1. Practice of Nutrition Assessment
Chief, Department of Nutrition, Sempo Tokyo Takanawa Hospital
It is known that nutrition assessment is performed to determine the level of nutrient deficiency or excess by assessing drugs, digestive function, clinical condition, excretion, biochemical examination and follow-up/palpation in addition to assessing the nutritional status by delivery route such as oral, parenteral and enteral routes. Secondly, it is necessary to distinguish if undernutrition is caused by improper nutrient intake or other factors and to find out what the nutritional problem is.
When the relationship between nutritional intake and weight, laboratory data, vital signs or changes/values after admission is analyzed, the margin of error will be checked as the time lag between immediate information, and the amount of intake/examinations can cause discrepancy. This is because the nutritional problem cannot be solved unless the content is consistent considering the time lag. That is, the patient information collected should be assessable if it is adequate.
Assessment starts with the amount of intake
For nutritional intake, nutrient deficiency or excess is considered not only with the amount of oral nutrition but also with the total amount of oral nutrition, parenteral nutrition and enteral tube feeding. All nutrients are subject to assessment but particular focus will be placed on energy, sodium and water.
Nutrition assessment is first performed to determine nutrient deficiency or excess and then combine other information. Determination may vary among applicable patients such as comparing actual intake with nutritional requirement, whether minimum requirements are met and whether the amount of nutrients in consideration of the length of time has elapsed since discharge is consumed. Laboratory data may apparently show normal levels but there will be no oversight if determined from the amount of nutrients. Nutritional intake should be reassessed if the amount of intake is appropriate when laboratory values, weight or vital signs indicate problems though the intake is adequate and information that is lacking should be added and reviewed.
If you can distinguish between nutritional cause and non-nutritional cause, you will never get to the nutritional problem. In order to solve the non-nutritional problem, information such as side effects of drugs, organic condition and patient’s cognition are required. Although several causes such as the effect of diet, symptom/inflammation, side effects of drugs and clinical condition are considered, it is necessary to organize non-nutritional items such as onset time and dose increase/switching drugs to further narrow down the cause.
Skill is a challenge
Nutrition assessment requires comprehensive judgment, which is also essential to gather accurate information. This is because necessary information varies among individual cases and changes in the clinical condition. It is therefore necessary to enhance the assessment skill. This can only be learned through the accumulation of experience in real patients.