Taking Charge | Good Medical Care for the Elderly and How To Get It

Appendix N

Monitoring Nutritional Status and Managing

Protein/Energy Malnutrition

Use this checklist to help you monitor for protein/energy malnutrition.

(Check all that apply)

Indicator		Action
	Resident has 5% involuntary weight loss in 30 days, or	Monitor weight weekly; encourage increased intake
	Resident has 10% involuntary weight loss in 180 days or less, or
	BMI is 21 or less (703 x weight in lbs/height in inches), or
	Resident leaves 25% or more food on tray in last seven days
In addition to action recommended above:		Evaluate laboratory tests:
	Serum albumin <3.4g/dL
	Cholesterol<160 mg/dL
	Hgb<12 g/dL
	Serum transferrin<180

Indicator		Action
Conditions resident has:
	Takes medications other than multivitamins/ minerals	Consult with pharmacist
	Takes more than three (3) medications daily	Consult with pharmacist
	Experiences symptoms of depression/anxiety	Ask for assessment
	Experienced infection (UTI, URI, pneumonia, GI) in last seven days	Begin laboratory tests (urinalysis for infection); review lab work from last 30 days
	Experienced fecal impaction in last seven days	Implement bowel program
	Undergoing tube feeding	Contact dietitian for assessment
	Experiencing functional ADL decline	Consider occupational or physical therapy assessment
	Experiencing difficulty swallowing	Contact speech therapist for assessment and dietician for review of diet for consistency, texture
	Developed pressure ulcer in low-risk patient	Begin skin care program
	Presence of fever (2º above baseline)	Report to director of nursing, physician
	Presence of diarrhea
	Presence of constipation
	Presence of vomiting, nausea
	Presence of dentition problem (ill-fitting dentures, missing teeth, bleeding gums)	Consult dentist

Disclaimer: See the authors' disclaimer.

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