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Nurses need to make sure that individual nutritional assessments


are completed when patients are admitted to the care setting and that the assessments are routinely updated. Use of validated tools for nutritional risk screening (e.g., Mini Nutrition Assessment,5-7 Malnutrition Screening Tool,8 Tool,9-10


Nutrition Risk Screening11


Malnutrition Universal Screening and the Short Nutrition Assess-


ment Questionnaire) and nutritional assessment are available for nurses to use in assisting with the accurate identifi cation, referral to the registered dietitian and subsequent treatment of patients who are malnourished or at risk of malnutrition. Nutrition risk screening identifi es those at potential risk for malnutrition as well as those who are malnourished. Patients identifi ed through screening as “at risk” are subsequently referred for further nutritional assessment, which is usually performed by a dietitian. Nutrition screening can be performed by a member of the IP team but is usually completed by the nursing or nutrition assistant staff . Areas that the nurse can assess at screening may include:33 • Current weight and usual weight • History of unintentional weight loss or gain (> 5% in 30 days or > 10% in 180 days)


• Body mass index • Adequacy of food/nutritional intake: how often does the patient eat, what types of food


• Signs of dehydration (e.g., skin turgor, urine output, elevated serum sodium or calculated serum osmolality)


• Dental health: lack of teeth, presence of poorly fi tting dentures, poor oral hygiene


• Oral and gastrointestinal history including chewing and swallowing diffi culties and ability to feed oneself, nausea/vomiting, diarrhea


• Medical/surgical history or interventions that infl uence nutrient intake or absorption of nutrients: history of celiac disease, Crohn’s disease, ostomy surgery


• Psychosocial factors aff ecting food intake: - Anorexia, fatigue - Ability to obtain and pay for food - Facilities for cooking and environment for eating - Food preferences - Cultural and lifestyle infl uences on food selection


As part of the IP team, nurses can help to develop and promote a


nutrition intervention plan based on the nutritional risk screening and assessment. Areas to be addressed in the plan may include: encouraging a balanced diet, off ering supplements between meals, modifying dietary restrictions to increase nutritional intake, recommending enteral or parental support if oral intake is inadequate and encouraging fl uid intake.26 In developing a nutrition care plan,


cultural food preferences must be taken into account. Too often foods are pro- vided to patients that they will not eat. If acceptable foods are not available in the facility, families should be encouraged to bring in food that the patient will eat. Policies addressing outside food may need to be established if they do not exist.


Nurses also play an important role in the education of patients


on interventions to improve nutrition. Evidence from a study sug- gests that dietary advice from a nurse (either with or without oral nutritional supplements) may improve weight, body composition and grip strength.34


Teamwork Hippocrates noted that healing is sometimes a “matter of opportunity.”


Interprofessional collaboration with RDNs on the care of patients with wounds helps to maintain a climate of respect and shared values. RDNs are trained to complete not only dietary intake evaluations, but also nutrition-focused physical assessments for evidence of nutrient defi ciencies and functional impairments that hinder eating. Examples specifi c to hindered eating include signs of muscle wasting of the interosseous and thenar muscles of the hand and of the biceps, triceps and deltoids on the arms and shoulders. Loss of muscle mass is determined by palpating these muscles and strength is assessed using a dynamometer. Chewing impairments may be identifi ed by palpation of the muscles of mastication (temporalis and masseter).35 Hydration evaluation is part of NFPA and may be done collabora-


tively with nursing staff . Examples specifi c to dehydration include dry skin, dry mucous membranes, furrowed tongue, peeling lips, and dark or golden urine. Examples specifi c to overhydration include fl uid accumulation and translucent urine.35 Evaluating the healing of wounds is another part of NFPA.


T e progress of the wound either towards stalling or worsening versus healing will determine the types of nutrition interventions recommended.35


T e nurse has the advantage of more face time


with the wound care patient and may observe pertinent data useful for the RDN’s assessment and interventions. Examples include food intake habits, refusal of oral nutrition supplements, limited intake of water and other beverages, pattern of eating (e.g., eats one meal per day, eats two to three meals per day or nibbles throughout the day). Other information helpful for the RDNs includes diffi culty swallowing pills, complaints about certain food items (e.g., meat is tough, food is tasteless) and whether the patient requires assistance during meals. Nursing professionals have the opportunity to communicate their daily observations of the patient’s intake habits as well as wound status to the RDNs in order to determine the most appropriate interventions to address the healthcare needs of patients with wounds. Physicians and physician extenders can use their global knowledge of physiological systems, diff erential diagnosis and disease management with RDNs to determine the most eff ective interventions to manage acute and chronic conditions while optimizing tissue synthesis and wound healing. Medical nutrition therapy pro- vided by the RDN is an integral part of supportive care during acute illness and disease management of chronic conditions that can provide signifi cant benefi t to


the patient. • Mary Litchford, PhD, RDN, LDN, is president


of CASE Software & Books, a professional and educational resource company.


2016 • Visit us at NURSE.com 35


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