Chapter 1: Perform nutrition assessment

Nutrition assessment is a fundamental phase within the nutrition care process, essential for identifying nutritional problems, planning interventions, and evaluating outcomes. For nutrition and dietetics professionals in Kenya, conducting thorough assessments ensures that interventions are tailored to the diverse needs of patients in hospitals, community health programs, and specialized clinics. This chapter explores the nutrition care process, emphasizing the role of personal protective equipment (PPE) during assessment, which safeguards both practitioners and clients in various healthcare and community settings.

1.1 Overview of nutrition care process

The nutrition care process is the method a dietitian or nutritionist follows to give nutrition care in an organised, repeatable way. Instead of giving advice from habit, the practitioner collects data, names the nutrition problem, plans and carries out an intervention, and then checks whether it worked. This topic defines the terms used in the process, explains why it matters and what its steps are, and covers the protective equipment a practitioner wears while collecting assessment data.

1.1.1 Definition of terms

Clear terms prevent confusion when a dietitian writes a record that a nurse, a doctor or a colleague at another facility will read. The six terms below are used throughout the Nutrition Care Process unit.

1.1.1.1 Nutrition

Nutrition is the process by which the body takes in food, digests and absorbs it, and uses the nutrients for energy, growth, repair and regulation. It is also the science that studies how diet affects health and disease. In the nutrition care process, nutrition is the subject of the practitioner's work: it is what is assessed, diagnosed and treated.

Example: a client who attends an outpatient clinic with repeated tiredness may have a nutrition problem such as too little iron in the diet, a problem with absorption, or both. Finding out which is the first task of the practitioner.

1.1.1.2 Nutrition care

Nutrition care is the service a qualified practitioner gives to an individual, a family or a group to improve or maintain their nutrition and health. It is wider than giving a diet sheet. It covers assessing the client, deciding what the nutrition problem is, planning and carrying out the actions needed, teaching the client, and following progress until the goal is reached or the client is referred.

Example: a dietitian who visits the ward each morning to check on feeding for an underweight patient, adjusts the meal plan with the kitchen, and explains the plan to the patient's family is giving nutrition care.

1.1.1.3 Nutrition status

Nutrition status is the state of a person's body that results from the balance between the nutrients taken in and the amount the body needs and uses. It may be good, or it may show undernutrition, overnutrition or a specific deficiency or excess. It is judged from several sources of evidence taken together, not from one measurement.

Example: a young child whose weight, length and mid-upper arm circumference are all below the expected range, who looks pale and eats very little, has a poor nutrition status. The same measurements, taken again after a month of feeding support, show whether the status has improved.

1.1.1.4 Nutrition care process

The nutrition care process is a standardised, step-by-step way of giving nutrition care. It has four linked steps: nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation. It is a problem-solving method, not a list of forms: the practitioner uses it with every client, whatever the condition or the setting.

The process is a cycle. Monitoring and evaluation often show that new data are needed, so the practitioner returns to assessment and the cycle runs again. The four steps are described later in this topic.

1.1.1.5 Diagnosis

In this process, diagnosis means the nutrition diagnosis: naming a nutrition problem that the dietitian is trained and responsible to treat. It differs from a medical diagnosis, which names a disease and is made by the doctor.

Example: a medical diagnosis may be type 2 diabetes. The nutrition diagnosis for the same client may be excessive carbohydrate intake or inconsistent timing of carbohydrate meals. The first names the disease, the second names a problem that diet can change. How a nutrition diagnosis is written is taught in the next chapter of this unit.

1.1.1.6 Interventions

An intervention is a planned action taken to change the nutrition problem, its cause, or its effects. Interventions are chosen to fit the diagnosis and the client's situation. They include providing food or supplements, teaching and counselling the client, coordinating care with other professionals, and referring the client when the problem is outside the dietitian's scope.

Example: for a client with high blood pressure whose diet is heavy in salty foods, an intervention may be to teach ways of flavouring food with onions, garlic and herbs in place of added salt, to agree on a small goal for the coming month, and to refer the client to the clinician for treatment of the blood pressure itself. Planning interventions is taught in a later chapter of this unit.

1.1.2 Significance of nutrition care process

The process matters because it turns nutrition care from advice into a method that can be repeated, checked and improved. The points below give its main benefits.

Enhances patient-centred care

Each step starts from the client's own data and goals. Food habits, income, beliefs about food and living conditions are collected and used, so the plan fits the person and is more likely to be followed.

