The Joint Commission requires nutrition screening for all hospital patients within 24 hours of admission to identify those who may be malnourished or at risk for malnutrition. Assessment findings determine if the patient requires a detailed nutrition assessment. In most cases, nurses perform this screening as part of the general admission assessment.
Adults with any of the following may be considered to be at risk for malnutrition:
Once you identify an at-risk patient, be sure to communicate this finding to the RD.
A comprehensive approach to diagnosing nutrition problems, nutrition assessment relies on a combination of medical, nutrition, and medication histories; physical examination findings; anthropometric measurements; and laboratory data. When conducting a nutrition assessment, check the patient for:
Generally, an RD or a member of the nutrition support service performs a more in-depth nutrition assessment. This assessment delineates the malnutrition diagnosis and serves as the basis for the nutrition plan of care.
In 2012, the A.S.P.E.N./Academy of Nutrition and Dietetics Malnutrition workgroup identified six malnutrition characteristics to assess. Two or more of the following findings warrants a malnutrition diagnosis, with severity defined further through specific thresholds or parameters:
The nutrition care plan is a formal statement of nutritional goals and interventions prescribed for the patient, based on nutrition assessment data. The plan includes statements of nutritional goals and monitoring and evaluation parameters, the most appropriate administration route for nutrition therapy, nutrition access method, anticipated duration of therapy, and training and counseling goals and methods.
Nutrition interventions may include optimizing the patient’s oral intake, providing oral nutrition supplements, and administering enteral and parenteral nutrition. Nurses play a key role in implementing these interventions.
The patient’s nutritional status, nutrition goals, and safety and efficacy of interventions need to be monitored on a continual basis, particularly with transition-of-care planning. Be sure to communicate the patient’s nutrition care plan during care transitions. Too often, nutrition interventions stop when a patient is discharged from the hospital; in many cases, the patient needs to be readmitted with worsening malnutrition. Using a transition-of-care plan by nurses (such the A.S.P.E.N. Nutrition Care Pathway) can help prevent readmission of vulnerable patients.
Malnutrition is an acute, subacute, or chronic state of nutrition in which a combination of varying degrees of overnutrition or undernutrition (with or without inflammatory activity) have caused a change in body composition and diminished function.
Malnutrition occurs in three forms:
Peggi Guenter is senior director of Clinical Practice, Quality, and Advocacy at the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) in Silver Spring, Maryland. Ainsley Malone is a clinical practice specialist at A.S.P.E.N. and a member of the nutrition support team at Mt. Carmel West Hospital in Columbus, Ohio. Rose Ann DiMaria-Ghalili is an associate professor of nutrition in the doctor of nursing practice department at Drexel University in Philadelphia, Pennsylvania.
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Getting in some top exceptional fiber from non-starchy veggies can clear up this problem. Though if that’s not enough, typically psyllium husk powder will paintings or taking a probiotic.