Nutritional Assessment

Question 1

Causes of nutritional deficit

Answer 1

Inability to care for self - forgetting, unable to buy or prepare food
Reduced appetite - common in elderly patients
Malabsorption

Question 2

Features of a MUST score

Answer 2

5-step screening tool to identify adults who are malnourished, at risk of malnutrition or obese
1) Measure height and weight to get a BMI score
o If unable to measure, used recently self-reported height (if reasonable and realistic)
o Height can also be estimated from ulnar length
o BMI can be estimated from mid-upper arm circumference
o BMI > 20 – 0 points
o BMI 18-20 – 1 point
o BMI < 18 – 2 points
2) Note unplanned weight loss and use it to calculate a percentage score
o If unable to measure, used recently self-reported weight loss (if reasonable and realistic)
o < 5% weight loss – 0 points
o 5-10% weight loss – 1 point
o > 10% weight loss – 2 points
3) Establish acute disease effect
o If patient is acutely ill and there has been or is likely to be no nutritional intake for > 5 days – 2 points
4) Add scores from steps 1, 2 and 3 to calculate risk of malnutrition
5) Use management guidelines and local policy to develop care plan
o 0 – low risk, routine clinical care
o 1 – medium risk, observe, document dietary intake for 3 days and consider treatment based on findings
o 2 or more – high risk, refer to dietitian, set goals to increase nutritional intake

Question 3

Complications of malnutrition

Answer 3

Infection
Ovulation abnormalities
Reduced strength 
Fatigue
Loss of temperature regulation

Question 4

Features of refeeding

Answer 4

Avoid refeeding syndrome - change from catabolism to anabolism causes decreased phosphate, potassium and magnesium
Risk is increased if BMI < 16 or unintentional weight loss > 15% over last 6 months