Hi, I'm Cathy with Level Up RN. In this video, I'm going to begin my coverage of topics from the second section of our Level Up RN nutrition flashcards. Specifically, I'll be talking about performing a nutritional assessment of your patient, and I will also be talking about the different types of oral diets so you can know exactly what your patient can and can't eat when a particular diet is ordered. At the end of the video, I'm going to give you guys a quiz to test your understanding of some of the key points I'll be covering, so definitely stay tuned for that. And if you have our Level Up RN flashcards, go ahead and pull them out so you can follow along with me.
Let's first talk about key components of a nutritional assessment. So first of all, you need to obtain your patient's height and weight, and you need to ask your patient about any recent weight gain or weight loss. And then most electronic health record systems will automatically calculate the patient's BMI, or body mass index, based on their height and weight. You also need to assess your patient for any difficulty with chewing or swallowing per your facility's policy. At my hospital, when a patient is admitted, we give them a very small cup of water, and have them take a small sip, and we assess whether they have any difficulty with swallowing or start coughing when they take that sip. And if that were to occur, then we would definitely keep that patient NPO, so nothing to eat or drink until they are assessed by a speech-language pathologist. So a speech-language pathologist is the key resource that is going to perform a comprehensive swallow evaluation for your patient and recommend the appropriate type of diet for your patient. And then as a reminder, if your patient is admitted to the hospital with known swallowing issues, or if they're being admitted for aspiration pneumonia, then you would definitely keep them NPO until they are evaluated.
Other parts of your nutritional assessment include asking your patient about any food allergies and dietary restrictions. And then you also want to discuss any religious or cultural dietary preferences. Key lab results that need to be reviewed include prealbumin and albumin. Prealbumin should be between 15 and 36 milligrams per deciliter, and if it is decreased, then that is indicative of the presence of malnutrition. Albumin should be between 3.5 and 5 grams per deciliter. If albumin is decreased, that may also indicate the presence of malnutrition, but albumin is also decreased with other conditions such as liver disease and kidney disease.
And then finally, we need to assess our patient for signs and symptoms of malnutrition, which include dry, brittle hair, dry, scaly skin, poor wound healing, muscle wasting, lethargy, and weakness. As the nurse, if you have any concerns about your patient's nutritional status, then you should definitely recommend a consult with a dietician or nutritionist. Patients with acute illnesses and wounds will require additional protein and additional calories in order to recover and heal properly, so proper nutrition will need to be a key part of their treatment plan.
Moving on to oral diets now. NPO means nothing by mouth, so nothing to eat and nothing to drink. When a patient has been NPO, we often advance their diet in stages. So they will be NPO, and then go to a clear liquid diet, and then a full liquid diet, and then a soft diet, and then their regular diet. A clear liquid diet includes items that are clear at room temperature, such as ice chips, water, clear soda, Jello, coffee, tea, and clear broth. And then a full liquid diet includes any liquids, so all of the liquids I just mentioned with a clear liquid diet, plus things such as milk, orange juice, and soup. A puréed diet includes foods that have a smooth consistency. So a food processor or blender is used until there are no solid pieces or lumps in the food. Examples of puréed foods include mashed potatoes, puréed meat, and pudding. A soft diet includes foods that have a soft consistency, are low in fiber, and easy to digest. Examples include low-fat dairy, eggs, pudding, cooked vegetables, tofu, and lean, skinless meat. And then a dysphagia diet is used for patients with difficulty swallowing. There are different levels of dysphagia diets, but in general, a dysphagia diet includes thickened liquids, as well as moist and soft or puréed foods. And then a regular diet is one that doesn't have any dietary restrictions.
All right. It's quiz time, and I've got four questions for you. Question number one. Which interdisciplinary team member performs a swallow evaluation for a patient?
The answer is a speech-language pathologist. Question number two. What is the significance of a decreased pre-albumin level?
The answer is, a pre-albumin level that is below the normal range may be indicative of the presence of malnutrition. Question number three. Blank means nothing by mouth.
The answer is NPO. Question number four. A blank diet includes thickened liquids and moist, soft foods.
The answer is dysphagia. All right. That's it for this video. I hope it was helpful. Take care and thank you so much for watching.
[BLOOPERS]
Poor wound healing, muscle wasting, and soft or puréed food.
