Food-Service-Manual-for-Health-Care-Institutions

Food Service Manual for Health Care Institutions
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Table 9.3. Physical Signs Indicative of Malnutrition (continued)
Body Area Normal Appearance Signs Associated with Malnutrition
Gastrointestinal No palpable organs or Liver enlargement; enlargement of spleen
system masses (in children,
however, liver edge may
be palpable)
(usually indicates other associated diseases)
Nervous Psychological stability, Mental irritability and confusion; burning and
system normal reflexes tingling of hands and feet (paresthesia); loss of
position and vibratory sense; weakness and tenderness
of muscles (may result in inability to
walk); decrease and loss of ankle and knee
reflexes
Source: Adapted from Christakis.
Laboratory analysis may be necessary to determine serum or blood levels of various nutrients,
and the reason for any abnormal values should be identified. Abnormal laboratory values
that correlate with poor intake of a particular nutrient warrant changes in food intake. For
example, if the serum protein or serum albumin level is low and the patient’s dietary intake of
protein is low, increasing protein intake might be advisable, along with adding high-protein
supplements. Nutritional status should be reevaluated at appropriate intervals according to the
patient’s medical condition.
In extended care facilities such as nursing homes, residents’ food intake patterns can be
changed gradually, and low intake can be overlooked. These patients’ food intake should be
noted daily, and their weight should be monitored regularly. Laboratory tests should be done
whenever there is significant change in a patient’s food intake or weight. An assessment should
be completed by a consulting dietitian and a care plan developed for the certified dietary manager
or other staff members to follow. These care plans should be updated with each visit from
the dietitian and the dietitian notified should significant changes occur between visits.
Assessments of patients on hospital skilled-nursing units and rehabilitation units generally
are more time-consuming for dietitians. Frequently, these patients have more eating, swallowing,
digestion, and elimination difficulties than other patients. Regulations provide specific
guidelines for conducting team conferences and patient–family conferences. Guidelines also
specify the type and frequency of assessments and documentation of care plans expected. The
dietitian attends family conferences with other health care professionals. Generally, team conferences
are held once a week, and the dietitian must be present to provide input and to update
the patient’s overall care plan.
Nutrition Care Plan
When a nutrition assessment indicates that a patient is at risk, a nutrition care plan should outline
what nutrition care is needed and how it is to be provided. Results of the nutrition assessment
and the nutrition care plan should be charted in the patient’s medical record and
communicated to the physician. Although the physician will use the medical record, it may be
necessary to place a sticker on the record to call the physician’s attention to the nutrition note.
The medical record then serves as
• A means of communication among all members of the treatment team
• A resource to be used in treating the patient’s illness
• A means of providing continuing patient care in different health care settings
• An important tool in utilization management and quality assessment programs