Assess client’s dietary requirements and intake by asking client to keep a 3-day diary of food and fluid intake. You may also use Box 9-2.
| ASSESSMENT PROCEDURE | NORMAL FINDINGS | ABNORMAL FINDINGS |
|---|---|---|
| Estimate client’s daily caloric requirements. See Table 9-6 for estimated daily calorie needs Compare intake with USDA-recommended food guidelines (Fig. 9-3) | Meets caloric requirements | Consumes more or less than caloric requirements for age, height, body build, and weight Consumes more or less than recommended |
Birth weight doubles at age 4 to 6 months and triples by 1 year.
Growth decreases from ages 1 to 6 years, but biting, chewing, and swallowing abilities increase.
Muscle mass and bone density increase from ages 1 to 6 years.
There is a latent uneven period of growth from ages 1 to 12 years.
Nutritional needs increase during growth spurts (ages 10-15 years for girls and ages 12-19 years for boys).
Allow 1,000 calories plus 100 more per each year of age (e.g., a 5-year-old needs 1,500 calories/day).
Children need three milks, two meats, four fruits or vegetables, and four grains per day.
Adolescents need four milks, two meats, four fruits or vegetables, and four grains per day.
The American Academy of Pediatrics (2012) recommends exclusive breastfeeding for about 6 months, followed by breastfeeding as complementary foods are added into the infant’s diet, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Exclusive breastfeeding is sufficient for optimal growth and development for approximately the first 6 months. Solid foods should not be introduced before age 6 months. When they are introduced, solid foods should be iron enriched.
Infants: Obtain weight, length, and head circumference. Identify type of feeding and iron source.
Children and adolescents: Weigh child and obtain height. Identify adequacy of meals and snacks and sources of iron, calories, and protein.
Older clients may have atrophy on dorsum of hands even with good nutrition.
Assess for poor-fitting dentures and decreased ability to taste.
Body weight may decrease with aging because of a loss of muscle or lean body tissue.
Older adults tend to consume less food and eat more irregularly as they age. This tends to increase with social isolation.
Older adults have decreased peristalsis and nerve sensation, which may lead to constipation. Encourage fluids and dietary bulk to avoid laxative abuse.
Caloric requirements decrease in response to a decreased basal metabolic rate, decreased activity, and change in body composition. A 10% decrease in calories is recommended for people aged 51 to 75 years and a 20% to 25% decrease in calories for people older than 75 years.
A decrease in mobility and vision may impair the ability to purchase and prepare food. Sensory taste losses may lead to anorexia.
Fifty percent of older adults are thought to be economically deprived. This factor may affect their nutrition if meat and milk are omitted from the diet to save money.
Skinfold measurements are often inaccurate owing to changes in subcutaneous fat.
Great variations may be seen in nutritional preferences, eating habits, and patterns of various groups.
Foods, beverages, and medications are classified as hot/cold by many Asians and Hispanics (e.g., yin/yang by Chinese); it is very important to these clients to seek a balanced consumption based on these theories.
Many people, especially of non-northern European descent, have some degree of lactose intolerance.1
Classifications of "food" and "nonfood" items vary in cultures.
Cultural or religious dietary rules or laws are of great importance to some groups (e.g., Orthodox Jews).
Some groups may have diseases precipitated by certain foods or medications (e.g., glucose-6-phosphate dehydrogenase [G-6-PD] deficiency, lactose deficiency).
Some cultural food preferences are contraindicated in specific disease states (e.g., Japanese client with hypertension who consumes high-sodium soy sauce).
1 Clients with lactose intolerance may be able to consume yogurt, buttermilk, fermented cheese, and acidophilus milk, or they may use products such as chewable tablets or liquid drops to act in place of the lactose enzyme.