Updated: Feb 23, 2020
As a Registered Dietitian, I have to say that I LOVE doing Nutrition Assessments…
Okay, I know not everyone shares my enthusiasm for this sometimes very tedious step of the Nutrition Care Process! Believe it or not, I used to dread the assessment, especially when the Nutrition-Focused Physical Exam (NFPE) became a “thing” for Dietitians. However, now that I really have it down to an organized and simple checklist, I really enjoy doing dietetic assessments! I promise to make this a very comprehensive, yet easy guide!
My goal is to help you conduct an excellent nutrition assessment every time, and get really confident in your NFPE’s!
Be sure to read on to the end of this post, because I have a totally FREE…
Nutrition Assessment Checklist Pdf for you!
In this comprehensive guide, you will learn:
The Key Components of the Registered Dietitian’s Nutrition Assessment
How to Easily Conduct a Patient Assessment of Nutrition Status
And…You Will Take Home a FREE Nutrition Assessment Checklist (A Printable Pdf Just For YOU!)
Let’s start with the basics!
Nutrition Assessment is the very first step in the Registered Dietitian Nutritionist’s Nutrition Care Process (NCP).
The Two Purposes of the Nutrition Assessment:
To collect as much data as possible about your patient.
To interpret this data to help identify any nutrition-related problems, which leads into the second stage of the NCP, which is Nutrition Diagnosis.
The Two Ways That Nutrition Assessment Data Are Collected:
A Review Of The Patient’s Medical Records, including medical charts, nursing and physician assessments, and CNA records for food and fluid intake and any other details about feeding. You will want to check the diet order and any listed food allergies at admission (usually in the nurse’s assessment), and even call the dietitian at the previous facility the patient was at to determine the diet, nutritional diagnosis, and any nutrition interventions that may have previously been in place for the patient.
A Patient Interview. During the interview, you will ask questions such as: what the patient’s usual body weight is, if there has been a recent weight loss, what the patient likes to eat, if they have been on a special diet order (to their knowledge), what foods they like and dislike, and if they have any food allergies. You will also want to ask about their appetite and if they have been eating less or more than usual. Often, it is helpful or necessary to involve the patient’s family members, especially if the patient is elderly and with any cognitive impairment, or if the patient is a child. Caregivers often provide useful information for your nutrition assessment.
The 5 Categories of Nutrition Assessment
😀 One of the reasons I enjoy nutrition assessments is that they are like finding treasure that you can sort into 5 different categories. This is a fun process if you get the hang of it, and the organization of the 5 parameters helps you get all your ducks in a row before moving on to your nutrition diagnosis.
😀 I like to organize this data into an easy chart/checklist format, which, like I promised, I will provide to you for free at the end of this post! First, read on so you understand what a comprehensive assessment entails. For all 5 categories, you will gather information from both the medical records and the patient interview.
😀 TIP: Whenever possible, always review the records before seeing the patient!
This will enable you to have a thorough picture of the medical status, diagnoses, medications, and more before you see the patient! Usually, you will already have some ideas in place before you see the patient (such as supplements that might be needed) that you will want to ask the patient about. This can save a lot of time, especially when there is a high RD-to-patient ratio, and you will not have to re-visit patient rooms so often!
*Here are your 5 assessment categories:
Category 1: Food/Nutrition-Related History
Diet Order - written on medical record on nurse’s intake. Check medical records for continuity of previous diet if patient was transferred from another facility.
Food Allergies and Intolerances - list any on medical record and verify with patient about food allergies.
Food and Nutrient Intake - *ask the patient AND check the CNA records
Food and Nutrient Administration - ex. oral, tube feeding, etc.
Patient’s Appetite - including recent changes - ask the patient/caregiver
Patient’s Usual Diet - ask the patient/caregiver
Physical Activity Level - needed for nutrition needs calculation (ex. bed-bound, sedentary, light activity).
Category 2: Anthropometric Measurements
Current Body Weight (CBW)
Body Mass Index (BMI)
Ideal Body Weight (IBW)
Percent of Ideal Body Weight (%IBW)
Recent Weight Change & Weight History: ask patient and check medical records to identify a recent weight loss or gain.
