Assessing Risk Level

During clinical rotation, interns spend eight weeks learning what it is like being a clinical dietitian and for the last two weeks they are in staff relief putting together the new skills that they have learned. I am happy to announce that I am officially done with my first clinical rotation and time flies by so quickly! I have spent one week alone in the critical care unit and two weeks of staff relief on a general medicine floor. During the past few weeks I learned that in a clinical setting it is important to look at the bigger picture when determining risk levels. Is the patient stable, low/moderate, or high risk?

Here are some things to consider when determining the patient’s nutrition risk level:

• How was the patient eating prior to admission? Was the patient well nourished and is the patient weight stable?
• Does the patient’s medical diagnosis increase calorie or protein needs?
• Is the person ventilator dependent? How will the patient meet estimated nutrition requirements?
•  How is the patient’s skin integrity?
• What type of diet was the patient previously on? What type of diet do they have in the hospital?
• Is the patient tolerating their current diet?
• Are there any medications that may have caused nausea, vomiting, diarrhea, constipation, hypokalemia, hyperglycemia and etc.?
• Has the patient been NPO for a prolonged period of time?
• Is the patient at risk of aspiration and are there any difficulties chewing/swallowing?
• Does the patient have a functioning gut?

During my time in the critical care unit I realized that it is not easy to gather all the information because most of the time patients are nonverbal since they are intubated. This makes communication between the medical team crucial in order to provide the best care for the patient. With the information gathered, I can assess the patient’s nutritional risk and develop an intervention that best meets the patient’s nutrition needs.