Nutrition screening and assessment nutrition 526 2010
This presentation is the property of its rightful owner.
Sponsored Links
1 / 87

Nutrition Screening and Assessment Nutrition 526: 2010 PowerPoint PPT Presentation


  • 63 Views
  • Uploaded on
  • Presentation posted in: General

Nutrition Screening and Assessment Nutrition 526: 2010. Steps to Evaluating Pediatric Nutrition Problems. Screening Assessment Data collection Evaluation and interpretation Intervention Monitor reassessment. Nutrition Screening: Purpose.

Download Presentation

Nutrition Screening and Assessment Nutrition 526: 2010

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Nutrition screening and assessment nutrition 526 2010

Nutrition Screening and AssessmentNutrition 526: 2010


Steps to evaluating pediatric nutrition problems

Steps to Evaluating Pediatric Nutrition Problems

  • Screening

  • Assessment

    • Data collection

    • Evaluation and interpretation

    • Intervention

    • Monitor

    • reassessment


Nutrition screening purpose

Nutrition Screening: Purpose

To identify individuals who appear to have or be at risk for nutrition problems

To identify individuals who require further assessment or evaluation


Screening definition

Screening: Definition

Process of identifying characteristics known to be associated with nutrition problems

ASPEN, Nutri in Clin Practice 1996 (5):217-228

Simplest level of nutritional care (level 1)

Baer et al, J Am Diet Assoc 1997 (10) S2:107-115


Examples of screening risk factors

Anthropometrics: weight, length/height, BMI

Growth measures < than 5th %ile

Growth measures > than 90th %ile

Alterations in growth patterns

Change in Z-scores

Change 1-2 SD

Change percentiles

Medical and developmental Conditions

Medications

Improper or inappropriate food/formula choices or preparation

Psychosocial

Laboratory Values

Examples of Screening risk factors


Examples of screening risk factors1

Jayden:

PG

Weight gain

Nutritional Practices

Barbara:

Breastfeeding

Weight changes

Dietary practices

Infant feeding practices

Mark

Newborn

Weight loss

Breastfeeding

Jake

10 month old

Hct: 29

Examples of Screening risk factors


Assessment

Assessment

Systematic process

Uses information gathered in screening

Adds more in depth, comprehensive data

Links information

Interprets data

Develops care plan

monitor

Reassess


Process

Identify Problem or risk

Identify Etiology

Determine intervention

Monitor and Reevaluate

Process


Goals of nutrition assessment

Goals of Nutrition Assessment

  • To collect information necessary to document adequacy of nutritional status or identify deficits

  • To develop a nutritional care plan that is realistic and within family context

  • To establish an appropriate plan for monitoring and/or reassessment


Ncp nutrition care process

NCP: Nutrition Care Process

  • Provides a framework for critical thinking

  • 4 Steps

    • Assessment

    • Diagnosis

    • Intervention

    • Monitoring/Evaluation


Nutrition screening and assessment nutrition 526 2010

NCP

  • Assessment

    • Obtain, verify, interpret information

    • Data used might vary according to setting, individual case etc…

    • Questions to ask

      • Is there a problem?

      • Define the problem?

      • Is more information needed?


Nutrition screening and assessment nutrition 526 2010

NCP

  • Diagnosis

    • Identification or labling of problem that is within RD practice to treat

      • Examples:

        • Inadequate intake

        • Inadequate growth


Examples of nutrition diagnosis options

Altered GI Function

Altered nutrition related laboratory values

Decreased nutrient needs

Evident malnutrition

Inadequate protein-energy intake

Excessive oral intake

Increased energy expenditure

Increased nutrient needs

Involuntary weight loss

Overweight/obesity

Limited adherence to nutrition related recommendations (vs food and nutrition related knowledge)

Underweight

Food and medication interactions

Examples of Nutrition Diagnosis Options


Nutrition screening and assessment nutrition 526 2010

NCP:

  • Diagnosis written as a PES statement

    Problem/Etiology/Signs and symptoms

    “Must be clear and concise. 1 problem

    one etiology”


Examples of screening risk factors2

Jayden:

PG

Weight gain

Nutritional Practices

Barbara:

