• Anthropometric Assessment (measurement of the body)
• Biochemical Data
• Clinical
• Dietary Data

• Usual intake
• Recent weight gain or loss
• Appetite
• Medications (including vitamins and supplements)
• Alcohol and Tobacco use
• Financial resources
• Mobility Issues
• Medical history
• History of nausea/vomiting
• Culture/Religion
• Food allergies or intolerances
• Ability to chew and swallow (dentures/missing teeth)
• Knowledge about nutrition
• Eliminiaton patterns (diarrhea/constipation)
• Self-Concept/Stress
• Beverages consumed
• Eat in or out
• Who shops for food and prepares meals

• General Appearance (well-nourished person looks healthy, has positive attitudde)
• Skin
• Hair (glossy, dull)
• Eyes (clear, conjunctiva pink?)
• Tongue, Teeth, Gums (missing, loose teeth, dentures, bleeding gums, beefy red tongue, fissured tongue)
• Nails (brittle, spooned, furrowed, clubbing)
• Abdomen (swollen, distended, bowel sounds)

• Color (pale, pink, grey, yellow)
• Edema or Poor Skin Turgor (tenting)
• Poor Wound Healing

• Motor
• Sensory

• Height and Weight
• Calculate BMI (Body Mass Index)
• <18.5 = underweight
• 18.5-24.9 = normal
• ≥30 = obesity
• IBW (Ideal Body Weight)
• Percentage Weight Change Calculation
• weigh at same time w/same clothing on same scale
• Daily fluctuations of ±2 lbs reflect water weight
• Midarm circumference and triceps or scapular skinfold, abdominal girth, waist to hip ratio

• RBC count
• Male: 4.7 to 6.1 million cells/mcL
• Female: 4.2 to 5.4 million cells/mcL
• WBC count
• 4,500 to 10,000 cells/mcL
• Hematocrit
• Male: 40.7 to 50.3%
• Female: 36.1 to 44.3%
• Hemoglobin
• Male: 13.8 to 17.2 gm/dL
• Female: 12.1 to 15.1 gm/dL
• Platelets
• 150,000 - 450,000
• MCV, MCH, MCHC, RDW

• Glucose: 64 to 128 mg/dL
• BUN (blood urea nitrogen): 7 to 20 mg/dL
• ↑BUN may = dehydration (encourage fluids)
• ↑BUN + ↑Creatinine may = kidney dysfunction
• Creatinine: 0.8 to 1.4 mg/dL
• Calcium - serum: 8.5 to 10.9 mg/dL
• Chloride: 101 to 111 mmol/L
• Sodium: 135 to 145 mEq/L
• Potassium: 3.5 to 5.0 mEq/L
• Phosphorus - serum: 2.4 to 4.1 mg/dL
• Albumin: 3.9 to 5.0 g/dL
• protein in the blood

• Total cholesterol: 100 to 240 mg/dL
• CO2 (carbon dioxide): 20 to 29 mmol/L
• Alkaline phosphatase
• ALT (alanine transaminase)
• AST (aspartate aminotransferase): 10 to 34 IU/L
• Direct bilirubin: 0.0 to 0.3 mg/dL
• Total bilirubin: 0.2 to 1.9 mg/dL
• (these are indicators of liver function)
• Uric acid: 4.1 to 8.8 mg/dL
• if uric acid is high, may indicate gout

• LDL: 60 to 130 mg/dL
• HDL: greater than 40 mg/dL
• Total cholesterol: less than 200 mg/dL
• Triglycerides: 10 to 150 mg/dL
• VLDL: 2 to 38 mg/dL
• (lipid panels are often done while fasting)

• Iron: 60-170 mcg/dl
• TIBC (Total Iron Binding Capacity): 240-450 mcg/dl
• Transferrin saturation: 20-50%
• Ferritin
• Male: 12-300 mg/mL
• Female: 12-150 ng/mL

