This document contains two nutritional screening tools:
1) A 2-step initial screening that identifies patients at nutritional risk based on factors like BMI, weight loss, dietary intake, and illness severity.
2) A more comprehensive subjective global assessment of a patient named Herman Cramer that evaluates criteria like weight loss, food intake, functional status, disease stress, physical exam findings, lab results, and nutritional status to determine his nutritional risk level.
3) Herman was found to have a high nutritional risk level of 3, requiring follow-up from the nutritional support team.
This document contains two nutritional screening tools:
1) A 2-step initial screening that identifies patients at nutritional risk based on factors like BMI, weight loss, dietary intake, and illness severity.
2) A more comprehensive subjective global assessment of a patient named Herman Cramer that evaluates criteria like weight loss, food intake, functional status, disease stress, physical exam findings, lab results, and nutritional status to determine his nutritional risk level.
3) Herman was found to have a high nutritional risk level of 3, requiring follow-up from the nutritional support team.
This document contains two nutritional screening tools:
1) A 2-step initial screening that identifies patients at nutritional risk based on factors like BMI, weight loss, dietary intake, and illness severity.
2) A more comprehensive subjective global assessment of a patient named Herman Cramer that evaluates criteria like weight loss, food intake, functional status, disease stress, physical exam findings, lab results, and nutritional status to determine his nutritional risk level.
3) Herman was found to have a high nutritional risk level of 3, requiring follow-up from the nutritional support team.
This document contains two nutritional screening tools:
1) A 2-step initial screening that identifies patients at nutritional risk based on factors like BMI, weight loss, dietary intake, and illness severity.
2) A more comprehensive subjective global assessment of a patient named Herman Cramer that evaluates criteria like weight loss, food intake, functional status, disease stress, physical exam findings, lab results, and nutritional status to determine his nutritional risk level.
3) Herman was found to have a high nutritional risk level of 3, requiring follow-up from the nutritional support team.
Question Yes No Is BMI < 20.5? ✓ Has the patient lost weight within the last three months? ✓ Did the patient have a reduced dietary intake in the last ✓ week? Is the patient severely ill (e.g intensive theraphy)? ✓ __ Current Status: No Nutritional risk If yes to any question, go to STEP 2
STEP 2-Final Screening
Nutritional Status Indicators (choose one only) Score Place score
if YES Normal Nutritional Status 0 0 Weight loss >5% in 3 months/ or food intakes below 50-75% 0 1 of normal requirement in preceding week Weight loss > 5% in 2 months / or BMI 18.5-20.5 + impaired 2 0 general condition / or food intake 25-60% or normal requirement in preceding week Weight loss > 5% in one month (or > 15% in 3 months) / or 3 0 BMI < 18.5 + impaired general condition / or food intake 0- 25% of normal in preceding week Clinical condition (may choose than one) Hip fracture chronic patients, in particular with acute 1 1 complications; cirrhosis, COPD, chronic hemodialysis, diabetes, oncology Major abdominal surgery, stroke, severe pneumonia, 2 2 hematologic malignancy Head injury, bone marror transplantation, intensive care 3 3 patients (APACHE >10) TOTAL SCORE 6 ACTION TO BE TAKEN Total Score ≥ 3: The patient is nutritionally at risk and nutritional care plan is initiated □ Total score <3: Weekly rescreening of the patient/ if the patient is scheduled for major operation a preventive care plan is considered to avoid aasociated risk status SUBJECTIVE GLOBAL ASSESSMENT Table 3 Assessment nutritional status of Patient Herman Name: Herman Room: 312 Surname: Cramer Date Admitted: October 23, 2019 Middle: Rivera Age: 65 y/o Attending MD: Dr. Santos Sex: Male
Weight loss None 10% of usual weight >10 of usual weight Food intake (last 1- No change Suboptimal Starvation 2months) Gastro Symptoms None Nausea, Vomiting Anorexia, diarrhea >2 weeks Functional capacity No change Dysfunction: < 3wks Bedridden > 2wks Bedridden <2 wks Disease and relation No or low stress Moderate Stress Severe Stress to nutritional req. Physical Subcutaneous fat and /or Subcutaneous fat and Subcutaneous fat and /or Examination muscle loss 0 /or muscle loss +1 or +2 muscle loss Edema/Ascites None None +1 or +2 SGA Grade 0 B1 C3 BMI 18.5-25.0 25.1-30.1 <18.5 or > 30.2 Albumin g/dL >3.4 2.5-3.41 <2.52 TLC >15000 900-1500 <9002 Total Score NUTRITION 0 Low risk 1-2 Moderate Risk (level >3 High Risk(level 3) RISK (level 1) 2) LEVEL Nutritional Status Normal Moderate Malnutrition Severe Malnutrition Risk level 1 or 2, would you like to refer your patient to the nut. support team for follow up? Yes No Risk level 3: Req. to be followed up by the Nut. Support Team
Dr. Santos Name of Attending MD
October 23, 2019 Date Signed
Assessment performed by(Name & Signature): Chelo Jan Geronimo