Lecture notes for chapter 15

  
Notes from lecture by professor  Betty Cohen as of  3/12/2001 recorded by Michael D.

                         Assessment

Assessment  consists of             A-anthropometric
                                    B-biochemical
                                    C-clinical
                                    D-dietary-(here we also include all historical data)

    The purpose of nutrition assessment is to create nutrition care plan. When making 
nutrition care plan one of the things that we need to keep in our mind, is to keep the
assessment as short as possible, and up to the point. 
     When we are making nutrition assessment, we are concentrating only on those parts 
that have to do with nutrition. Conditions that are not related to nutrition, are not 
subject of our interest in this case. Thus we are not going to be assessing for example 
patients edema that is related to other than nutritional cause.


   Nutrition assessment is part of Nutrition care plan that
consists of:
            A-analyses
            B-plan
            I-implementation of plan 
            E-evaluation of plan

Nutrition care plan then leads to 
                                 a) nutrition counseling
                                 b) successful treatment

     One thing we need to realize, however, is that not every patient needs full
assessment. To single out patients who are in need for full nutrition assessment, we 
need to do first screening.
     In the hospital setting we are screening patients for PROTEIN-KCAL MALNUTRITION.
 Based on this screening we are able to assign patients to appropriate risk level.
     In short, we could  say that the purpose of screening is to prioritize patients 
in order to avoid losing time with patients that are not at risk. This prioritizing is 
done through assigning level of care. 
     Generally we recognize three levels of care :

1) Nutritionally stable- thought the patient may seem nutritionally stable,you still
                     need to do meal rounds to make sure that this patient stays
                     nutritionally stable. These are the patients that may stay in the 
                     hospital longer than is necessary due to the fact that they get 
                     neglected in favor of patient in higher risk level.The result then 
                     is  declining  nutrition status and prolonged hospitalization.

2) Moderate risk for developing risk for protein kcal malnutrition

3) High risk for protein kcal malnutrition

     Nutrition screening is done in every hospital little bit differently.
Some of the fundamental parts of screening are-weight loss
                                              -change in appetite
                                              - type of disease
                                              - level of albumin

    If screening determines that patient is at risk for protein kcal malnutrition,
then full assessment is done.


              
     Functions of nutrients

     One of the things nutrients are necessary for, is development of cells. One of the 
most important part of cell, is the cell membrane. This is what holds the entire cell 
together. An important part of cell membrane  is protein. If there is protein deficiency
every part of our body will be affected. One of the most important functions of protein 
within cellular metabolism is its ability to regenerate and form new  epithelial cells.
Epithelial cells are the ones that cover our inner as well as outer part of our body. 
They are responsible for  lining of  our digestive tract. If they cannot be regenerated, 
because of protein deficiency, we lose ability to digest and absorb nutrients from food.
Food then passes through our gastro- intestinal tract without providing us with any 
nutrients. Because of the fact that these cells have very short life span, process
of malnutrition may be initiated at early stages of protein deficiency.
    Another important part of proper cell function  are antioxidants.They include 
vitamins A,C,E,Beta-carotene, and  minerals selenium and zinc. These antioxidants prevent
dangerous cell destruction by free radicals coming from our own body production during 
metabolism, as well as from our environment such as air we breathe , water we drink and
exposure to sunlight.