One key responsibility for RDNs in a clinical setting is to assess an individual who has had unintended weight loss. Developing a nutrition plan of care is specialized and is not “one size fits all.” Starting with a clean slate, individualizing each unintended weight loss assessment is essential. Also, utilizing the Nutrition Care Process (NCP) when evaluating weight loss is vital. The four steps are nutrition assessment, diagnosis, intervention, monitoring and evaluation.
There are many sub steps in the process, so take your time. Evaluating unintended weight loss is difficult, but it gets easier the more you do it. Below is a procedure for assisting with the process.
Review the Medical Record:
· Look for weight changes, labs, and changes in condition.
· Calculate the % of weight loss and whether it is significant over 30, 90, or 180 days.
· Remember that many times people may lose weight initially after the hospital due to receiving fluids during their stay. So if they eat 100% and have had a weight loss, this may be the cause. Knowing their UBW can help to identify this.
· Read nursing notes for changes in edema.
· Note any medication changes (look for changes or additions of steroids, diuretics, thyroid and diabetic medications, etc.)
· Assess for any declines in meal intake and socialization; look for increased lethargy.
· Speak to the staff, patient, or family members.
· Investigate possible chewing or swallowing problems.
· When speaking with the patient, look for signs and symptoms of malnutrition and dehydration. Complete a Nutrition-Focused Physical Exam if indicated.
· Calculate the % of unintended weight loss. Is it significant over 30, 90, or 180 days?
· What were your nutrition findings?
CREATING A PES STATEMENT:
A PES statement consists of the problem (P), the etiology (E), and the signs or symptoms (S). Dietitians use this to inform the team about the nutrition diagnosis of the individual.
The format is: _____(P)_____related to _____(E)_____as evidenced by _____(S)_____.
PES STATEMENT EXAMPLES:
· Unintended weight loss related to infection as evidenced by weight loss of >5% in 30 days.
· Unintended weight loss related to diuretic use as evidenced by weight loss of >5% in one week.
· Unintended weight loss related to dementia as evidenced by weight loss of > 10% in 180 days.
· Develop a plan to address the unintended weight loss with the patient, family, and nurse.
· Update the Patient/Resident Care Plan.
· Input recommendations into the EMR.
MONITORING AND EVALUATION:
· Monitor the individual at meal rounds.
· Assess weekly weights and overall intake of meals/supplements.
· State when you will follow up.