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Part II Nutrition Assessment, Consequences, and Implications BOX 19.1 Nutrition Assessment Instrument

1. Does the client experience any of the following problems? ●

Nausea and/or vomiting

If yes, is it associated with any of the following? taste of specific foods

➤➤ ➤➤ ➤➤ ➤➤

sight or smell of particular foods temperature of foods texture

● Diarrhea

● Constipation or GI obstruction ● Mouth sores

● Difficulty swallowing ● Dry mouth ● Poor appetite

If yes, is it caused by any of the following? pain or other symptoms depression or anxiety

➤➤ ➤➤ ➤➤ ➤➤

early satiety, fatigue, or weakness pressure ulcers

2. Does the client take any vitamin, mineral, or other food supplements? If yes, do they take any in excess? 3. Does the client have a gastrointestinal or intravenous feeding tube in place?

4. Does the client or family express significant remorse about weight change? ●

●

If the client has lost much weight, does the weight change make the client more dependent on others? ● Does the client or family want to try to reverse the weight loss with enteral or parenteral nutrition support? If the client has gained weight (or lost), is the weight change acceptable to the client?

5. Does the family exhibit any of the following behaviors? ●

● ● ● ● ●

inappropriate use of food as a crutch for emotional problems ● belief that disease is caused by what the client did or did not eat fear that if the client doesn’t eat, he or she will feel hunger pains fear that if the client becomes dehydrated, he or she will die soon

belief in unorthodox nutrition therapies, such as vitamin C, amygdalin (Laetrile), the macrobiotic diet, enzymes

belief that the client must eat more (either of a particular food group or just in general) no matter how it makes them feel (either emotionally or physically)

belief that the client must eat more to regain weight lost or to gain weight in general even if it will not benefit the client and even if this is not a realistic goal

may alert the nurse to the need for the services of an RDN.

Box 19.2 lists conditions and issues that generally require the services of an RDN.

Identifying Client and Family Concerns

Box 19.1 also includes questions about specific nutrition issues and dietary concerns that clients and families may wish to express. The RDN should pay

attention to offhand remarks that expose hidden fears, such as these:

●

“If I don’t drink anything, will dehydration be painful?”

● “If I give up alcohol, will my liver tumor shrink?” ●

“I’d like to eat, but I’m afraid I’ll choke and be unable to breathe if I eat too much.”

●

“If I had eaten ‘right,’ would I have avoided getting cancer?”