Review – Nutritional Assessment

HESI-Comprehensive-Review-for-the-NCLEX-RN

Nutritional Assessment

Description: Profile of the child’s and family’s eating habits

1. Iron deficiency occurs most commonly in children 12  to 36 months old, in adolescent females, and in females during their childbearing years.
2. The vitamins most often consumed in less than appropriate amounts by preschool and school-age children are:
   1. Vitamin A
   2. Vitamin C
   3. Vitamin B₆
   4. Vitamin B₁₂

Nursing Plans and Interventions

1. Determine dietary history.
   1. The 24-hour recall: Ask the family to recall all food and liquid intake during the past 24 hours.
   2. Food diary: Ask the family to keep a 3-day record (2 weekdays and 1 weekend day) of all food and liquid intake.
   3. Food frequency record: Provide a questionnaire and ask family to record information regarding the number of times per day, week, or month a child consumes items from the four food groups.
2. Perform a clinical examination.
   1. Assess skin, hair, teeth, gums, lips, tongue, and eyes.
   2. Use anthropometry: measurement of height, weight, body mass index (BMI), head circumference in young children, proportion, skin-fold thickness, and arm circumference.
      1. Height and head circumference reflect past nutrition.
      2. Weight, skin-fold thickness, and arm circumference reflect present nutritional status (especially protein and fat reserves).
      3. Skin-fold thickness provides a measurement of the body’s fat content (half of the body’s total fat stores are directly beneath the skin).
   3. Obtain biochemical analysis.
      1. Plasma, blood cells, urine, or tissues from liver, bone, hair, or fingernails can be used to determine nutritional status.
      2. Laboratory testing of Hgb, Hct, albumin, creatinine, and nitrogen is commonly used to determine nutritional status.
3. Implement appropriate nursing interventions, including client and family teaching to correct identified nutritional deficits (Table 5-2).

Nutrient	Signs of Deficiency	Food Sources
Iron	Anemia Pale conjunctiva Pale skin color Atrophy of papillae on tongue Brittle, ridged, spoon-shaped nails Thyroid edema	Iron-fortified formula Infant high-protein cereal Infant rice cereal Liver Beef Pork Eggs
Vitamin B2 (riboflavin)	Redness and fissuring of eyelid corners; burning, itching, tearing eyes; photophobia Magenta-colored tongue, glossitis Seborrheic dermatitis, delayed wound healing	Prepared infant formula Liver Cow’s milk Cheddar cheese Some green leafy vegetables (broccoli, green beans, spinach) Enriched cereals
Vitamin A (retinol)	Dry, rough skin Dull cornea; soft cornea; Bitot spots Night blindness Defective tooth enamel Retarded growth; impaired bone formation Decreased thyroxine formation	Liver Sweet potatoes Carrots Spinach Peaches Apricots
Vitamin C (ascorbic acid)	Scurvy Receding gums that are spongy and prone to bleeding Dry, rough skin; petechiae Decreased wound healing Increased susceptibility to infection Irritability, anorexia, apprehension	Strawberries Oranges and orange juice Tomatoes Broccoli Cabbage Cauliflower Spinach
Vitamin B6 (pyridoxine)	Scaly dermatitis Weight loss Anemia Irritability Convulsions Peripheral neuritis	Meats, especially liver Cereals (wheat and corn) Yeast Soybeans Peanuts Tuna Chicken Bananas
HESI Hint • Teach proper cooking and storage methods to preserve potency (e.g., cook vegetables in small amounts of liquid). Store milk in opaque container.