Facilitates multidisciplinary collaboration

All dietitians use the same framework and the same terms, so a doctor, a nurse or a pharmacist reading the record sees what was found, what was decided and why. Shared language reduces repeated questions and conflicting advice.

Improves documentation and continuity

Every step is recorded. When a client moves from the ward to home follow-up, or is transferred to another facility, the next practitioner can pick up the plan without starting again.

Supports evidence-based practice

Decisions are made from measured data and current guidance, not from habit. When a method is found to work better, it can be added at the relevant step without changing the framework.

Enables outcome evaluation

Because each plan states a goal and the data to be measured, progress can be compared with the goal. The results show whether the plan worked, and they can be reported for a group of clients as well as for one.

1.1.3 Steps involved in nutrition care process

The process has four steps that follow one another, with monitoring leading back to assessment when more information is needed. The steps are introduced here and taught in full in the chapters of this unit. A single client is followed through all four: a mother brings her 18-month-old child to a community health unit because the child is not gaining weight.

Nutrition assessment

The practitioner collects and interprets data to understand the client's nutrition status. The data come from body measurements, laboratory results, clinical signs, dietary intake, and the client's medical, social and economic background. For the child, the nutritionist measures weight, length and mid-upper arm circumference, and asks the mother what the child eats in a day.

Nutrition diagnosis

From the assessment data, the practitioner identifies and names the nutrition problem, its cause and the evidence for it, in a standard statement. For the child, the problem may be inadequate energy intake, caused by a diet of thin porridge given only twice a day, shown by low weight for age and a low arm circumference.

Nutrition intervention

The practitioner plans and carries out actions aimed at the cause of the problem. For the child, the plan may be to enrich the porridge, give feeds more often, add a snack, and teach the mother how to do this with foods she can afford. The goal and the date for review are agreed with her.

Nutrition monitoring and evaluation

The practitioner checks whether the plan is being followed and whether the data are moving toward the goal. At the next visit, the child is weighed again and the mother is asked how the feeding plan is working. If the weight is rising, the plan continues. If it is not, the practitioner returns to assessment to find what was missed.

1.1.4 Types of PPEs

Personal protective equipment, or PPE, is clothing and equipment worn to protect the wearer, and the client, from contact with infection, body fluids and hazardous materials. Nutrition assessment often involves touching clients, handling measuring equipment that touches skin, and sometimes handling blood, urine or stool samples. The table lists the items covered in this topic, followed by a section on each.

Other protective items

Aprons, eye protection and head covers may also be needed. A waterproof apron is worn over the lab coat when splashes are likely. Goggles or a face shield protect the eyes when a spill or a spray is possible, for example during handling of liquid samples. A cap or head cover keeps hair out of the work area and away from the client.

1.1.4.1 Gloves

Gloves form a barrier between the practitioner's hands and anything that could carry infection. They are made of nitrile or latex. Nitrile is an alternative for people who are allergic to natural rubber latex, and powder-free gloves are preferred because the powder can irritate skin.

Wear gloves when handling blood, urine, stool or other body fluids, when cleaning equipment that has touched a client's skin, and when examining a client who has a wound, a rash or a skin infection. Gloves are single-use: put on a new pair for each client and replace a pair that tears. Hands must still be washed before putting gloves on and after taking them off.

1.1.4.2 Face masks

A face mask covers the nose and mouth. A surgical mask is made of three layers and reduces the spread of droplets from the wearer's breath and from the client's coughs. It protects both people when worn during close contact, such as measuring a coughing client or taking a diet history at a bedside.

A particulate respirator such as an N95 fits tightly over the face and filters very small airborne particles. It is worn when the client has, or may have, an airborne infection such as pulmonary tuberculosis. Masks must cover the nose and mouth, fit snugly at the edges, and be replaced when they become wet, soiled or damaged.

1.1.4.3 Lab coat

A lab coat protects the practitioner's clothes and skin from splashes, spills and contact with surfaces. It should be long-sleeved, reach the knees and be fastened at the front. Cotton or polycotton coats can be washed at high temperature with detergent.

A lab coat is worn while working in the assessment area or laboratory and is taken off before leaving the area, before eating and before going home. A coat that is heavily soiled or contaminated is changed at once.

1.1.4.4 Bio hazard waste bins

A biohazard waste bin is a container for used PPE and other waste that may carry infection, such as soiled gloves and masks. It must be leak-proof, have a lid that closes, and carry the biohazard symbol. Many facilities use foot-operated lids so that hands do not touch the bin.

