Nov 10 2022 by Myrna Buiser Schnur, MSN, RN
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When obtaining a patient’s health history, it is important to assess and document the nutritional status. Nutrition is critical in maintaining a healthy weight and to preventing conditions such as cardiovascular disease and diabetes. In addition, adequate nutrition is vital to healing and recovery from illness and injury (Hinkle, 2021). A complete nutritional assessment helps clinicians evaluate overall dietary status, and identify malnutrition and its underlying causes. Malnutrition can be both an inadequate or excessive intake of nutrients and is categorized as follows (Kesari & Noel, 2022):
- Undernutrition (low weight-for-height, low height-for-age, and low weight-for-age)
- Micronutrient (vitamins and minerals) deficiency or excess
- Overnutrition (overweight, obesity, type 2 diabetes mellitus, cardiovascular disease)
There’s a mnemonic you can use to remember the different components of a complete nutritional assessment ABCD: anthropometric, biochemical, clinical, and dietary.
Anthropomorphic Measurements
Anthropomorphic measurements are attributes of the human body including size and shape.
- Height, weight, and BMI
- Circumference (arm, abdomen, and thigh) measurements are indicators of protein stores
- Skinfold thickness (biceps, triceps, subscapular, and suprailiac skinfold) is an indicator of energy (fat) stores.
Biochemical Measurements
Diagnostic tests are often performed to verify the patient’s clinical presentation.
- Routine laboratory tests such as serum electrolytes, blood urea nitrogen (BUN), creatinine, blood glucose levels, lipid profile, liver enzymes, complete blood count, and cholesterol can identify malnourishment.
- Proteins such as albumin, prealbumin, transferrin, and retinol-binding protein can help evaluate nutritional status but should not be used alone.
- Micronutrient level of B vitamins (thiamine, riboflavin, niacin, pyridoxine, folic acid, B12), vitamins A, C, D, E, and K, iron, zinc, selenium can be measured if deficiencies are suspected.
Clinical Signs
The patient’s nutritional status is often evident in the head-to-toe physical assessment.
Carefully examine the patient for the following physical signs that may indicate undernutrition (Chu & Delmore, 2020; Cleveland Clinic, 2022):
- Low body weight, prominent bones
- Muscle wasting
- Poor skin integrity, dry, inelastic skin, rashes, and lesions
- Loss of subcutaneous fat tissue
- Low body temperature
- Low heart rate and blood pressure
- Thin arms and legs with edema in the abdomen and face
- Reduced handgrip strength, weakness, fatigue
- Irritability, apathy, or inattention
- Poor dental health
- Brittle hair, hair loss, or hair color loss
Conversely, these physical signs may indicate overnutrition (Chu & Delmore, 2020; Cleveland Clinic, 2022):
- Obesity
- Is adipose tissue distributed evenly, concentrated over the upper torso, or around the hips?
- High blood pressure
- Insulin resistance and hyperglycemia
Dietary
Complete the comprehensive nutritional assessment by asking questions that allow the patient to provide subjective responses related to their daily dietary habits (Bickley, 2021).
- Have you experienced a loss of appetite?
- Can you describe your eating habits?
- Do you eat fruits and vegetables daily?
- What do you eat on a typical day?
- Have you maintained the same weight, or has it fluctuated?
- How do you feel about your current weight?
- Do you prepare your meals at home?
- How many meals do you eat each day and what are your portion sizes?
- How often do you eat out?
- Do you follow any restrictive diets (i.e., vegan, vegetarian)?
- Do you exercise and if so, how often?
- Have you experienced nausea or vomiting?
- Have you noticed any changes in your menstrual cycle?
I hope this easy mnemonic will help you during your next patient assessment. For more resources on physical assessments click here.
References:
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.
Chu, A.S. & Delmore, B. (2020). Parameters for Nutrition Assessment. Advances in Skin & Wound Care: The Journal for Prevention and Healing.33(5), 232-232.
Cleveland Clinic. (2022, May 4). Malnutrition. https://my.clevelandclinic.org/health/diseases/22987-malnutrition
Hinkle, J. (2021). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer Health. https://wolterskluwer.vitalsource.com/books/9781975161057
Kesari, A. & Noel, J.Y. (2022). Nutritional Assessment. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK580496/
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