Proper nutrition is important to maintain health and prevent illness. Health care providers must routinely evaluate patients’ nutritional status and to identify any existing or potential nutritional problems. This allows for appropriate referrals and interventions to be provided.
Various physical conditions can disrupt nutritional absorptions. For example, patients with gastrointestinal problems such as inflammatory bowel disease or liver cirrhosis may experience malnutrition. Those with lung problems might have insufficient oral intake due to breathing difficulties. Diabetes patients often face inadequate glucose homeostasis. Psychiatric disorders or depression can lead to functional impairments that cause poor nutritional intake. Cancer patients may suffer from cancer cachexia and malnutrition, and those in pain might decrease their oral intake.
Many medications can also interfere with nutritional absorptions. D iuretics, f or example, may cause dehydration and electrolyte imbalances. Narcotics and opioids can lead to nausea and vomiting, while anticholinergic drugs may cause dry mouth, affecting food intake.
Malnutrition is defined as “deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients” (WHO, 2021). According to the World Health Organization (WHO), malnutrition encompasses several conditions:
Body Mass Index (BMI) estimates body fat using a person’s weight and height. Research has shown that BMI is highly correlated with many metabolic and cardiovascular diseases (CDC, nd.) and is recommended as the primary screening method for weight control and metabolic health assessment. However, BMI has limitations, as it cannot distinguish between fat and lean body mass or subcutaneous fat. Measuring waist circumference to assess abdominal fat is critical and is strongly associated with NCDs (Yurista et al., 2023).
Click the link of BMI Calculator and follow the instructions to calculate your BMI (NHLBI, nd.).
| BMI ( kg/m 2 ) | Status |
| Below 18.5 | Underweight |
| 18.5 – 24.9 | Normal weight |
| 25 – 29.9 | Overweight |
| Above 30 | Obese |
Digestion begins in the mouth, where chewing and mixing with saliva initiate the breakdown of food. In the stomach, food mixes with gastric juices to produce a mixture called chyme. Chyme then passes into the small intestine, where most digestion takes place. In the small intestine, food is dissolved, and nutrients are absorbed into the body. Unabsorbed wastes are passed down to the colon.
Nutrients are divided into macronutrients and micronutrients. Macronutrients refer to carbohydrates, fats, and proteins that must be consumed daily to produce energy and ensure proper bodily function.
Watch the following short video clip to review digestion in the small intestine.
Micronutrients refer to dietary minerals and vitamins that support the body’s metabolism.
The following short video clip provides information on the essential nutrients for life: minerals and vitamins.
| Anthropometry | measurement of the body ratios and sizes including height, weight, skinfold thickness, waist circumference, mid-arm circumference, and calf circumference |
| Body mass index (BMI) | a measure of body fat based on height and weight; a person’s weight in kilograms divided by the square of height in meters |
| Malnutrition | deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients |
| Obesity | is defined as abnormal or excessive fat accumulation that poses a risk to health; BMI >30 kg/m 2 |
| Recommended dietary allowance (RDA) | the levels of intake of essential nutrients sufficient to meet the nutrient requirements of practically all healthy people |
| Failure to thrive | in the elderly, weight loss of more than 5%, decreased appetite, poor nutrition, and physical inactivity, often associated with dehydration, depression, and immune dysfunction; a state of decline |
IV. Nutritional Assessment
Nutritional assessment is an ongoing component of daily assessment, especially for patients with nutritional concerns and those at risk for nutritional deficits.
| Screening for Nutritional Status | Additional Information |
| 1. Obtain health history |
Problems with intake such as indigestion, heartburn, bloating, difficulty chewing or swallowing will affect nutritional status.
If the patient has a specific concerns about hair, skin, or nails, a focused assessment regarding to the specific sign/symptom should be performed.
Waist circumference can also be measured for adult patients to determine if they are at risk for cardiovascular disease. A normal waist circumference should be less than 40 inches for men and less than 35 inches for women. However, there are variations in waist circumference and cardiovascular risk among different ethnic backgrounds (Yurista et al., 2023).
Expected findings include alertness and orientation, a normal proportion of body structure, normal skin tone, and skin color appropriate to ethnicity, with no signs of malnutrition.
Many diseases are directly or indirectly caused by a lack of essential nutrients in the diet. Changes in the skin and mucous membranes can offer valuable clues to the presence of nutritional deficiencies. For example, gingivitis and bleeding gums may be cause by vitamin C deficiency.
In the integumentary system, malnourished patients are likely to have brittle and dry hair, or experience hair loss. The skin may appear pale, dry, and rough, and wounds may take longer to heal.
General Assessment for Nutritional Status (Hinkle, 2021)
| Body Parts | Normal Findings | Signs of Poor Nutrition (will require further assessment) |
| Appearance | alert and oriented | lack of energy |
| Weight | normal for height and age | overweight or underweight |
| Face | consistent skin color | face swollen, skin flaky |
| Lips | pink color, smooth | swollen and puffy, lesion at the corner |
| Tongue | papillae present | smooth and shiny appearance of the tongue with loss of papillae |
| Gums | pink color, firm | inflammation, swollen, and bleeding |
| Hair | healthy scalp, shiny hair | fragile, thin, and sparse hair |
| Skin | smooth, color appropriate to ethnicity | rough, flaky, swollen, pale or yellowish appearance |
| Nails | pink | spoon nails, brown-gray nails |
| Skeleton/extremities | erect normal posture, no tenderness | bowed legs, weakness, tenderness |
| Abdomen | flat | swollen |
Access additional information to educate patients on healthy dietary patterns. The guidelines were developed by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) to provide recommendations on healthy eating, promoting health, and preventing chronic illness. These guidelines include recommendations for all stages of life, from birth through older adulthood, as well as for women who are pregnant or breastfeeding.
Sample Narrative Documentation
Patient was admitted with peptic ulcer this morning. Continues to experience decreased appetite and intermittent epigastric pain, rates 2 on 0-10 pain scale currently. Abdomen soft, distended, and tender to touch. Normal bowel sounds in all 4 quadrants. No bowel movement for 2 days. Pale skin color, warm, dry. Lips pale, oral mucosa moist and intact. Afebrile, BP 110/68, P 100, R 22. Denied shortness of breath. Clear lung sounds bilaterally. No acute distress. Declined pain medication. IV D5W in Left forearm at 50 mL/hr. NPO, wait for the scheduled upper endoscopy procedure.
Nutritional assessment is an ongoing process for hospitalized patients. If assessment findings suggest nutritional concerns, such as inadequate oral intake or poor wound healing, further diagnostic and laboratory tests may be conducted to uncover underlining causes and provide nutritional support.
Certain laboratory results can help determine a patient’s nutritional status. Serum albumin and prealbumin levels are useful for assessing patient’s protein requirements. Electrolytes (such as serum calcium, magnesium, and phosphorous), blood urea nitrogen (BUN), and creatinine can be evaluated to assess fluid volume status and the need for parental nutrition. If diet-related noncommunicable or metabolic diseases are suspected, glucose and lipid levels (total cholesterol, LDL, HDL, and triglycerides) may be assessed. Transferrin, a protein that transports iron through the blood to various tissues and organs, can indicate protein status. Low transferrin levels may signal iron deficiency and anemia. In the evaluation of anemia, a complete blood count (CBC), serum iron level, serum vitamin B12, and folate levels are also checked. Additionally, blood tests for specific vitamin deficiencies may be necessary for patients with gastrointestinal malabsorption (Hinkle, 2021).
Click the link to access additional nutritional assessment OERs: Nutrition.