The bin is lined with a strong bag and is placed close to where waste is produced, so that the used items are dropped in without carrying them across the room. Colours and labels follow the facility's waste policy. Sharp items such as needles and lancets do not go into the bin: they are placed in a puncture-proof sharps container.

1.1.5 Importance of PPEs

PPE is used because it lowers the chance that infection or harmful substances pass between the practitioner and the client. Its value depends on correct use every time, not on occasional use.

Protection of the practitioner

Gloves, masks and a lab coat keep blood, body fluids and respiratory droplets off the practitioner's skin, eyes, mouth and clothes. Practitioners who handle samples or examine many clients each day are exposed to infection, so this protection matters for their own health.

Protection of the client

A practitioner who is carrying an infection, even without symptoms, can pass it to a client through touch or breath. A mask, clean gloves and a clean coat lower that risk. This matters particularly for malnourished children, who have a weakened defence against infection, and for clients who are very ill.

Reduces cross-contamination

Changing gloves between clients, cleaning equipment and keeping used items in the bin stops organisms from moving to surfaces, equipment and other people. Cross-contamination is stopped at several points: gloves are changed, hands are washed and equipment is disinfected.

Compliance with health and safety requirements

Health facilities have infection prevention and control policies, and employers have duties for the health and safety of staff. Using PPE as the policy states shows that the practitioner meets these duties and can be relied on to work safely.

Builds client confidence

When a client sees a practitioner wash hands, put on clean gloves and use equipment correctly, the client is more likely to trust the care and to cooperate in providing information. Visible care for safety is part of professional practice.

1.1.6 Care, Maintenance & Disposal of PPEs

PPE protects only while it is in good condition and handled correctly. Single-use items are used once and then discarded. Reusable items are cleaned and stored so that they stay safe.

Care and maintenance

• Gloves: store the box closed in a cool, dry place away from direct sunlight and heat, which weaken the material. Check the expiry date, and discard any glove with a tear or a hole. Gloves are never washed or reused.
• Face masks: keep new masks in their packet until needed. Replace a mask when it is wet, soiled or damaged, and do not hang it around the neck or place it in a pocket for later use. Surgical masks and respirators used for routine care are single-use.
• Lab coat: wash after use or when soiled, with detergent at high temperature, separately from household clothes. Dry fully, and hang in a clean place in the work area.
• Aprons: waterproof reusable aprons are wiped down with disinfectant and dried after use. Disposable aprons are used once.
• Eye protection: wash with soap and water, disinfect after each use, dry and store in a clean case to prevent scratches.
• Head covers: disposable caps are used once and put in the biohazard waste bin. Reusable caps are washed with detergent after use.

Disposal

Used PPE that may be infectious is waste and is handled with care. The usual steps are:

1. Remove gloves first, because they are the most contaminated item, turning them inside out as they come off.
2. Drop used gloves, masks and disposable aprons directly into the biohazard waste bin, not into general waste.
3. Place used needles and lancets in a puncture-proof sharps container, never in the bin.
4. Wash hands with soap and clean water, or use an alcohol-based hand rub, immediately after taking off PPE.
5. Close the bin when it is nearly full. Do not press the contents down or overfill the bag.
6. Hand over full bins to the trained waste handlers, who take the waste for treatment according to the facility's waste management policy and the requirements of the county public health office.

Chapter Summary

This chapter introduced the nutrition care process by defining key terms such as nutrition, nutrition care, nutrition status, diagnosis, and interventions, and highlighted the significance and steps involved in delivering effective nutrition care. It emphasized the importance of personal protective equipment including gloves, face masks, lab coats, and biohazard waste bins, along with their maintenance and proper disposal to ensure safety during nutrition assessment. The chapter detailed anthropometric measurement methods and tools such as height, weight, BMI, MUAC, waist and hip circumferences, and head circumference, explaining their role in assessing nutritional status. Biochemical parameters were covered, focusing on various samples used to detect protein, vitamin, mineral deficiencies, glucose levels, and lipid profiles. Clinical and physical assessments were explored through medical history and physical examination of general appearance, skin, hair, nails, eyes, mouth, tongue, teeth, and gums. Dietary assessment methods including 24-hour recall, food frequency questionnaires, dietary records, diet history, weighed food records, duplicate diet methods, and observation were explained. The chapter also discussed socioeconomic assessment factors like income, education, employment, food access, cultural norms, household composition, housing conditions, and healthcare access. Finally, it addressed functionality assessments through body functionality analysis and the importance of thorough documentation using paper-based records, electronic health records, and nutrition software or mobile applications.