Question

2. You are a nurse in a free community clinic continually treating patients who, for one reason or another, do not access healthful foods. Every body system is affected by poor nutrition, yet it is very difficult to communicate the importance of balanced nutrition to your patients from every age group. (Learning Objectives #4 & #5)

a. In assessing your patients’ nutritional status, what data should be included?

b. Outline potential clinical barriers to dietary intake.

c. What can laboratory tests reveal regarding nutritional status?

d. What nursing diagnoses can result from imbalanced nutrition?

e. The acronym DETERMINE assists in nutritional screening by prompting the Rn to assess?

Answer 1

Ans) 2) a) The assessment of a patient's nutritional status should include a general observation of the person, looking for signs of malnutrition, such as the appearance of hair and skin. In a malnourished person hair is likely to be dull, brittle and dry, and there may be signs of hair loss.

- Data that should be included in a patient’s nutritional assessment include: •Dietary•Medical•Socioeconomic•Anthropometric•Clinical•Laboratory

b) Barriers to an adequate dietary intake include interrupted meals, unwanted food, poor appetite, nausea and fatigue. Patients often have higher nutritional requirements as a result of increased gluconeogenesis, muscle catabolism and decreased absorption.

Potential clinical barriers to dietary intake include:•Dysphagia•Aspiration•Diminished sensory abilities•2d. Information laboratory tests reveal regarding nutritional status include:•Blood and urine levels of nutrients•Blood and urine levels of biochemical function•Protein status•Hemoglobin/hematocrit levels•Hydration status•Blood glucose•Blood cholesterol•Blood triglycerides•Protein metabolism

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c) Serum proteins (albumin, transferrin, prealbumin, retinol-binding protein) are perhaps the most widely used laboratory measures of nutritional status. They are hepatically produced negative acute-phase reactants with reduced levels during systemic inflammation.

d) Nursing diagnoses that can result from imbalanced nutrition include:•Activity intolerance•Impaired dentition•Ineffective health maintenance•Anxiety•Constipation•Diarrhea•Deficient fluid volume•Risk for infection•Impaired home maintenance management•Impaired skin integrity•Deficient knowledge •Noncompliance •Chronic low self-esteem •Disturbed sleep pattern •Social isolation

e)•Disease

•Eating poorly

•Tooth loss/mouth pain

•Economic hardship

•Reduced social contact

•Multiple medicines

•Involuntary weight loss/gain

•Needs assistance in self-care

•Elder years >80