Breastfeeding

Weight changes

Dietary practices

Infant feeding practices

Mark

Newborn

Weight loss

Breastfeeding

Emma

12 months

Weight @ 95th percentile

Diet information

Jake

10 month old

Hct: 29

Examples of Screening risk factors


Ncp process

NCP Process

Jayden, Barbara, Mark, Emma, Jake


Nutrition screening and assessment nutrition 526 2010

NCP

  • Intervention

    • Etiology drives the intervention

  • Monitoring and Evaluation


Challenges and pitfalls

Challenges and Pitfalls


Challenges

Challenges

Nutrient needs influenced by:

genetics, activity, body composition, medical conditions and medications

Individuals anthropometric date influenced by:

genetics, body composition, development, history


Challenges1

Challenges

Identification of etiology

Weighing risk vs benefit

Supportive of:

Family

Individual

Development/temperament


Challenges2

Challenges

  • Information

    • Availability

    • Accurate

    • Representative

    • complete

  • Goals and expectations

    • Available

    • Evidence bases

    • applicable


Comprehensive nutrition assessment

Comprehensive Nutrition Assessment

  • Collection of Nutritional data

  • Interpretation of data

    • Linking information

      • Goals and expectations

      • Individual data

      • evidence

    • Asking questions

  • individualized intervention

  • monitoring outcomes of intervention


Potential pitfalls

Potential Pitfalls

Excuses

Assumptions

Faulty reasoning

Incorrect or inaccurate information

Not evidence based

Biased


Information collected current and historical

Information Collected: Current and Historical

Growth

Dietary

Medical history

Diagnosis

Feeding and developmental information

Psychosocial and environmental information

Clinical information and appearance (hair, skin, nails, eyes)

Other (laboratory)


Assessment tools

Assessment Tools


Nutrition assessment

Tools of Assessment

Growth

Measurements

Growth charts

Absolute size (percentile)

Pattern

Body composition

Water, bone, muscle, fat

Intake

Additional information

Intake

Food record, food recall, analysis

Additional information

Medical,

Development

Social

Laboratory

Other anthropometrics

etc

Nutrition Assessment


Nutrition screening and assessment nutrition 526 2010

Who is the regulator of growth?

Who regulates Intake?

What do measurements mean?

Weight

Weight gain

Lab values

Intake information


Growth

Growth


Growth1

Growth

Growth is a dynamic process defined as an increase in the physical size of the body as a whole or any of its parts associated with increase in cell number and/or cell size

Reflects changes in absolute size, mass, body composition


Growth2

Growth

A normal, healthy child grows at a genetically predetermined rate that can be compromised by imbalanced nutrient intake


Growth assessment

Growth Assessment

Progress in physical growth is one of the criteria used to assess the nutritional status of individuals


Absolute size

Absolute size

  • Absolute size

  • Body composition

  • Growth/changes over time


Absolute size1

Absolute size


Nutrition screening and assessment nutrition 526 2010

Adam


Other anthropometrics

Other Anthropometrics

  • Upper arm circumference, triceps skinfolds

  • Arm muscle area, arm fat area

  • Sitting height, crown-rump length

  • Arm span

  • Segmental lengths (arm, leg)

    All have limitations for CSHCN, but can be additional information for individual child


Body mass index for age

Body Mass Index for Age

  • Body mass index or BMI: wt/ht2

  • Provides a guideline based on weight, height & age to assess overweight or underweight

  • Provides a reference for adolescents that was not previously available

  • Tracks childhood overweight into adulthood


Guidelines to interpretation of bmi

Guidelines to Interpretation of BMI

  • Underweight

    • BMI-for-age <5th percentile

  • At risk of overweight

    • BMI-for-age  85th percentile

  • Overweight

    • BMI-for age  95th percentile


  • Interpretation of bmi

    Interpretation of BMI

    • BMI is useful for

      • screening

      • monitoring

    • BMI is not useful for

      • diagnosis


    Who might be misclassified

    Who might be misclassified?

