Previous Page
Chapter 6 Nutrition Assessment of Older Adults Figure 6.5 Nursing Nutritional Checklist (For Use in Care Planning)
Nursing Nutritional Checklist (for use in Care Planning) The Academy of Nutrition and Dietetics supports the Nursing Nutritional Checklist (for use in Care Planning). Representatives from the American Dietetic Association were instrumental in its development. This Nursing Nutritional Checklist (for use in Care Planning) was developed by the Council for Nutrition.
the nursing home. Problem List (check all that apply)
1. Patient has ≥5% involuntary weight loss in 30 days? 2. Patient has ≥10% involuntary weight loss in 180 days or less. 3. BMI is ≤21. (703 x weight in lbs/height in inches2 )
or weight in kilograms/height in meters2 4. Resident leaves 25% or more food on tray? (in last 7 days)
5. Quality Indicators — Does patient have: A. Fecal impaction in last 7 days B. Infection (UTI, URI, Pneumonia, Gl) in last 7 days C. Tube feeding D. Functional ADL decline E. Development of pressure ulcer in low risk patient
6.
7. Available labwork completed in the last 30 days: Hgb Hct
Albumin
Serum WBC Sodium
Potassium Glucose BUN
Creatinine
8. Nursing assessment of physical/psychological problems A. Skin (pressure ulcers and skin tears) B. Presence of fever (2° above baseline) C. Presence of diarrhea D. Presence of constipation E. Takes drugs other than multivitamins/minerals F. Symptoms of depression/anxiety G. Loss of usual appetite H. Presence of nausea/vomiting I. Presence of dysphagia/choking J.
9. (for example, ethnic preferences) 10. Patient needs meal time assistance 8.
A. Implement skin program B. Implement facility protocol C. Implement facility protocol D. Implement facility protocol E. Contact pharmacy consultant for drug review F. Evaluate for depression/anxiety (short geriatric mini depression scale)
G. Implement care plan to increase appetite H. Implement facility protocol I. Contact dietitian for evaluation J. Contact dentist or dental technician
9. Stop therapeutic diets and provide preferred foods/food substitutions
10. Provide timely, polite assistance during dining Provide tray set up Provide partial assistance/supervision (evaluate resident/staff ratio and supervision by licensed professional staff) Provide total assistance (consider resident/staff ratio and supervision by licensed professional staff) Consider training staff to provide meal time assistance
11. Patient has motor agitation, tremors, or wanders
11. Consider OT evaluation Provide meal time assistance Provide self-help feeding devices
12. Presence of environmental distractions or meal time environment concerns
13. Inadequate lighting in the dining room 14. Patient needs 30–60 minutes to eat
15. Patient is unable to tolerate current food consistency 16. Supplements are given at meal time 17. Medications are given at meal time 18. Impaired visual acuity
19. Impaired hearing 20. Patient has a decline in taste and smell Completed by:
12. Minimize environmental distractions Provide compatible companions
13. Evaluate location in dining room
14. Implement dining program, e.g., special area to eat for impaired residents or two meal time sessions
15. Contact dietitian for texture screen
16. Give liquid supplements in a pattern that optimizes nutrient intake 17. Contact pharmacist for appropriate administration time
18. Assure resident is wearing clean glasses at meal time Provide meal time assistance (see #10)
19. Ensure that hearing aid is in place and working at meal time
20. Season foods Serve food at proper temperature
When problem list is completed, contact physician, dietitian, and pharmacist as appropriate with suggested action plan. Date:
Source: Reprinted by permission. Copyright ©2000, Programs in Medicine.
Cholesterol U/A:
Urine WBC
Spec. Gravity Leuk. Esterase
Other 5.
A. Implement bowel program B. Get physician order for U/A C. Contact dietitian for assessment D. Consider OT/PT assessment E. Implement skin program
6.
(e.q., 300 mL with meals and 240 mL between meals) 7. Notify physician of values
101
Suggested Action Plan (check when completed)
1–4. Monitor weight weekly. Continue to step #5 on problem list