STM4201 Lecture 2- Nutrition Care Process: Screening

03/17/2024 STM4202- NCP:Screening

03/17/2024 STM4202- NCP:Screening
 Nutrition Screening (NS)
• Purpose: To quickly identify individuals who are
malnourished or at nutritional risk and,
to determine if a more detailed assessment is
warranted.

• Usually completed by DTR, nurse, physician, or

other qualified health care professional.

• At-risk patients referred to dietitian.

03/17/2024 STM4202- NCP:Screening

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 Characteristics of NS
• Simple and easy to complete
• Routine data
• Cost effective
• Effective in identifying nutritional
problems
• Reliable and valid

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 Nutrition Screening Tools
• Acute-care hospital or residential setting
• Perinatal service
• Pediatric practice
• Malnutrition Screening Tool (MST)
• Nutrition Screening Initiative (NSI)

Cornerways

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The Hawthorns Care Centre
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 Nutrition Questionnaire

03/17/2024 STM4202- NCP:Screening

03/17/2024 STM4202- NCP:Screening
 Nutrition Care Process: Screening
• The Joint Commission (TJC) requires that nutritional
risk be identified within 24 hrs in all hospitalized pts.
• TJC also requires nutrition screening in accredited
ambulatory facilities.
• Standards of Care protocols determine process;
evidence-based guidelines.
• Use simple techniques, available info.
• May be done by other than RD.
• Usually simple form with targeted info.

03/17/2024 STM4202- NCP:Screening

 Commonly Used Criteria for Nutrition Risk
Screening-Acute Care
• Diagnosis • Problems with
• Wt chewing or
• Wt change swallowing
• Need for diet • Diarrhea
modification or • Constipation
education • Food dislikes or
• Laboratory values intolerance

Institute of Medicine, 1999

03/17/2024 STM4202- NCP:Screening
 Food and Nutrient Intake Risk Factors
• Intake > or < than required
• Swallowing difficulties
• GIT disturbances, bowel irregularity
• Impaired cognitive function or depression
• Unusual food habits (pica)
• Misuse of supplements
• Restricted diet
• Inability/unwillingness to consume food
• ↑ or ↓ in activities of daily living

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Hammond KA. Assessment: Dietary and Clinical Data. In Krause, 12 th edition, p. 386
 Psychological/Social Risk Factors
• Language barriers
• Low literacy
• Cultural or religious factors
• Emotional disturbances associated with
feeding difficulties (e.g., depression)
• Limited resources for food preparation or obtaining
food/supplies
• Alcohol/drug addiction
• Limited/low income
• Lack of ability to communicate needs
• Limited use or understanding of community resources

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Hammond KA. Assessment: Dietary and Clinical Data. In Krause, 12 th edition, p. 386
 Physical Risk Factors
• Extreme age (>80 years, premature infants, very young children)
• Pregnancy: adolescent, closely spaced, or three or more
pregnancies
• Alterations in anthropometric measurements, marked o’wt/
u’wt for age, ht, both; depressed somatic fat and muscle stores
NOTE: recent unintentional wt loss is more predictive of morbidity/mortality
than wt/ht status

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 Physical Risk Factors (cont)
• Chronic renal/cardiac disease, diabetes, ulcers,
cancer, AIDS, GI complications, hypermetabolic
stress, immobility, osteoporosis, neurological
impairments, visual impairments

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 Abnormal Laboratory Values
• Visceral proteins (albumin, prealbumin,
transferrin)
• Lipid profile (cholesterol, HDL, LDL,
triglycerides)
• Hemoglobin, hematocrit, other blood tests
• BUN, creatinine, electrolytes
• Fasting and PP blood glucose levels, HbA1c

Hammond KA. Assessment: Dietary and Clinical Data. In Krause, 12th edition, p. 386
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 Prevalence of Nutrition Risk in Acute Care
• The prevalence of nutrition risk will vary depending
on the population screened and the criteria used for
screening.
• In published studies, prevalence of malnutrition in
hospitalized pts ranged from 12% - > 50%.
• There is little published data regarding nutrition
screening for other purposes.

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 Adult-Geriatric Inpatient Screening Criteria
1. Pregnant or lactating mother admitted to unit other than
ante-partum or mother-baby.
2. Sig unintentional wt loss 4.5 kg in past 1-2 mths.
3. Pt desires education on a therapeutic diet.
4. Pt unable to take oral or other feedings ≥5 days prior to
admission.
5. Pt on enteral or parenteral feedings.
6. Geriatric pt admitted for surgical procedure.
7. Pt with skin breakdown (decubitus ulcer).

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 Infant-Child-Adolescent
Inpatient Screening Criteria
1. Recent wt loss.
2. On special diet and needs education.
3. On tube/parenteral feedings.
4. Diabetic.
5. Receives ↑ cal feeds/concentrated formula.
6. Food allergy.
7. FTT.
8. Feeding problems/intolerance.
9. Teen who is pregnant or lactating.
10. Child being breast fed.

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 Issues in Nutrition Screening
• Most nutrition screening is done by staff other than
nutrition professionals.

• Identified at-risk pts are referred to nutrition

professionals less than half the time.

• Much of the research that exists validates more

comprehensive nutrition screening tools.

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 Issues in Nutrition Screening
• Little research has been done to validate or
evaluate nutrition screening as it currently
exists in most acute care institutions.

• There is no “gold standard” of nutritional

status that can be used as a benchmark.

03/17/2024 STM4202- NCP:Screening