Nutritional Assessment
Components of Nutritional Assessment
Body mass index
- Ratio based on body weight and height
- Formula = weight (kg)/[height (m)]²
- Compared to established standards —> highly correlated with body fat
- Must take ethnicity into account
- BMI < 18.5 —> poor nutritional status
- BMI 25-29.9 —> overweight
- BMI > 30 —> obese
Waist circumference
- Measures excess abdominal fat
- Tape measure is placed around the abdomen at the iliac crest
- Males —> greater than 40 inches
- Women —> greater than 35 inches
- Risk for diabetes, dyslipidemia, hypertension, heart attack, and stroke
ideal body weight
- Women: 100 lbs for 5ft of height, add 5 lbs for every additional inch
- Men: 106 lbs for 5ft of height, add 6 lbs for every additional inch
- Subtract 10% for small frame, add 10% for large frame for both genders
Biochemical assessment
- Uses laboratory measurements to assess general nutritional status and identify
specific nutritional deficiencies
- Serum prealbumin and albumin —> measures of protein deficit
- Serum transferrin —> iron deficiency leading to anemia
- Retinol-binding protein —> useful for monitoring acute, short-term changes in
protein status
- Complete blood count —> tests components of your blood including hematocrit
(amount of red blood cells), white blood cells, platelets, and hemoglobin concentration
- Electrolytes —> provide information about fluid and electrolyte balance and kidney
function
- Urine tests —> used to calculate creatinine-height index that assesses metabolically
active tissue and degree on protein depletion
Dietary data
,- Helps estimate whether food intake is adequate and appropriate
- Food Record = record is kept of food consumed over a period of time, usually 3-7 days
- 24-Hour Recall = recall of food intake over a 24-hour period
- Dietary Interview = questions are utilized to elicit needed information and is
conducted in a non-directive and exploratory way
Eye and Vision Disorders
Anatomy of the Eye
The eyeball is composed of three layers:
- 1. Outer dense fibrous layer, including sclera and transparent cornea
- 2. Middle vascular layer containing the iris, ciliary body, and choroid
- 3. Inner neural layer including the retina, optic nerve, and visual pathway
Divided anatomically into two segments:
- 1. Anterior segment between the anterior cornea and posterior iris, including the
anterior and posterior chamber
- 2. Posterior segment between the posterior lens and the retina, including the vitreous
chamber
- Aqueous humor = transparent nutrient-containing fluid that fills the anterior and
posterior chambers of the eye —> related to the intraocular pressure (IOP)
- Normal IOP is < 21 mmHg
- Vitreous humor = transparent gelatinous tissue that fills the eyeball behind the lens,
composed mainly of water —> maintains the shape of the eye
Assessment and Evaluation of Vision
Ocular history
- Nurse collects subjective data related to eye health
- Genetics play a large role in many eye and vision disorders
- Diagnosis of ophthalmic disorder will be ascertained based on data collected
Visual acuity
- The sharpness of vision, measured by the ability to discern letters or numbers at a
given distance according to a fixed standard
- Snellen chart —> composed of a series of progressively smaller rows of letters read
from 20 ft away, tests for distance vision
, - Rosenbaum pocket screener —> tests for near vision at 14 ft away
Eye Examination
External
- Ptosis = drooping of the eyelid
- Ectropion = turning out of the lower eyelid
- Entropion = turning in of the lower eyelid
- Trichiasis = turning in of the eyelashes
- Nystagmus = involuntary oscillating movement of the eyeball
Diagnostic procedures
- Ophthalmoscopy — ophthalmoscope is used to examine the back part of the eyeball
(fungus), including the retina, optic disc, macula, and blood vessels
- Slit-lamp —> binocular microscope that magnifies the eye 10-40 x the real image,
used to evaluate inflammation of the eye and cataracts
- Color vision testing —> most common test is performed using Ishihara polychromatic
plates bound in a booklet where the patient tries to identify the hidden shapes
contained within them
- Central vision identifies color —> patients with central vision conditions therefore
have more difficulty identifying colors than those with peripheral vision conditions
- Color-blindness can be inherited, as a side effect of medication (ie. Digoxin), or
pathological (ie. cataracts)
- Amsler grid —> consists of a geometric grid of identical squares with a central fixation
point, patient reports any distortion while being tested separately with each eye -
squares may look faded or lines may be wavy
- Used to test for macular problems, such as macular degeneration
- Ultrasonography —> B-scan identities pathology such as orbital tumors, retinal
detachment, and vitreous hemorrhage
- A-scans are used to measure the axial length for implants prior to cataract surgery
- Fundus photography —> used to detect and document retinol lesions
- Tonometry —> measures the pressure needed to flatten the cornea - the intraocular
pressure to screen for and manage glaucoma
- Patient is encouraged to relax and avoid squeezing the eyeballs, holding their breath,
performing the Valsalva maneuver - will result in abnormally high IOP
- Laser scanning —> used to measure nerve fiber layer thickness, an important
indicator of glaucoma progression
