Notes

CFS 109 Nutrition




Module 12, Nutrition & Nursing Assessment

Chapter 13



The changing dynamics of the hospital setting place more emphasis on the nursing staff to perform basic nutrition assessments and evaluations on all patients admitted to the hospital. Even if you are not a nursing student, chances are you or a loved one will experience a hospital stay at some time in your life. You hope for well-trained nursing staff but 'arming' yourself with basic information can help you recognize the need for a more complete intervention.

Malnutrition, effects of illness, and impaired immunity can all interact to slow recovery and worsen malnutrition. Basically, if you don't eat well, you are more likely to get sick. (You may not notice this at our young age, but wait a decade or so and you will notice a change.) Mature adults don't bounce back as readily as younger ones. Poor nutrition can lead to illness which can lead to hospital stays. If you didn't feel like eating before you went into the hospital, chances are you won't feel like eating when you get there. No, I am not making any comments about hospital foods - I have eaten my fair share of hospital food and I don't mind it at all. Enough said about that. But the food will most likely be different from what a person is used to and may not sound appetizing. Medications can often alter your taste buds which can also contribute to anorexia (loss of appetite). Medications may also cause nausea and vomiting. You are starting to notice a downward spiral. Malnutrition can lead to illness which makes it harder to eat which can worsen illness and so on. Trying to spot malnutrition or, preferably, risk for malnutrition is the focus of this chapter.

The text does a good job covering food-medication interactions so I won't be redundant. There are entire books written on the subject. In the hospital setting, monitoring food-medication interactions are usually done by the pharmacy staff and nutrition staff. Outside of the hospital, you have probably noticed that certain medications have warnings on them about avoid certain foods or taking with or without meals. After reading the text, you will know why.

Nutrition Screening

Nutrition screening is typically done on all patients at the time of admission. Most likely there will be some type of form to fill out with questions for you to ask. The criteria used to determine risk varies from hospital to hospital but almost all of them will include the same basic information.


The Nutrition Screening Initiative is a broad-based coalition targeting the health of our elderly population. Their goal is to incorporate nutrition screening and intervention into the healthcare delivery system at a variety of points and not waiting until a person is admitted into the hospital to address their nutritional needs.


Health history: which includes a review of eating habits, the need for any diet modifications, disabilities, etc. You will find out if the patient is nauseated, has diarrhea, food preferences, do they have teeth, can they feed themselves, etc. All of these things play a big role in making sure the patient is able to eat. It is not uncommon to find the admitting doctor has written a regular diet order (the patient can eat anything they want to) for a diabetic patient or a patient without any teeth and who has swallowing difficulty. The diet order is sent to the kitchen who hasn't seen the patient. Although a nurse cannot change a diet without the doctor writing a new order, the message can be sent to the kitchen that the patient is diabetic or doesn't have teeth. Changes can then be made to accommodate those needs in advance. Otherwise, it could be hours before a patient gets to eat.

There are many ways to gather info about a patient/client's eating habits. These are rarely performed by the nursing staff.

1. 24-hour recall Essentially, you ask a person what they ate during the last 24 hours. It is easiest to start with "what is the first thing you ate or drank yesterday?" Avoid the phrasing, "what did you eat for breakfast?" I learned that one the hard way. I asked a patient what she had eaten for breakfast, lunch, & dinner. She said she didn't eat breakfast, and told me about what she had for lunch & dinner. At the end I asked her if she had eaten anything else. She said yes, she had juice and a muffin. I of course asked when and she replied in the morning. Oddly enough, she didn't consider that breakfast. Also remember to ask if that days intake was usual. Bear in mind that people usually eat differently on weekends than on weekdays. The limitation with 24 hour recalls is that people can forget what they ate and often underestimate portion sizes.

2. Food Frequency Questionnaire These typically ask how often a person eats foods in specific categories. I find these personally frustrating to use because people's diet vary. However, it can provide you with a generalization about food habits.

3. Calorie Counts These are common in the hospital setting and the nursing staff play a key role. This is typically done for patients who are not eating well. Nurses are asked to write down all the food/beverages that the patient consumes. Dietitians will then take that info and calculate what the patient consumed in terms of calories, protein, fat, and carbohydrate. This information is often used to determine if a patient needs alternative nutrition intervention (feeding that does not involve eating).

4. Food records - these are typically done for 3 or 4 days. You write down everything you eat including how it was prepared, the portion size, and often you are asked to write you where you ate it (home, out, etc). A dietitian will then review them (usually with the client) and, using a computer program, determine a complete nutrient analysis. These can be great tools to determine what nutrient areas need attention to help people with weight loss, blood sugar control, and food tolerances. The major drawbacks with diet records is that the client must be motivated to complete them as they are time consuming and that people often eat differently while they keep records. Portion sizes are difficult to estimate and mixed dishes are especially difficult if you didn't prepare them yourself.

Physical Examinations

Growth and development in children is evaluated by measuring weight, length or height, and head circumference and comparing that to standard growth charts. A child's length is measured laying down until they are 2 years old and after that height is typically used which means a standing measure. Head circumference reflects brain development. These measures are useful when looked at over time. It is not uncommon for a child to 'fall off the curve' at any given time. It would be worrisome if the child had a steep drop or continued to fall.

As adults, we are evaluated by our weight in relation to height. In later chapters we will talk more about the validity of such measures. Other ways to assess health is BMI or body mass index. A person's current weight may not be his/her ideal body weight (see formula on page 329); it is important to also consider usual body weight especially when it comes to hospitalized/sick patients. Current body weight is like looking at a picture of a car on the edge of a cliff. It just tells you where that car is but not which way it is going. If a person is currently overweight your first instinct might be to minimize the risk for 'malnutrition'. However, if this patient usually weights quite a bit more, they are indeed at risk for malnutrition (like the car going over the cliff).

Aside from weight, here are other physical signs that reflect nutritional status. You should exercise caution when using physical signs as an indicator of nutrition status. They are often nonspecific and can reflect several nutrient deficiencies. The text covers this in more detail on page 332.

Biochemical Analysis or blood tests yield information about malnutrition, vitamin & mineral status, fluid status, organ function, and metabolic status. Page 333 has a nice table that reviews the uses of certain blood tests. Biochemical analysis, combined with a diet history, help determine if a patient needs aggressive nutrition intervention. As the text points out, one of the key areas of attention is given to assessing protein status and are reevaluated during the course of intervention.