Nutrition screening and helping patients eat
- Fundamental
Nurses spot the risk of malnutrition early (weight, intake, swallowing) and help the patient eat what they need.
What it is
Malnutrition in hospital is common and slows recovery. Screening uses a few questions and measurements to find who needs a full assessment: unintentional weight loss, poor intake, chewing or swallowing problems and illnesses that raise needs. For older adults there is, for example, the short form of the Mini Nutritional Assessment (MNA-SF). Beyond screening, nurses prepare the patient and the setting so they can eat.
Key points
- WHO describes three forms of malnutrition: undernutrition, micronutrient-related malnutrition, and overweight or obesity.
- BMI: under 18.5 underweight; 18.5 to 24.9 desirable; 25 to 29.9 overweight; 30 or more obese.
- A weight loss under 5 % in 6 months is considered acceptable.
- The MNA-SF is a screening tool for older adults who are malnourished or at risk.
- Weak chewing and poor dentition are signs of a possible nutritional deficit.
Components
- History: illnesses, surgery, usual diet, preferences, cultural and religious practices, allergies and special diets.
- Risk factors: swallowing disorders, eating disorders, alcohol use, prolonged fasting, stress or depression.
- Measurements: weight, height, BMI and weight change over time.
- Mouth exam: mucosa, ulcers, tongue, dentition and whether swallowing causes coughing.
- Laboratory tests as ordered: albumin, prealbumin, haemoglobin and others.
What it is for
- Finding the patient at risk early, for referral to the dietitian.
- Choosing the diet texture according to dentition and swallowing.
- Following progress with weight and recorded intake.
- Working with the dietitian on calorie needs and enteral feeding decisions.
In nursing practice
- Prepare the setting: remove odours and unpleasant sights, and avoid painful procedures at mealtimes.
- If the patient has pain or nausea, coordinate the ordered treatment before the meal.
- Encourage self-feeding; for people with low vision, describe the tray using clock positions.
- Respect cultural and religious preferences, and reheat food that has gone cold.
- Where indicated, offer high-protein, high-calorie finger foods, and allow pauses between bites.
Common mistakes
- Recording a stated weight instead of weighing the patient.
- Reading albumin alone as a measure of nutrition.
- Leaving the tray closed and out of reach of a patient who cannot open it.
- Not recording how much the patient actually ate.
- Not referring a patient with significant weight loss to the dietitian.
Test yourself
Think of the answer, then tap the question to see it.
Which weight loss over 6 months is significant and reported?
A loss of more than 10 % of body weight in 6 months. A loss under 5 % in that period is considered acceptable.
Why is albumin not enough to assess nutrition?
Because it changes with inflammation, liver or kidney disease and other factors; it is read with weight, intake and the clinical picture.
What do you do if the patient coughs or chokes while eating?
Stop the meal and call, because it may be a sign of dysphagia with a risk of aspiration.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing Fundamentals, 14.3 Nutrition: Applying the Nursing Process (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Nursing Fundamentals, 14.2 Nutrition Basic Concepts (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Malnutrition (fact sheet) (World Health Organization, 2024).
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Representative model, for educational purposes only.