Assessing Nutrition Status

Nutritional assessment involves the collection and analysis of subjective data, or the information your patient shares with you, and objective data, or the information you observe. As the nurse, you'll use information about your patient's nutritional status, which is the balance of nutrient requirements and intake, to provide insight into your patient's overall health.

Start your collection of subjective data by gathering information about your patient's eating patterns and access to food. You can use tools such as a 24-hour diet recall, where your patient lists everything they have had to eat or drink in the past 24 hours; a food frequency questionnaire, that estimates how often they eat certain foods; or a food diary, where they keep track of everything consumed over a certain period. Then, ask about religious or cultural diet traditions or restrictions, as well as food allergies or intolerances that could influence their eating patterns. Lastly, be sure to gather information about their access to transportation to a grocery store, who shops for and prepares their food, and any difficulties obtaining or preparing food.

Next, determine if there are any physiological factors that can impact their nutritional status. Ask about changes in appetite, taste, smell, chewing, or swallowing; gastrointestinal issues such as nausea, vomiting, diarrhea, or constipation; and psychological symptoms like depression or anxiety. Inquire about any chronic medical conditions such as diabetes or inflammatory bowel disease, as well as acute conditions such as recent trauma or surgery.

Also gather information about any diet modifications, exercise regimens, medications, or surgery used to resolve weight-related problems; and ask them if they've recently experienced unintentional weight loss. Also, determine if they are taking any medications that can impact digestion, absorption, and metabolism of nutrients, including laxatives, steroids, or anticonvulsants; as well as supplements they are using. Finally, determine if they use any substances that can impair nutrition, including tobacco, alcohol, or illicit drugs.

Alright, next you'll collect objective data about your patient's nutritional status, starting with anthropomorphic measurements, which are measurements of body composition. First, calculate their body mass index, or BMI, by dividing their weight in kilograms by their height in meters squared; and note results outside the normal range of 18.5 to 24.9. Then, to determine your patient's waist-hip ratio, divide their waist circumference in centimeters, which is the narrowest point below their rib cage and above their umbilicus, by their hip circumference in centimeters, which is the widest point of their hips at the greatest protrusion of the buttocks. A waist-hip ratio of 0.8 or more in those assigned female at birth or 1 or more in those assigned male at birth indicates increased risk of cardiovascular disease and diabetes due to an excessive distribution of fat in the abdomen.

Next, perform a focused physical assessment to identify clinical manifestations of impaired nutrition. Observe their general appearance noting the presence of excess adipose tissue; signs of fat and muscle wasting, like prominent cheek and clavicle bones; or edema. Assess their eyes, which should appear moist and have clear, shiny corneas. Excessively dry eyes and foamy plaques on the cornea, known as Bitot spots, indicate vitamin A deficiency.

Next, note the appearance of their skin, hair, and nails. Their skin should be smooth and free of rashes, bruises, or flaking. Dry, flaky, or scaly skin can indicate deficiencies in vitamin A, essential fatty acids, and zinc, and excessive bruising or petechiae can suggest vitamin C and K deficiencies. Your patient's hair should appear shiny and evenly distributed. Dry and dull hair with patchy areas of hair loss may indicate a protein or zinc deficiency. Lastly, their nails should be smooth and firm. Brittle, ridged, or spoon-shaped nails can indicate an iron deficiency.

Moving on to the mouth and oral cavity, your patient's lips should be smooth, moist, and intact. Inflammation of the lips that causes crusting, scaling and painful cracking of the corners of the mouth, called cheilosis, can signify a deficiency of iron or several B vitamins. Their tongue should appear red and smooth and without lesions. Glossitis, or a swollen, beefy red tongue, could be due to vitamin B complex deficiency; a purplish magenta tongue could indicate a vitamin B2 deficiency; and a pale tongue suggests iron deficiency. Next, their gums should be reddish pink, firm, and without swelling. If swelling, ulcerations, or bleeding are present, this can point to a vitamin C deficiency.

As you assess your patient's musculoskeletal and neurological systems, look for an erect posture; extremity alignment; and strength and movement that's equal bilaterally. Muscle weakness or atrophy may suggest inadequate protein, carbohydrates, or fat. If they're experiencing difficulty walking or recurrent bone pain, they may have a condition called osteomalacia, which is caused by impaired mineralization and weakening of the bones due to a deficiency of vitamin D and calcium. Lastly, a neurologic assessment should reveal an appropriate affect and orientation, and normal sensation. Irritability or a flat affect may indicate a deficiency of calories or several B vitamins. Numbness, tingling, or pain in the hands and feet could indicate peripheral neuropathy, which suggests vitamin B1 or B6 deficiencies.

Alright, as a quick recap… Nutritional assessment involves the collection and analysis of subjective and objective data about your patient's nutritional status, which will provide insight into your patient's overall health.