Here are the 5 underrated but crucial items you should always evaluate for when writing your nutrition assessment.
5 Crucial (but underrated) Parts of a Great Nutrition Assessment
Do you know how to complete a nutrition assessment?
How about what the best indicator of nutritional status is? Or maybe you’re need to know what you should be looking for when you’re starting to write a nutrition assessment?
Writing a nutrition assessment isn’t just about evaluating lab values, recognizing medications or writing really good PES statements.
Sure they’re a big part of it. They’re extremely important to review and to be able to understand.
But you also need to remember to look at 5 other very specific things. Once you begin to make note of each of these elements, you’re going to find it much easier to assess your patient’s nutritional status.
How do you assess a patient’s nutritional status?
Start with identifying these 5 core elements.
- The most acute issue
- Dysphagia evaluation
- Skin integrity
- Weight status
- Diet order
Use this list as a template as you evaluate each patient’s nutritional status.
When you follow this nutrition assessment template and work your way through all 5 on the list, you’ll be prompted to collect all the information you need to successfully evaluate your patient.
Things like labs, medications and all other key information will begin to fall into place as you work through these core assessment elements.
And once you’re finished, you’ll have everything you need to write out a solid problem statement and nutrition note.
Let’s start at the beginning.
1. The most acute issue
Let’s be very clear. You’re looking to identify the most acute nutritional issue.
We don’t always learn this in school but there are 2 types of acute issues your patient might be dealing with: a medical issue and a nutritional issue. And it can be easy to get confused about their differences.
So how can you figure the difference between the most acute medical issue and the most acute nutritional issue?
There’s only one question you should be asking yourself:
What is the one thing I can do as a dietitian to help this patient be discharged as quickly as possible?
Keep in mind that in an acute or critical care setting, the medical team is there to take care of all those medical issues. You can think of those medical conditions as anything that requires direct medical interventions like medication, surgery or diagnostic evaluations to directly manage that condition.
Want an example of an acute MEDICAL condition?
Take a broken leg. This is a strictly medical issue.
Why? Because there is no diet in the world that will set and support that broken leg.
Yes, there are nutritional interventions that will help your patient remain nutritionally stable and well supported both during and after treatment to their leg. But there’s no MNT that will directly heal or support the setting of the leg in the way orthopedics or the surgical team can.
If this was the only reason your patient was admitted and they had no other nutrition related issues, this is when you might write in your nutrition note something like: “no nutritional issues noted” or “no significant nutritional issues at this time”.
So what’s an acute NUTRITIONAL issue?
Let’s say that same patient who broke their leg suddenly develops sepsis after surgery and has been intubated.
Your patient has a lot more acute nutritional needs all of a sudden.
Now there’s increased nutrient needs from the infection and the recent surgery. Your patient is also NPO and don’t yet have enteral nutrition support in place.
This is where you’re also looking at lab work, impact of medications on nutrition status and how other medical diagnoses might play a role in the most acute issue.
Getting your NPO patient fed set up with an NG tube then managing their care as they get their feeds slowly brought up to their enteral nutrition goal rate is likely now your primary concern.
And that makes their NPO status, their sepsis and their overall increased nutrient needs, the most acute nutrition issue.
Feeling a little stuck on how to determine the most acute nutritional issue?
The next 3 tips will help you narrow this down so you can identify what the most acute nutritional issue is.
2. Dysphagia Evaluation
With every single patient, you should at least consider if your patient needs a Speech and Language Pathologist evaluation.
Many times they won’t need support. But other times, they will. And if there is any indication that your patient could be at any level of risk for aspiration, SLP becomes a mandatory referral.
This could be something in the chart about coughing during meals. Maybe your patient was admitted for a stroke. Or they might be complaining about not wanting the baby food purees that they’ve been receiving.
In many cases, someone on the health care team has also noticed the red flags and SLP recently met with your patient. If this is the case, make sure you read and reference the most recent SLP therapy note.
Whatever it is, all red flags that stand out as potential causes for dysphagia should be taken seriously.
SLP evaluations will always give you a better understanding of what’s happening with your patient’s ability to swallow the food they’re receiving.
With that information, you’ll be able to not only provide them with more appropriate diet orders but you’ll also get more clarity on the most acute nutritional issue and be able to write better PES statements.
3. Skin Integrity
The goal for all your patients is to have and maintain their skin integrity. More specifically, you want your patients to keep their skin intact and free of all pressure ulcer or pressure injuries.
For those who have impaired skin integrity and even those at high risk for skin breakdown, you want to know this as you work out both their estimated nutritional needs and then write their nutrition assessment.
Not only does impaired skin integrity lead to increased nutrient needs but it will usually be directly tied to the most acute nutritional issue.
This will typically require both immediate and regular nutritional interventions to be provided until resolved. And without a doubt, this will become a crucial component of the diet order you’ll recommend.
4. Weight Status
Is your patient malnourished? Are you concerned about any recent significant weight changes? Do they have appetite or intake limitations, or medical concerns that you consider red flags?
Understanding your patient’s weight status will go a long way to determining what their most acute issue is.
Knowing their weight status will also directly inform what additional parts you need to include in their diet order. This is both about the numbers reported from their weight history, as well as what they look like.
Do they have increased nutrient needs? Energy needs? Are they protein-energy malnourished? Or are they cachectic? Do they have edema? Dysphagia? Are they edentulous?
Each one of these questions takes you a step closer to being able to clearly state reasons for their current weight status and what you plan to do about it.
5. Diet Order
The primary objective of a clinical dietitian is to make sure your patient is meeting their estimated nutritional needs. This is the bottom line. The entire reason why you’re evaluating your patient.
Writing a diet order that supports this person you’re seeing is where everything in your nutrition assessment comes together and gets tied up.
In school, you likely learned to write diet orders by matching up a therapeutic diet with a medical condition. Heart attack? Cardiac diet.
But now, you’re going to write nutrition assessments that are much more comprehensive. And a whole lot better.
You’re going to take all the information you’ve just pulled together and write a diet order that makes sure every component of your patient’s needs are met. And you do it in one singular sentence.
Here are 3 examples:
- Cardiac diet
- Ground, cardiac diet
- Ground, cardiac diet with Ensure daily
If there are modified consistencies, they should be included. And if they have altered nutritional needs, they should be noted. If you want to give them supplements, here’s your chance.
And that’s it!
These are the 5 core elements that you should use each time you meet with a new patient. Start with this nutrition assessment template and you’ll be able to fill in the gaps around lab work, medications and more easily.
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