Comprehensive Nutritional Assessment and Screening
A key function of the nurse in nutritional care is the initial screening and assessment to identify patients at risk for malnutrition. This involves a multi-component evaluation:
- Anthropometric Measurements: Tracking weight and calculating BMI.
- Dietary History: Gathering information on eating habits, preferences, allergies, and swallowing difficulties.
- Physical Examination: Observing for signs of poor nutrition like muscle wasting or skin changes.
- Biochemical Data: Reviewing lab results relevant to nutritional status.
Planning and Implementation of Nutritional Interventions
Nurses collaborate with healthcare teams to create and implement individualized nutritional care plans. This includes promoting oral intake through various strategies or administering specialized nutritional support when needed.
Administration of Specialized Nutrition
Nurses administer enteral (tube) and parenteral (IV) nutrition for patients unable to eat orally. Responsibilities include confirming tube placement, monitoring feeding tolerance, and managing administration sites for enteral feeding, and monitoring IV sites and infusion rates for parenteral nutrition.
Comparison of Common Nutritional Support Methods
| Feature | Oral Nutritional Supplements (ONS) | Enteral Nutrition (EN) | Parenteral Nutrition (PN) |
|---|---|---|---|
| Route of Administration | Mouth | Gastrointestinal tract (via tube) | Intravenous (IV) |
| Patient Eligibility | Patients who can chew and swallow but have inadequate intake or increased needs. | Patients with a functioning GI tract but unable to consume sufficient nutrients orally. | Patients with a non-functional GI tract (e.g., severe malabsorption, intestinal obstruction). |
| Risk of Aspiration | Low (if no swallowing difficulties) | Moderate to High (Requires proper patient positioning and monitoring) | None (bypasses the GI tract) |
| Primary Nursing Role | Encouraging intake, educating on supplements, monitoring consumption. | Verifying tube placement, managing infusion pump, monitoring tolerance and complications. | Administering infusion, monitoring IV site, bloodwork, and electrolyte balance. |
| Infection Risk | Low | Low to Moderate (Insertion site and formula contamination) | High (IV access site) |
Patient and Family Education
Nurses educate patients and families on various nutritional topics, including prescribed diets, the link between nutrition and recovery, safe administration of home feedings, and respecting cultural dietary needs. Teaching aids are often utilized.
Continuous Monitoring and Advocacy
Ongoing monitoring of nutritional intake, tolerance, and patient progress is crucial. Nurses advocate for patients by recommending consultations, communicating changes to the team, and supporting better hospital nutrition policies. More information on nutritional assessment can be found on the NCBI Bookshelf.
Conclusion
Nurses perform essential, multi-faceted roles in nutritional care. Their involvement in assessment, planning, administration, monitoring, and education significantly impacts patient recovery and well-being. By ensuring patients receive appropriate nutrition and empowering them with knowledge, nurses are vital to achieving positive health outcomes.