Estimated nutrition requirements: Total Calories, Protein needs, Fluid needs. Use Mifflin St Jeor or other appropriate equation with Injury or Activity Factor adjustment.
Growth Charts & Percentile Ranks: for children
Waist Circumference or Waist-to-Hip ratio/WHR (used in some outpatient or bariatric settings to evaluate as a parameter for metabolic syndrome and obesity-related disease risk)
Category 3: Biochemical Data, Medical Tests, and Procedures
Blood/Lab work: including electrolytes, blood glucose, lipid testing, visceral proteins. Examine and record findings of any available nutrition-related labs.
Imaging: X-rays, MRIs, CT Scans and the related findings.
Other testing: gastric emptying study, gallbladder testing, resting metabolic rate etc.
Category 4: Nutrition-Focused Physical Findings
Nutrition-Focused Physical Exam (NFPE): includes oral health such as dentures and tooth pain, skin turgor and integrity, loss of subcutaneous fat/muscle mass, etc.
Swallowing and Chewing Status - dysphagia, dentition, oral sores, etc.
Physical Findings of Vitamin and Mineral Deficiencies
Evaluate for Characteristics of Malnutrition: insufficient energy intake, recent weight loss, loss of subcutaneous fat, loss of muscle mass, fluid accumulation that may mask weight loss or be a sign of protein deficiency, diminished functional status, grip strength (if grip strength tools are available).
Go to "A Guide to The Nutrition-Focused Physical Exam" to learn more!
Category 5: Client History
Here you will chart current and past Medical, Surgical, Family, and Social History, with a focus on identifying any nutritionally relevant medical issues.
Diagnoses - list all you find on medical record
Skin/Wound Status - nurse’s intake - this determines if supplementation may be needed to meet nutritional needs for wound healing (protein, vitamin C, zinc, etc).
Recent Surgeries and Procedures - including colonoscopy, orthopedic surgery, etc)
Past Medical History, Surgical History, Family Medical History
Medications and Supplements - usually on medical record on nurse’s intake
Allergies - list any on medical record and verify with patient.Note any nutritionally relevant drug side effects like loss of taste, smell, appetite, weight loss/gain, as well as potential drug/nutrient interactions.
Any personal/social factors that may affect food intake and availability, such as cognitive capacity, communication or language barriers, income, occupation, education level, use of/eligibility for government programs, motivation level, person responsible for shopping, preparing food at home.
FOOD AND NUTRITION
Food intake: Dietary recall or food frequency analysis if appropriate setting and time allowance with patient.
Knowledge and Beliefs about food; food availability; nutrition quality of life
Eating habits and patterns: usual and current appetite, weight history, physical or mental abilities that may affect food intake and self-feeding, typical diet and meal pattern, ethic or religious food preferences.
Lifestyle habits and patterns: Alcohol intake, smoking, frequency of dining out, physical activity type/frequency, previous diet education, interest in dietary change, complimentary and alternative medicine use.
ARE YOU OVERWHELMED YET?
I know, it really looks like a lot! However, I promise you that…
Practice makes progress, and progress makes perfect!
Over time, going through the assessment steps, you will be surprised at how well it becomes an automatic and easy process for you. In the meantime, I created a *FREE Nutrition Assessment Pdf* just for you! I organize the step sof assessment into actions that make sense. This blog contains the "textbook" description of nutrition assessment, but in practice most RDNs do not take the steps in the order they are written. THAT is why I created this Pdf for you! You can print it and go through the checklist with each patient until you get the hang of it. This is what I WISH I had when I stepped into my dietetic career!
And it’s your’s free compliments of Brilliant Dietitians when you subscribe at the bottom of the page. We will deliver it straight to your inbox!
Next, be sure to read: "A Guide to The Nutrition-Focused Physical Exam"
“Have a fantastic day and get out there and BE A BRILLIANT DIETITIAN!”
Your Brilliant Dietitian Coach
Width, M. & Reinhard, T. (2018). The Essential Pocket Guide for Clinical Nutrition, 2nd Ed. Philadelphia, PA: Wolters Kluwer.