Question

What is nutrition focused physical assessment (NFPA)?

Give an example of an assessment measure

What types of patients are good candidates for NFPA?

Answer 1

Nutrition Focused Physical Assessment (NFA)

Nutritonal screening is an essential part of health assessment . Screening a patient is quick method of identifying for malnutrition related problems

Goals of NFPA

• Identify the signs and symptoms of altered nutrition
• Gather data from patients regarding nutritional practices
• Determine patient's nutritional energy needs
• Obtain patient's diet history
• Assess illness effects is having on ability to prepare meals at home

Parameters measured during NFPA includes the following

Objective Data

1. Height
2. Weight
3. Weight change
4. Primary Diagnosis
5. Presence of other co-morbidities

Subjective data

Helps to gain information regarding

• Unintentional weight loss
• Presence of a modified diet
• Presence of altered nutritional symptoms such as nausea, vomiting, diarrhea, constipation

Standardized Nutritional Screening tools

1. Subjective Goal Assessment

Uses person's history, weight and physical assessment data to evaluate nutritional status

Is a simple and inexpensive technique that is able to predict nutrition related complications

2.Mini Nutritional Assessment (MNA)

Used as a screening tool for older adults in home-care programs, nursing homes and hospital.

This tool has 18 items that are divided into screening and assessment

If a patient scores 11 or less on the screening portion, the health care provider completes the assessment portion

A total score of less than 17 indicates protein energy malnutrion (PEM)

Mini Nutritonal Assessment

Screening	Score
A.Has food intake decline over pat 3 months due to loss of appetite, digestive problems,chewing or swallowing difficulties? 0= severe decrease in food intake 1= moderate decrease in food intake 2=No decrease in food intake
B. Weight loss during the last 3 months? 0= weight loss greater than 3 Kg (6.6 lbs) 1 = Does not know 2= wieight loss between 1 and 3 Kg (2.2-6.6 lbs) 3= No weight loss
C.Mobility 0= bed or chair bound 1= able to get out of bed/chair but does not go out 2= goes out
D.Has suffered psychological stress or acute disease in the past 3 months? 0= Yes 2= No
E.Neuropsychological Problems 0= severe dementia or depression 1= mild dementia 2= no psychological problems
F1. Body Mass Index (BMI) (weight in kg/height in m2 ) 0= BMI < 19 1= BMI 19- <21 2= BMI 21 - < 23 3= BMI 23 or greater If BMI is not available replace Q F1 with Q F2
F2.Calf Circumference (CC in cms) 0= less than 31 3= 31 or greater

Screening score- Max 14 points

• 12-14 normal nutritional status
• 8-11 at risk of malnutrition
• 0-7 malnourished

3. Malnutrition Screening Tool

The malnutriton screening tool is an effective measure of nutritional problems for patients in a variety of health care institutions

Good candidates for NFPA

1. Patients who have conditions that interfere with their ability to ingest,digest or absorb adequate nutrients
2. Patients with Congenital anomalies and surgical revisions ogf GI tract
3. Patients fed only by IV infusion of 5% or 10% dextrose are at risk of nutritional deficiences
4. Patinets with chronic diseases or increased metabolic requirements are at high risk of developing nutritional deficiencies
5. Infants and older adults are high risk group