Page 15 - Nutrition Essentials for Nursing Practice

CHAPTER 1 Nutrition in Nursing 3

B ased on Maslow’s hierarchy of needs, food and nutrition rank on the same level as air in
the basic necessities of life. Obviously, death eventually occurs without food. But unlike
air, food does so much more than simply sustain life. Food is loaded with personal, social,
and cultural meanings that define our food values, beliefs, and customs. That food nour-
ishes the mind as well as the body broadens nutrition to an art as well as a science. Nutrition
is not simply a matter of food or no food but rather a question of what kind, how much,
how often, and why. Merging want with need and pleasure with health are keys to feeding
the body, mind, and soul.

Although the dietitian is the nutrition and food expert, nurses play a vital role in nutri-
tion care. Nurses may be responsible for screening hospitalized patients to identify patients
at nutritional risk. They often serve as the liaison between the dietitian and physician as
well as with other members of the health-care team. Nurses have far more contact with the
patient and family and are often available as a nutrition resource when dietitians are not,
such as during the evening, on weekends, and during discharge instructions. In home care
and wellness settings, dietitians may be available only on a consultative basis. Nurses may
reinforce nutrition counseling provided by the dietitian and may be responsible for basic
nutrition education in hospitalized clients with low to mild nutritional risk. Nurses are inti-
mately involved in all aspects of nutritional care.

This chapter discusses nutrition within the context of nursing, including nutrition
screening and how nutrition can be integrated into the nursing care process.

NUTRITION SCREENING

Nutritional Screen: Nutrition screening is a quick look at a few variables to identify individuals who are mal-
a quick look at a few nourished or who are at risk for malnutrition so that an in-depth nutrition assessment
variables to judge a can follow. Screening tools should be simple, reliable, valid, applicable to most patients
client’s relative risk for or clients in the group, and use data that is readily available (Academy of Nutrition and
nutritional problems. Dietetics, 2012). For instance, a community-based senior center may use a nutrition
Can be custom de- screen that focuses mostly on intake risks common to that population, such as whether
signed for a particular the client eats alone most of the time and/or has physical limitations that impair the abil-
population (e.g., preg- ity to buy or cook food (Fig. 1.1). In contrast, common screening parameters in acute
nant women) or for care settings include unintentional weight loss, appetite, body mass index (BMI), and
a specific disorder disease severity. Advanced age, dementia, and other factors may be considered. There is
(e.g., cardiac disease). no universally agreed upon tool that is valid and reliable at identifying risk of malnutrition
in all populations at all times.
Malnutrition: literally
“bad nutrition” or any The Joint Commission, a nonprofit organization that sets health-care standards and
nutritional imbalance accredits health-care facilities that meet those standards, specifies that nutrition screening be
including overnutrition. conducted within 24 hours after admission to a hospital or other health-care facility—even
In practice, malnutrition on weekends and holidays. The Joint Commission allows facilities to determine screening
usually means undernu- criteria and how risk is defined. For instance, a hospital may use serum creatinine level as a
trition or an inadequate screening criterion, with a level greater than 2.5 mg/dL defined as “high risk” because the
intake of protein and/or majority of their patients are elderly and the prevalence of chronic renal problems is high.
calories that causes The Joint Commission also leaves the decision of who performs the screening up to indi-
loss of fat stores and/or vidual facilities. Because the standard applies 24 hours a day, 7 days a week, staff nurses are
muscle wasting. often responsible for completing the screen as part of the admission process. Clients who
“pass” the initial screen are rescreened after a specified amount of time to determine if their
status has changed.