Nutrtional Assessment

This assignment is an account of a nutritional assessment that I carried out on a patient in the elderly care ward I work on. I did this whilst being observed by my work-based supervisor (WBS). I will describe the tool used; the reasons for the assessment; the results of the assessment and the action taken .I will discuss the importance of nutritional screening of all patients in hospital. Confidentiality of the trust, my patients and my colleagues will be maintained throughout this assignment in accordance with the Nursing and Midwifery Council (NMC) Code of Conduct. Nutritional care is a fundamental aspect of health care yet there are still concerns about the effectiveness of care provided especially for elderly patients who are most vulnerable (Age UK 2010) .Having enough to eat and drink is a basic human right and is essential to life and that Assistant Practioners (AP) have a key role in providing good nutritional care to the patient (Potterton and Thatcher 2012).
The National Institute for Health and Clinical Excellence( NICE),( 2006) states that nutritional screening should be carried out on admission of a patient to hospital and repeated weekly thereafter if there is clinical need. Our hospital policy is for screening to take place within four hours of admission and weekly thereafter, if there is a change in the patient 's condition it can be updated more frequently.
The objective of nutritional assessment is to determine accurately nutritional status of the patient and to monitor changes during nutritional support (Jeejeebhoy and Keith 2005) . Brooker ( 2007) states that there should be a holistic approach to nutritional screening that includes physical, social, emotional, spiritual and psychological aspects. Screening tools used to gather information about the nutritional state of a person should contain such factors that can potentially influence intake of food (Jackson and Smith 2007).
There are a number of different nutritional assessment tools in use (Jackson and Smith 2007).These tools use a questionnaire that examines causes known to lead to or be associated with malnutrition (Green and Watson 2005).Jackson and Smith( 2007) suggests that screening assessments should include weight, height, history of weight loss or gain, pre-existing conditions, medication and age.
The most widely used of these screening tools is the Malnutrition Universal Screening Tool (MUST) developed by the Malnutrition Advisory Group (MAG) of. British Association for Parenteral and Enteral Nutrition (BAPEN) (2010).The BAPEN states it is valid, reliable, and is suitable for all adult patients regardless of their underlying illness. This tool uses height and weight to calculate the patient’s Body Mass Index (BMI).Although Inelmen et al (2003) states that the use of BMI index is questionable in the elderly due to a variance in body weight depending on adipose fat deposit and the loss of lean tissue.UK Nursing Groups have also criticized the Must Tool as being too difficult having to calculate the BMI being a negative aspect (Anthony 2008).

Our Hospitals’ assessment tool which has been ratified by the Trusts Document Group uses a scoring system to identify patients at risk. This tool is used across the hospital and is not specifically designed for the elderly (See appendix. A).Patients identified as high risk should be referred to the dietician for more detailed assessments (Brooker,2007).
M r J was an 80-year-old gentleman with dementia who was admitted to the elderly care ward with a urinary tract infection (UTI); I carried out a nutritional assessment on Mr J on his admission as recommended by NICE (2006) and in line with hospital policy.
I weighed Mr J and, as he was unable to stand asked him his height. He was 5 foot 11inches tall and weighed 73.45kg .On completion of the assessment Mr J’S score was 15 indicating he was at high risk.(see appendix A).He scored two for mental condition as he was confused due to his dementia; the score of three for weight was due to a significant weight loss as reported by his family ; the score of two for ability to eat was due to Mr J having Dupuytren’s contractures of his left hand. This is a condition that affects the hands and fingers. It is caused by a lump tissue called nodules which over time shortens and causes contractures of one or more fingers which makes it difficult to extend the fingers. (NHS choices, 2011).Due to this he was unable to cut his food up unaided.He also scored two for Medical condition as he was admitted with a UTI which can reduce the patients appetite (Perry 2012).
Mr J 's score of 15 made him at high risk nutritionally. As a result of this I followed the action plan which I firstly discussed with my WBS. I organised a high protein supplement drink daily to increase his calorific intake. I started him on a three day food record chart to monitor his intake. The Hospital has a policy for the use of red and yellow trays at meal times.The red tray is for patients who need help with feeding and are at risk of aspiration. The yellow tray which Mr J was given is for patients on food charts; who are slow at eating and need help such as cutting up food. This is to identify these patients to bank staff and volunteers who may not be familiar with the patients. Patients in the elderly care unit are all on fortified menus to ensure they get a high calorific intake so it was unnecessary to refer him to the dietician at this point. I encouraged him to have drinks and snacks such as milk and biscuits between meals as recommended in the action plan. If Mr J’s appetite had been reduced I would have given him and his relatives a small appetite leaflet. As it was Mr J ate well but slowly (See appendix. B).
The nutritional assessment and actions taken were documented in the patient’s assessment booklet in his end of bed folder where it was easily accessible to all staff thus ensuring continuity of care as required by the NMC guide lines for Record Keeping (NMC 2009).
I have learned from research and my practice how important early nutritional assessment is .As ensuring adequate nutrition helps in recovery.There are serious concerns about malnutrition in hospital. However our hospital is not only proactive in assessments but in action,in particular there are policies that ensure there are sufficient staff includding non-clinical staff who have done feeding assessments to assist patients with feeding at meal times.

