Chapter 070. Nutritional Requirements and Dietary Assessment (Part 6)

Acute Care Settings Acute care settings, anorexia, various diseases, test procedures, and medications can compromise dietary intake. Under such circumstances, the goal is to identify and avoid inadequate intake and ensure appropriate alimentation. Dietary assessment focuses on what patients are currently eating, whether they are able and willing to eat, and whether they experience any problems with eating. Dietary intake assessment is based on information from observed intakes; medical record; history; clinical examination; and anthropometric, biochemical, and functional status. The objective is to gather enough information to establish the likelihood of malnutrition due to poor dietary intake or other...
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Chapter 070. Nutritional Requirements and Dietary Assessment (Part 6) Chapter 070. Nutritional Requirements and Dietary Assessment (Part 6) Acute Care Settings Acute care settings, anorexia, various diseases, test procedures, andmedications can compromise dietary intake. Under such circumstances, the goal isto identify and avoid inadequate intake and ensure appropriate alimentation.Dietary assessment focuses on what patients are currently eating, whether they areable and willing to eat, and whether they experience any problems with eating.Dietary intake assessment is based on information from observed intakes; medicalrecord; history; clinical examination; and anthropometric, biochemical, andfunctional status. The objective is to gather enough information to establish thelikelihood of malnutrition due to poor dietary intake or other causes and to assesswhether nutritional therapy is indicated. Simple observations may suffice to suggest inadequate oral intake. Theseinclude dietitians and nurses notes, the amount of food eaten on trays, frequenttests and procedures that are likely to cause meals to be skipped, nutritionallyinadequate diet orders such as clear liquids or full liquids for more than a fewdays, fever, gastrointestinal distress, vomiting, diarrhea, a comatose state, anddiseases or treatments that involve any part of the alimentary tract. Acutely illpatients with diet-related diseases such as diabetes require assessment because aninappropriate diet may exacerbate these conditions and adversely affect othertherapies. Abnormal biochemical values [serum albumin levels Nutritional monitoring is especially important for patients who are very illand who have extended lengths of stay. Patients who are fed by special enteral andparenteral routes also require special nutritional assessment and monitoring byphysicians with training in nutrition support and/or dietitians with certification innutrition support (Chap. 73). Ambulatory Settings The aim of dietary assessment in the outpatient setting is to determinewhether the patients usual diet is a health risk in itself or if it contributes toexisting chronic disease-related problems. Dietary assessment also provides thebasis for planning a diet that fulfills therapeutic goals while ensuring patientadherence. The outpatient dietary assessment should review the adequacy ofpresent and usual food intakes, including vitamin and mineral supplements,medications, and alcohol, as all of these may affect the patients nutritional status.The assessment should focus on the dietary constituents that are most likely to beinvolved or compromised by a specific diagnosis, as well as any comorbidities thatare present. More than one days intake should be reviewed to provide a betterrepresentation of the usual diet. There are many ways to assess the adequacy of the patients habitual diet.These include a food guide, a food exchange list, a diet history, or a foodfrequency questionnaire. A commonly used food guide for healthy persons is theUSDAs food pyramid, which is useful as a basis for identifying inadequateintakes of essential nutrients, as well as likely excesses in fat, saturated fat,sodium, sugar, and alcohol (Table 70-3). The guide is available online(www.MyPyramid.gov) and can be tailored to the needs of persons of differentages and life stages by varying the number of servings. The process of reviewingthe guide with patients helps to identify food groups eaten in excess ofrecommendations or in insufficient quantities and helps them to transition tohealthier dietary patterns. For those prescribed therapeutic diets, assessmentagainst prescriptions stated as food exchange lists may be useful. These include,for example, the American Diabetes Association food exchange lists for diabetes,or the American Dietetic Association food exchange lists for renal disease. Table 70-3 My Pyramid: The USDA Food Guide Pyramid for HealthyPersons Servings and Lower: Moderate: Higher:Examples of Standard 1600 kcal 2200 kcal 2800 kcalPortion Sizes Fruits, cups 1.5 2 2.5 Servings and Lower: Moderate: Higher:Examples of Standard 1600 kcal 2200 kcal 2800 kcalPortion Sizes Vegetables, cups 2 3 3.5 Grains, oz eq 5 7 10 (1 slice bread, 1 cupready to eat cereal, 0.5 cupcooked rice, pasta, cookedcereal) Meat and beans, oz eq 5 6 7 (1 oz lean meat,poultry, or fish; 1 egg, 1 Tbsp.peanut butter, 0.25 cup cookeddry beans, or 0.5 oz nuts orseeds) Servings and Lower: Moderate: Higher:Examples of Standard 1600 kcal 2200 kcal 2800 kcalPortion Sizes Milk, cups 3 3 3 (1 cup milk or yogurt,1.5 oz natural or 2 ozprocessed cheese) Oils, tsp 5 6 8 Discretionary calorie 132 290 426allowance, kcal (remainingcalories after accounting forall of the above) Abbreviation: oz eq, ounce equivalent. Source: Data from United States Department of Agriculture.http://www.MyPyramid.com