• Vitamin D (important for calcium absorption)
• Vitamin B12
• Vitamin A: 50 to 200 mg/dl
• Prealbumin: 12-42 mg/dl (fluctuates on a daily basis, most accurate indicator of malnutrition)
• Thyroid Function (metabolism)
• Finger Stick Blood Sugar (FSBS): 70-110 mg/dl

• Imbalanced Nutrition: More or Less than Body Requirements
• Examples of etiologies for undernutrition
• Difficulty chewing/swallowing; alcoholism; metabolic disorders
• Examples of etiologies for overnutrition
• Overeating; lack of exercise; endocrine problems

• Activity Intolerance r/t inadequate intake of iron rich foods leading to anemia
• Constipation r/t inadequate fiber and fluid intake
• Low self-esteem r/t obesity
• Ineffective Coping a.e.b. binge eating when stressed
• Risk for infection r/t immunosuppression secondary to decreased protein intake
• Self-Care Deficit (Feeding, Income)
• Knowledge Deficit r/t community resources, dietary guidelines

• Counsel re: good nutrition and dietary and nutritional supplementation
• Teach clients on a limited budget how to buy nutritious foods 
• Physician ordered diets
• Assist clients with meals
• Teach food safety practices
• Collaborate
• (teaching - assess knowledge base, educational level, how they learn best, how to read nutrition label, nutrient density)

• Standards: RDAs and DRIs (standards based on healthy populations)
• Food Guides: Exchange Lists, MyPlate, USDA
• Nutrition Fact Labels
• Height and Weight Tables, BMI
• Use as reference and to educate your patients

• Regular
• Advance as Tolerated
• NPO (nothing by mouth)
• Ice Chips
• Clear Liquids
• Full Liquids
• Dysphagia Diets: Mechanical Soft, Pureed, Nectar or Honey Thickened fluids
• Low Na++, Low Fat, ADA
• Lactose Intolerant, Food Allergies

• Homeostasis, in terms of energy balance, occurs when the number of kilocalories eaten equals the number used to produce energy
• To lose 1 pound of body fat/week, an adult must have an energy deficit of 3800 calories (500 calories/day)
• The combination of balanced diet and regular physical activity have a stronger effect on balance than either strategy alone

• Monitor Dietary Intake and Eating Habits
• Teach about balanced diet and the kcal content of foods
• Weigh weekly
• Counsel for poor self image/coping behaviors
• Emphasize Self-Montoring and Behavior Modification
• Exercise: "cornerstone" of weight loss
• Consider Medications and Surgery
• Watch for "fad diets"
• Food Diary
• Healthy choices vs. calorie counting
• safe weight 1-2 lbs a week
• Don't cut too many calories - may result in metabolism slowing down

• Aerobic
• Decreases blood pressure and risk of cardiovascular disease
• Enhances blood sugar control
• Decreases risk of obesity
• Decrease risk of osteoporosis
• Burns calories
• Anaerobic
• Tones muscle
• Increases strength and endurance
• Increases muscle mass
• Burns fat

• Etiology or Intervention
• Vegan (plant products only), Lacto- (dairy products), Lacto-Ovo (dairy and eggs)
• Monitor protein, B12, D, Calcium, Iron, and Zinc (B12 is only found in animal products, may need supplementation)
• Omega 3 fatty acids found in fatty fish
• Teach complementary proteins: grains, nuts, seeds and legumes and beans can be combined

• Build lean muscle mass by consuming protein and exercising
• Supplemental Vitamin D, B12, and Calcium
• Water!
• Manage Constipation (increase fiber)
• Salt restriction: use substitutes (be careful, most salt substitutes use potassium chloride) or herbs and spices
• Provide nutrient dense foods (Older adults need fewer calories but the same amount of nutrition)
• (Omega 3 may prevent dementia)

• Offer frequent small meals
• Limit fluids with meals
• Keep environment neat and clean and free from unpleasant sights/odors
• Colorful, varying textures and flavors may help with gustatory deficit
• Encourage socializing at mealtime
• Make sure patient is comfortable/pain free
• Encourage family to bring in foods that the patient likes

