What's the Risk?

During clinical rotation, interns spend eight weeks learning the ropes of a clinical dietitian and two more weeks putting their new skills to the test in staff relief. I am excited to announce that I am heading into my second week of staff relief, and it is flying by too quickly! I am finally getting comfortable on my unit, which includes patients from Med Surg and Critical Care. The biggest challenge with these patients is assessing their nutritional risk. When considering if a patient is at a high or low risk, it is important to look at the bigger clinical picture.

Here are some quick tips for determining the patient's nutritional risk:

• Was the patient well nourished or malnourished prior to admission?
• Does the patient's diagnosis increase calorie and protein needs?
• What type of diet is the patient tolerating: clear liquids, full liquids, or general?
• If the patient is not tolerating the diet, how many days of inadequate intake?
• Do the patient's medications affect appetite or cause nausea, vomiting, or constipation?
• Are there any swallowing or aspiration concerns?
• Last but not least, does the gut work?

Coming to these conclusions is not always an easy task because it involves communication between many disciplines of the medical team. However, collecting this information is imperative to assess the whole clinical picture of the patient. With this information, I can make an accurate assessment of the patient's nutritional risk and develop a plan of care that best meets his or her prescribed nutritional needs.