Nutrition
Nutrition
Nutrition
NUTRITION
Disclaimer language, methods such as Makaton, meeting a patient for the first time.
Please note that easy to read symbols or the use of an –– Brittle nails – a diet lacking in the main
information provided interpreter may be considered. food groups, particularly protein, will
by Nursing Standard is »» Ensure the patient is in a comfortable slow and damage nail growth.
not sufficient to make position for the assessment, for example 3. Assess the patient’s normal dietary
the reader competent sitting in a chair or on a bed. intake, including portion size,
to perform the task. All »» Ensure all necessary equipment is frequency of intake and range of foods
clinical skills should be available and in effective working order, consumed. One method for finding out
formally assessed at including: this information is to ask the patient
the bedside by a nurse –– Accurately calibrated weighing scales. what they ate during the previous day.
educator or mentor. It is –– Height measure. 4. Assess the patient’s oral health. This
the nurse’s responsibility –– Tape measure. can be undertaken by observing the
to ensure their practice It should be noted that some types of scale fit of any dentures and whether the
remains up to date may be able to provide height and weight patient’s mouth is dry. In patients with
and reflects the latest measurements simultaneously. severe malnutrition, the tongue can be
evidence dry, redder than normal and swollen,
Procedure which interferes with their ability
1. During the initial nutritional to swallow.
assessment, obtain the patient’s height 5. Ask the patient if they have weighed
and weight measurements using themselves recently and/or if they think
calibrated weighing scales and a height their weight has changed recently. Also,
measure; this information will enable ask if they know what their normal
the selected nutritional screening weight is, and if they have experienced
tool to be completed. Where this is not any unplanned weight loss in the past
possible, calculate the patient’s mid- few months.
upper arm circumference by measuring 6. Ask the patient if they have experienced
the ulna length and upper arm changes to their appetite, and/or sense
circumference with a tape measure, as of taste, smell or sight. Sensory changes
detailed in the MUST (BAPEN 2011). can have a significant effect on patients’
2. Use your observational skills to enjoyment of food, their desire to eat
examine the patient for the following and their appetite.
common signs of malnutrition: 7. Ask the patient about their energy
–– Clothing – loose-fitting clothing may levels, mood – in particular, how they
be an indication that there has been feel about eating – and concentration.
significant unintentional weight loss. Lack of energy, low mood, loss of
–– Muscle-wasting – severe malnutrition interest in food and increased irritability
results in muscle breakdown (muscle are features of several illnesses, for
tissue is used as an energy source), example chronic fatigue, and can affect
resulting in a skeletal appearance. nutritional intake, as well as being
This is often particularly evident in a consequence of malnutrition.
the arms and face, with prominent 8. Ask the patient about their access to
cheekbones and sunken eyes. food, including whether they are able
–– Reduced skin elasticity – this is caused to shop for groceries, and whether they
by a reduction of collagen in the have the ability to store food and cook.
skin. A simple test involves pinching 9. Observe the patient for any motor skills
the skin gently and observing for its deficits, which may have resulted from
natural recoil. It is important to note a stroke, Parkinson’s disease, multiple
that any recoil of the skin will be sclerosis or motor neurone disease, for
reduced in older adults because of the example, and which may have affected
natural thinning of the skin with age. their ability to eat – such as difficulty
–– Hair loss – thinning hair is common holding cutlery. Ask the patient if
in people with malnutrition, although there is anything that is affecting
this can be challenging to assess when their ability to eat.
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