• Toileting and Oral Hygeine before meals
• Encourage socialization/out of bed
• Open food containers and orient them to their tray
• If they need help with feeding, give them time to chew and swallow
• Record amout of food and fluid
• Know interventions for patients with impaired swallowing

The nurse is completing a nutritional assessment of her client. He notes that the client's diet intake is 40% Carbohydrate, 20% Protein and 40% Fat. The nurse would recommend that the client:

a-increase carbohydrate intake and lower fat intake

b-decrease protein intake and fat intake

c-increase fat and protein intake

d-increase carbohydrate and protein intake

An elderly patient has a decubitis ulcer with drainage, mobility impairment and a large amount of interstitial fluid. She has dysphagia and consumes few than 500 calories per day. She is in:

a-positive nitrogen balance

b-anabolism

c-negative nitrogen balance

d-antrhopometric crisis

Women's bodies normally contain more _______ and less _________ than men's bodies.

a-carbohydrate, protein

b-fat, protein

c-protein, ash

d-water, fat

Which of the following techniques is used to estimate the body's protein stores?

a-estimating body frame size

b-measuring midarm circumference

c-calculating the body mass index

d-determining triceps skinfolds

1. balance calories
2. enjoy your food but eat less
3. avoid oversized portions
4. eat more vegetables, fruits, whole grains, fat-free or 1% fat dairy products
5. make half your plate fruits and vegetables
6. switch to fat-free or low-fat milk
7. make half your grains whole grains
8. cut back on food high in solid fats, sugars, salt
9. compare sodium in foods
10. drink water instead of sugary drinks

which patient is most likely experienceing a positive nitrogen balance? a patient admitted:

a-with third-degree burns of his legs

b-in preterm labor

c-from a nursing home who has been refusing to eat

d-with acute pancreatitis

A patient has anemia. An appropriate goal would be that the patient will increase his intake of which nutrient?

a-calcium

b-magnesium

c-potassium

d-iron

Which laboratory result most accurately refects a patient's nutritional status?

a-albumin

b-prealbumin

c-transferring

d-hemoglobin

Patients may be deficient in which vitamin during the winter months?

a-vitamin A

b-vitamin E

c-vitamin D

d-vitamin K

A nurse is planning dietary teaching for a client who is a vegetarian. Which of the following nutrients is likely deficient in the client's diet? Select all that apply.

a-protein

b-carbohydrates

c-vitamin B12

d-magnesium

e-potassium

a-protein

c-vitamin B12

to lose 2 pounds of body fat per week, an individual must eat ___ fewer kilocalories each day for 7 days without a change in energy expenditure

a-1000

b-1500

c-2000

d-2500

What percentage range of an adult's kilocalories is recommended as the maximum to be obtained from fat?

a-20 to 30

b-20 to 35

c-30

d-more than 50

Fill in the appropriate calories per gram for the following macronutrients.

Protein:

Carbohydrates:

Fats (Lipids):

Protein: 4 

Carbohydrates: 4

Fats (Lipids): 9

Basic Feeding Formulas

High Protein Formulas

Elemental Formulas

Diabetic Formulas

Renal Formulas

Pulmonary Formulas

Leaking at PEG site

Tube migration

Tube obstruction

Electrolyte fluctuation

Dehydration

Blood sugar increase

Blood sugar decrease

Infection

Delayed gastric emptying

Vomiting

Aspiration

Diarrhea

Constipation

Distention

• Assess client for physical, cultural, economic, and psycholgical stressors influencing nutritional intake
• Assess client's bowel sounds
• Compare/contrast the different types of enteral feeding, why certain feeding is being used
• Assess the patency and functioning of enternal feeding tubies via pump and by gravity
• Assess medical history: history of allergies, type of medications, diet history

Client will exhibit signs of adequate nutritional intake (increased weight, improved lab values, etc.)

Client will exhibit normal bowel elimination pattern with enteral feeding

Client will maintain skin integrity while on enteral feedings

ausculation of bowel sounds

insertion of NG tube

check for placement of tube

check for patency of tube

administration of nasogastric/gastrostomy feeding/irrigations

administration of medications