    • BMI does not distinguish fat from muscle

      • Highly muscular children may have a ‘high’ BMI & be classified as overweight

      • Children with a high percentage of body fat & low muscle mass may have a ‘healthy’ BMI

      • Some CSHCN may have reduced muscle mass or atypical body composition


    Nutrient analysis

    Nutrient Analysis

    • Fluid

    • Energy

    • Protein

    • Calcium/Phosphorus

    • Iron

    • Vitamin D

    • Other


    Nutrient needs

    Recommendations established for over 43 essential and conditionally essential nutrients

    Nutrient Needs


    Basis of recommendations

    Basis of recommendations

    • Basis

    • Physiology

      • GI

      • Renal

    • Growth and Development

    • Preventing deficiencies

    • Meeting nutrient needs

      • Water

      • Energy

      • Vitamin D

      • Iron


    Dietary information

    Dietary Information

    Collect data

    Nutrient Analysis

    Comparison with recommendations, guidelines, evidence

    Link with additional information

    Interpret


    Dietary information1

    Dietary Information

    • Family Food Usage

    • 24 hour recall

    • Diet history

    • 3-7 day food record or diary

    • Food frequency

    • Other Information

      • Food preparation, history, feeding observation, feeding problems, likes/dislikes, feeding environment


    Approaches to estimating nutrient requirements

    Approaches to Estimating Nutrient Requirements

    • Direct experimental evidence (ie protein and amino acids)

    • extrapolation from experimental evidence relating to human subjects of other age groups or animal models

      • ie thiamin--related to energy intake .3-.5 mg/1000 kcal

    • Breast milk as gold standard (average [] X usual intake)

    • Metabolic balance studies (ie protein, minerals)

    • Clinical Observation (eg: manufacturing errors B6, Cl)

    • Factorial approach

    • Population studies


    Nutrition screening and assessment nutrition 526 2010

    Dietary Reference Intakes (DRI)(including RDA, UL, and AI) are the periodically revised recommendations (or guidelines) of the National Academy of Sciences


    Comparison of individual intake data to a reference or estimate of nutrient needs

    DRI: Dietary Reference Intakes

    expands and replaces RDA’s

    reference values that are quantitative estimates of nutrient intakes for planning and assessing diets for healthy people

    AI: Adequate Intake

    UL: Tolerable Upper Intake Level

    EER: Estimated Energy Requirement

    Comparison of individual intake data to a reference or estimate of nutrient needs


    Nutrition screening and assessment nutrition 526 2010

    DRI

    • Estimated Average Requirement (EAR): expected to satisfy the needs of 50% of the people in that age group based on review of scientific literature.

    • Recommended Dietary Allowance (RDA): Daily dietary intake level considered sufficient by the FNB to meet the requirement of nearly all (97-98%) healthy individuals. Calculated from EAR and is usually 20% higher

    • Adequate intake (AI): where no RDA has been established.

    • Tolerable upper limit (UL): Caution agains’t excess


    Nutrition screening and assessment nutrition 526 2010

    DRI

    • Nutrition Recommendations from the Institute of Medicine (IOM) of the U.S> National Academy of Sciences for general public and health professionals.

    • Hx: WWII, to investigate issues that might “affect national defense”

    • Population/institutional guidelines

    • Application to individuals.


    Dri s for infants

    DRI’s for infants

    • Macronutrients based on average intake of breast milk

    • Protein less than earlier RDA

    • AAP Recommendations

      • Vitamin D: 200 IU supplement for breastfed infants and infants taking <500 cc infant formula

      • Iron: Iron fortified formula (4-12 mg/L), Breastfed Infants supplemented 1mg/kg/d by 4-6 months


    Nutrition screening and assessment nutrition 526 2010

    Adam


    Nutrition screening and assessment nutrition 526 2010

    Adam


    Other guidelines

    Other Guidelines

    • AAP

    • Bright Futures

    • Educational or Professional teaching

    • Public Policy Guidelines

      • Consider source

      • Consider Purpose

      • ? How apply to individual


    Examples

    Examples

    • Baby cereal at 6 months

    • Juice

    • Introduction of Cows milk to infants

    • Weight gain in pregnancy

    • Family meals


    Energy

    Energy


    Factors that alter energy needs

    Body composition

    Body size

    Gender

    Growth

    Genetics

    Ethnicity

    Environment

    Adaptation and accommodation

    Activity/work

    Illness/Medical conditions

    Factors that alter Energy needs


    Energy1

    Energy

    Correlate individual intake with growth


    Medical information

    Medical Information


    Medical information and history

    Medical Information and History

    Conditions that may impact growth, nutritional status, feeding

    Medications that may impact nutrient needs, absorbtion, utilization, or tolerance

