Nutrition screening is nursing work and must be done within 24 hours of admission. Calculate a real BMI, waist circumference and percentage of unintentional weight loss; work out protein, fluid and fibre needs; learn why albumin is an inflammation marker, not a nutrition marker; build aspiration precautions; and verify a feeding tube the way that keeps a patient alive.
Measure, do not estimate
Weigh with the same scale, at the same time of day, in the same clothing, after voiding. Measure waist at the level of the iliac crest at the end of a normal expiration.
The two questions every validated tool asks — and you can ask them with no tool at all: Have you lost weight recently without trying? and Have you been eating poorly because of a decreased appetite? Validated tools include the MST, the MUST, and for adults over 65 the MNA-SF.
Protein, fluid and fibre
Requirements are per kilogram, so they change with every patient. Enter the weight and the clinical picture.
Refeeding syndrome risk
Select every risk factor this patient has.
Nutrition marker or inflammation marker?
This is the point students most often get wrong, and it changes what you chart and what you recommend.
The data point
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Correct
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Answered
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Swallow screen and aspiration precautions
A patient with a new stroke, a new neurologic deficit, a recent extubation or a new complaint of choking gets nothing by mouth — including water and medications — until a swallow screen is passed. Select every correct action.
Verify the feeding tube
This is a patient-safety issue with a right answer and a wrong one. Read the situation and choose.