection. Symptoms of this include dark urine, thirst and low energy. Functional assessments are given to individuals who are suspected to have muscle atrophy. Reduced heart and lung disorders can be assessed using a treadmill while more general tests include the use of a hand grip device.

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