    Illness, treatments, proceedures


    Medical conditions

    Medical Conditions

    • Congenital Heart Disease

    • Cystic Fibrosis

    • Liver disorders

    • Short gut syndrome or other conditions of malabsorbtion

    • Respiratory disorders

    • Neuromuscular

    • Renal

    • Prematurity

    • Recent illness

    • Others


    Drug nutrient interaction

    Drug-Nutrient Interaction

    Altered absorbtion

    Altered synthesis

    Altered appetite

    Altered excretion

    Nutrient antagonists

    Tolerance


    Feeding and developmental information

    Feeding and Developmental Information


    Feeding and development

    Feeding and development

    Feeding Interactions

    Feeding Relationship

    Feeding Skills

    Feeding Development

    Feeding Behaviors


    Nutrition screening and assessment nutrition 526 2010

    • What factors influence food choices, eating behaviors, and acceptance?


    Feeding

    Feeding

    Delays in feeding skills

    Feeding intolerance

    Behavioral

    Medical/physiological limitations

    Other


    Sociology of food

    Sociology of Food

    • Hunger

    • Social Status

    • Social Norms

    • Religion/Tradition

    • Nutrition/Health


    Psychosocial and environmental information

    Psychosocial and environmental information


    Psychosocial and environmental information1

    Psychosocial and Environmental Information

    • Family

      • Constellation

      • Dynamics

      • Views

      • Resources

      • other

    • Socioeconomic status

      • employment/education/income/other

    • Beliefs

      • Religious/cultural/other


    Clinical and laboratory assessment

    Clinical and Laboratory assessment


    Clinical assessment

    Clinical Assessment

    General appearance

    Temperature

    Color

    Respiratory/WOB

    Skin/hair/nails/membranes

    Output (urine and stool)

    Other


    Clinical signs of nutrient deficiency

    Clinical signs of Nutrient deficiency


    Laboratory assessmet

    Laboratory Assessmet

    Laboratory tests can be specific and may detect deficiencies or excess prior to clinical symptomotology.

    Useful for assess status, response to tx, tolerance

    Validity effected by handling, lab method, technician accuracy, disease state, medical therapies

    Complements other components of process


    Examples of laboratory tests

    Examples of Laboratory Tests


    Linking information

    Linking Information


    Assessment process

    Assessment Process

    Linking information collected with:

    Goals/expectations

    Reference data/standards

    Evidence

    individual

    Asking questions


    Case examples

    Case Examples


    Interpretation asking questions

    Interpretation: Asking Questions

    Is there a problem?

    Was there a problem?

    Does information make sense?

    What are goals and expectations?

    What is etiology of the problem?


    Intervention

    Intervention

    Identify etiology

    Identify contributing factors

    Support feeding relationship

    Consider psychosocial factors, family choice and input

    Weigh risk v.s. benefit


    Etiology contributing factors

    Etiology: Contributing factors


    Nutrition screening and assessment nutrition 526 2010

    • Adequate intake vs feeding relationship

    • Concentrating formula vs fluid status

    • impact on tolerance, compliance, errors, cost

    • solution to problem vs exacerbating problem


    Nutrition screening and assessment nutrition 526 2010

    Adam


    Nutrition screening and assessment nutrition 526 2010

    Adam


    Summary

    Summary:

    Screening

    Assessment

    Diagnosis

    Intervention

    Monitoring and reevaluation


    Summary1

    Summary

    Identify Problem or risk

    Identify Etiology

    Determine intervention

    Monitor and Reevaluate


    Summary assessment process

    Summary: Assessment Process

    Collect data

    Interpret data

    Link information

    Compare to references, standards, expectations

    Ask questions


    The end

    The End

    Questions?


  • Login