Nutritional Screening
A patient’s nutritional status is evaluated by examining information from several sources, such as the patient’s medical history, physical assessment findings, and laboratory results. If the nutritional screening determines the patient is at risk for a nutritional disorder, a comprehensive nutritional assessment may then be conducted to set goals and determine interventions to correct actual or potential imbalances.
Nutritional screening also examines certain variables to determine the risk for problems in specific populations—such as pregnant women, elderly people, or those with certain disorders (such as cardiac disorders)—to detect deficiencies or potential imbalances.
Equipment
Standing scale with measuring bar ▪ nutritional screening form ▪ Optional: chair or bed scale, tape measure.
Preparation of Equipment
Select the appropriate scale—usually, a standing scale for an ambulatory patient or a chair or bed scale for an acutely ill or debilitated patient. Then check to make sure the scale is balanced. Standing scales and, to a lesser extent, bed scales may become unbalanced when transported.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.4
Explain the purpose of and procedure for nutritional screening to the patient.
Ask the patient to remove his shoes and obtain his weight using a scale. Weight provides a rough estimate of body composition.
Ask about unplanned or unintentional weight loss. Determine how much weight the patient lost and over what period of time. A weight loss of more than 5% in 30 days or 10% in 180 days places the patient at nutritional risk.
Measure the patient’s height while he’s standing erect without shoes, using the measuring bar on the scale. If the patient can’t stand, approximate the height by measuring “wingspan.” (See Overcoming height measurement problems.)
Calculate or estimate body mass index (BMI) to evaluate weight in relation to height. (See Calculating BMI.)
A BMI of 18.5 to 24.9 defines healthy weight; a BMI of 25 to 29.9 defines overweight; a BMI of 30 or more defines obesity.5 (See Determining BMI.)
Evaluate the patient’s weight distribution by measuring his waist circumference around his abdomen at the level of the iliac crest. Before reading the tape measure, ensure that the tape is snug, but doesn’t compress the skin and is parallel to the floor. If the measurement is greater than 35″ (89 cm) for a woman or 40″ (102 cm) for a man (with a normal BMI), the patient is at greater risk for health problems. People with a high distribution of fat around their waists as opposed to their hips and thighs are at greater risk for such diseases as type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease.6
Question the patient about his eating habits, living environment, and functional status to determine whether he’s at risk for nutritional problems. A problem in any of these areas places the patient at risk and requires further nutritional assessment.
Examine the patient’s laboratory values. A serum albumin level less than 3.5 mg/dl is a nonspecific indicator of poor nutrition. Prealbumin is the most accurate indicator because it reveals the most recent nutritional status (past 7 to 14 days). Serum transferrin reflects the patient’s current protein status more accurately than albumin because of its shorter half-life. Elevated transferrin levels may indicate severe iron deficiency. Decreased hemoglobin levels and hematocrit suggest iron deficiency anemia. Decreased total lymphocyte count may indicate reduced protein stores.
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