Components of Nutritional Assessment
Body mass index
- Ratio based on body weight and height
- Formula = weight (kg)/[height (m)]²
- Compared to established standards —> highly correlated with body fat
- Must take ethnicity into account
- BMI < 18.5 —> poor nutritional status
- BMI 25-29.9 —> overweight
- BMI > 30 —> obese
Waist circumference
- Measures excess abdominal fat
- Tape measure is placed around the abdomen at the iliac crest
- Males —> greater than 40 inches
- Women —> greater than 35 inches
- Risk for diabetes, dyslipidemia, hypertension, heart attack, and stroke
ideal body weight
- Women: 100 lbs for 5ft of height, add 5 lbs for every additional inch
- Men: 106 lbs for 5ft of height, add 6 lbs for every additional inch
- Subtract 10% for small frame, add 10% for large frame for both genders
Biochemical assessment
- Uses laboratory measurements to assess general nutritional status and identify
specific nutritional deficiencies
- Serum prealbumin and albumin —> measures of protein deficit
- Serum transferrin —> iron deficiency leading to anemia
- Retinol-binding protein —> useful for monitoring acute, short-term changes in
protein status
- Complete blood count —> tests components of your blood including hematocrit
(amount of red blood cells), white blood cells, platelets, and hemoglobin concentration
- Electrolytes —> provide information about fluid and electrolyte balance and kidney
function
- Urine tests —> used to calculate creatinine-height index that assesses metabolically
active tissue and degree on protein depletion
Dietary data
,- Helps estimate whether food intake is adequate and appropriate
- Food Record = record is kept of food consumed over a period of time, usually 3-7 days
- 24-Hour Recall = recall of food intake over a 24-hour period
- Dietary Interview = questions are utilized to elicit needed information and is
conducted in a non-directive and exploratory way
Eye and Vision Disorders
Anatomy of the Eye
The eyeball is composed of three layers:
- 1. Outer dense fibrous layer, including sclera and transparent cornea
- 2. Middle vascular layer containing the iris, ciliary body, and choroid
- 3. Inner neural layer including the retina, optic nerve, and visual pathway
Divided anatomically into two segments:
- 1. Anterior segment between the anterior cornea and posterior iris, including the
anterior and posterior chamber
- 2. Posterior segment between the posterior lens and the retina, including the vitreous
chamber
- Aqueous humor = transparent nutrient-containing fluid that fills the anterior and
posterior chambers of the eye —> related to the intraocular pressure (IOP)
- Normal IOP is < 21 mmHg
- Vitreous humor = transparent gelatinous tissue that fills the eyeball behind the lens,
composed mainly of water —> maintains the shape of the eye
Assessment and Evaluation of Vision
Ocular history
- Nurse collects subjective data related to eye health
- Genetics play a large role in many eye and vision disorders
- Diagnosis of ophthalmic disorder will be ascertained based on data collected
Visual acuity
- The sharpness of vision, measured by the ability to discern letters or numbers at a
given distance according to a fixed standard
- Snellen chart —> composed of a series of progressively smaller rows of letters read
from 20 ft away, tests for distance vision
, - Rosenbaum pocket screener —> tests for near vision at 14 ft away
Eye Examination
External
- Ptosis = drooping of the eyelid
- Ectropion = turning out of the lower eyelid
- Entropion = turning in of the lower eyelid
- Trichiasis = turning in of the eyelashes
- Nystagmus = involuntary oscillating movement of the eyeball
Diagnostic procedures
- Ophthalmoscopy — ophthalmoscope is used to examine the back part of the eyeball
(fungus), including the retina, optic disc, macula, and blood vessels
- Slit-lamp —> binocular microscope that magnifies the eye 10-40 x the real image,
used to evaluate inflammation of the eye and cataracts
- Color vision testing —> most common test is performed using Ishihara polychromatic
plates bound in a booklet where the patient tries to identify the hidden shapes
contained within them
- Central vision identifies color —> patients with central vision conditions therefore
have more difficulty identifying colors than those with peripheral vision conditions
- Color-blindness can be inherited, as a side effect of medication (ie. Digoxin), or
pathological (ie. cataracts)
- Amsler grid —> consists of a geometric grid of identical squares with a central fixation
point, patient reports any distortion while being tested separately with each eye -
squares may look faded or lines may be wavy
- Used to test for macular problems, such as macular degeneration
- Ultrasonography —> B-scan identities pathology such as orbital tumors, retinal
detachment, and vitreous hemorrhage
- A-scans are used to measure the axial length for implants prior to cataract surgery
- Fundus photography —> used to detect and document retinol lesions
- Tonometry —> measures the pressure needed to flatten the cornea - the intraocular
pressure to screen for and manage glaucoma
- Patient is encouraged to relax and avoid squeezing the eyeballs, holding their breath,
performing the Valsalva maneuver - will result in abnormally high IOP
- Laser scanning —> used to measure nerve fiber layer thickness, an important
indicator of glaucoma progression
