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NS 210 Unit 7 Seminar:
Assessment of the
Hospitalized Patient
Here we are at Unit 7!
How was everyone’s week?
Overview
Assessing the Hospitalized Patient
 Purpose of Nutritional Screening
 Nutritional Screening Process
 Assessing Nutritional Risk
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History
 Dietary Information
 Stature and Body Weight
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Assessing the Nutritional Status of
the Hospitalized Patient
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Assessing the status of hospitalized
patients involves 4 goals:
Identifying those at nutritional risk
 Determining the severity and causes of
nutritional impairment
 Deterring the patient’s risk of dying from the
undernutrition or developing a related
disease condition
 Monitoring to evaluate response to nutrition
therapy

Nutrition Screening in the Hospital
Setting
30% of patients admitted to the hospital
are undernourished
 A large part of these patients are
undernourished when admitted to the
hospital
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A majority develop further nutritional
deficiencies during their stay
Clinical Nutrition (2003) 22(4): 415-421
Nutritional Screening
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Purpose
Identify malnourished individuals at nutrition
risk
 Should be done within the first 24-48 hours
 Best done by a dietetic technician
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Nutritional Screening Process
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Definition
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Process of identifying the characteristics known to be
associated with nutrition problems
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Screening can be facilitated by signing a checklist
or form
 Characteristics of the Screening process:
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Being completed in any setting
Facilitates completion of early intervention
Includes the collection of relevant data
Facilitates completion of early intervention and
treatment
Determines the need for more in-depth nutrition
assessment
Components of Nutritional
Screening
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Screening tools are designed to
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Detect protein and energy malnutrition
And/or to predict whether malnutrition is likely to
develop/worsen under the present and future
conditions
4 main Principles for screening tools
1.
2.
3.
4.
What is the condition now?
Is the Condition stable?
Will the Condition get worse
Will the disease process accelerate nutritional
deterioration?
Assessing Nutritional Risk
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Diagnosis and problems that can increase risk of
malnutrition include:
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Trauma
Bowel resection
Short bowel syndrome
Small bowel obstruction
Hypoglycemic
Failure to thrive
Congenital heart disease
Chronic obstructive pulmonary disease
Anorexia
Cancer
HIV/AIDS
Vomiting or Diarrhea
Anemic
Stroke
GI Bleeding
Nutritional Assessment
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Using a variety of data to evaluate the patients
nutritional status including:
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History
Dietary Information
Physical Examination
Knee Height
Estimating Stature
Midarm Circumference
Calf Circumference
Recumbent skinfold Measurements
Estimating Body Weight
History

Obtaining history is the first step in clinical
assessment of nutritional status
 Data can be obtained from medical records
and from interviews with the patient
 Parts of the medical record which are helpful
include:
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Medical history, entries made by physicians,
nurses, social workers, medical records
Other essential components include facts
about past and current health, use of
medications, personal and household
information
Usual Body Weight
% UBW = Current weight in lbs / Usual
body weight
 IBW or Reference Weight=
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Males= 106#(for 5’0” and 6# for each inch
after that) example: 5’7 male= 148#
 Women= 100# ( for 5’0” and 5# for each
inch after that) example: 5’3” = 115#
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Calculations
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%IBW = Current weight in pounds / IBW
in pounds
Assessment time!
Mario Martinez, was admitted to the hospital
with a new onset of vomiting for six days on
6/7/10. His past medical history includes:
Type II DM, Hypertension, and High
Cholesterol. He is 80 years old male (YOM)
and has not really eaten in 6 days due to
feeling full, nauseous, and started vomiting.
His height: 5’9” Weight: 175# Usually his
body weight is ~184#.. Serum albumin is
2.8. His diet order is NPO – Nothing by
Mouth
Assessment
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Jeremy Stein was admitted on 8/10/09 with a
primary diagnosis of Shortness of
Breath(SOB). He has no past medical history.
He is 32 year old male (YOM). He is 5’10#
Weight: 341#. His UBW is 340. After speaking
with him, you find out his appetite is great and
he is eating 100% of his meals. His diet is
House and his serum albumin is 3.6.
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Let’s figure out their Ideal body weight or
Reference weight!
Screening Exercise
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Minimal Nutrition Risk
 All other patients not identified at nutritional
risk.
 Nutritional Risk (meets 1 of the following
criteria)
 Clear liquid/NPO > 5 days
 Current weight > 200% or < *80%
 Recent weight loss of > 10 pounds in 1
month
Continued
Tubefeeding
 TPN
 >80 year old with score of 4 or more on
Nutrition Screnning Initiatives
 Serum Albumin < 3.0
 Transplant patients
 Diet restriction < 20 grams protein
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Dietary Information
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Dietary information includes
Patients food preferences
 Allergies and intolerances
 Usual eating pattern
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24 hour recall or simple food frequency
questionnaire can provide important data
on usual eating patterns and can help
generate additional questions on dietary
intake
Stature and Body Weight
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Stature and body weight are important
measures to be obtained from hospitalized
patients
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Under certain conditions they may have to
calculated using the following methods:
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Patients knee height
Calf circumference
Age
Sex
Measuring body length in bed
Calf Circumference
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Used to estimate body weight and as an
indicator of muscle and subcutaneous
adipose tissue
Energy Needs
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Based on an individual’s 24-hour
expenditure
Determined by resting energy expenditure
 Thermic effect of food
 Energy expended in physical activity
 Whether disease or injury is present
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24-Hour Energy Expenditure
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24 hour Energy Expenditure
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Determined through indirect calorimetry
Involves measurement of body's oxygen
consumption
 Carbon dioxide production
 Uses a computerized metabolic monitor
 In critically ill persons indirect calorimetry may
be preferable to estimating energy expenditure
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Roughly approximated from a variety of
equations
What Increase 24-hour Energy
Expenditure?
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What increases Expenditure
Surgery
 Trauma
 Infection
 Burns
 Various diseases
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Increased Protein Catabolism
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The degree and duration of increased
protein catabolism following injury vary
with the trauma’s severity
Protein catabolism may take several days to
peak before gradually returning to normal
 Recommended protein intake can be based
on
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Nitrogen balance
 Body weight
 Energy intake
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Nutrition Screening Initiative
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Nutrition Screening Initiative (NSI)
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Begun to encourage routine nutritional screening
To better nutrition care in America’s health and
medical care settings
Goals
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Raising public awareness of poor nutrition status
Developing assessment tools to identify potential
risk factors and major indicators of poor nutritional
status
Week 7 Project Portion
Calculate Following Height/Weight
Indices and discuss what the results
indicate about your patients
health(complete in unit 7)
 Relative Weight
 Weight/height ratio
 Quetelet’s Index (BMI)
 (Look in Chapter 6)!
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