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References
Age UK (2010) ‘age Concern ‘Still Hungry to be heard’. Available at hhttp://www.ageuk.org.uk (Accessed: 10 September 2012)
Anthoney,P.(2008) ‘Nutritional screening Tool for Hospitalized Patients’ Nutrition in Clinical Practice,23(4) pp.373-382. Sage Journals. Available at htpp://www.Sagepub.com/ (Accessed 12 September 2012)
British Association for Parenteral and Enteral Nutrition (BAPEN) (2010) ‘BAPEN MUST Report’: Available at http://www.bapen.org.uk/screening-for-malnutrition/ (Accessed 10 September 2012)
Brooker,C.and.(2007) ‘Prompting hydration and nutrition’, in Brooker,C.and Waugh, A.(eds.)Foundation of Nursing Practice Fundamentals of Holistic Care. Edinburgh: Mosby Elsevier.pp.531-568.
Greensand Watson.(2005) ‘nutritional screening and assessment tool for use by the nurse: literature review’ Journal of Advanced Nursing,50(1) Willey library (online) Available at htpp://onlinelibrary.wiley.com/ (Accessed 10 August 2012)
Inelmen ,E. Sergi, G.Coin, A .Miotto,F.Peruzza,S.and Enzi,G.(2003) ‘Can obesity be a risk factor in elderly people?’ Obesity Review, 4(3).pp147-155, Willey on line library (2003). Available at htpp://www.onlinelibrary.willey.com/ (Accessed 10 August 2012).
Jackson, L. and Smith ,J .(2007) ‘Nutrition’ ,in Adams, R. (ed.) Foundation of health and social Care .Basingstoke: Palgrave Macmillan.pp.202-209 .
Jeejeebhoy, K .and Keith, E.(2005) ‘Nutritional assessment’ In Gibney, M. Elia, M. Ljungqvist,O and Dowsett, J.(eds.) Clinical Nutrition. Oxford: Blackwell. pp. 15-29.
National Institute for Health and Clinical Excellence (2006) Nutritional support in Adults (CG32). London: National Institute for Health and Clinical Excellence.
NHS Choices (2001) Dupuytren’s Contractures Available at: htpp:www.NHS.uk/ Accessed 11 August 2012).
Nursing and Midwifery Council (NMC) (2009) The Code: guide to record keeping for Nurses and Midwives. London: Nursing and Midwifery council.
Nursing and midwifery Council (NMC). (2008) The Code: standards of conduct, performance and ethics for nurses and midwives. London: Nursing and Midwifery Council.
Perry. (2012) ‘How the signs and Symptoms of Common infections vary with age’ Practice Nursing, 23 (4).internurse (online).Available at htpp://internurse,com/ (Accessed 20 September)
Potterton, J. and Thatcher, C. (2012). ‘Role of health care assistants as nutritional champions’, British Journal of Healthcare Assistants, 6(4), pp. 164-168.

(Nursing and Midwifery Council (NMC), (2008))

References: Age UK (2010) ‘age Concern ‘Still Hungry to be heard’. Available at hhttp://www.ageuk.org.uk (Accessed: 10 September 2012) Anthoney,P.(2008) ‘Nutritional screening Tool for Hospitalized Patients’ Nutrition in Clinical Practice,23(4) pp.373-382 Greensand Watson.(2005) ‘nutritional screening and assessment tool for use by the nurse: literature review’ Journal of Advanced Nursing,50(1) Willey library (online) Available at htpp://onlinelibrary.wiley.com/ (Accessed 10 August 2012) Inelmen ,E Jackson, L. and Smith ,J .(2007) ‘Nutrition’ ,in Adams, R. (ed.) Foundation of health and social Care .Basingstoke: Palgrave Macmillan.pp.202-209 . Jeejeebhoy, K .and Keith, E.(2005) ‘Nutritional assessment’ In Gibney, M. Elia, M. Ljungqvist,O and Dowsett, J.(eds.) Clinical Nutrition. Oxford: Blackwell. pp. 15-29. National Institute for Health and Clinical Excellence (2006) Nutritional support in Adults (CG32). London: National Institute for Health and Clinical Excellence. NHS Choices (2001) Dupuytren’s Contractures Available at: htpp:www.NHS.uk/ Accessed 11 August 2012). Nursing and Midwifery Council (NMC) (2009) The Code: guide to record keeping for Nurses and Midwives. London: Nursing and Midwifery council. Nursing and midwifery Council (NMC). (2008) The Code: standards of conduct, performance and ethics for nurses and midwives. London: Nursing and Midwifery Council. Perry. (2012) ‘How the signs and Symptoms of Common infections vary with age’ Practice Nursing, 23 (4).internurse (online).Available at htpp://internurse,com/ (Accessed 20 September) Potterton, J (Nursing and Midwifery Council (NMC), (2008))