Acute care settings

Acute Care Settings
In acute-care settings, anorexia, various diseases, test procedures, and medications can compromise dietary intake. Under such circumstances, the
goal is to identify and avoid inadequate intake and assure appropriate alimentation. Dietary assessment focuses on what patients are currently eating,
whether or not they are able and willing to eat, and whether or not they experience any problems with eating. Dietary intake assessment is based on
information from observed intakes; medical record; history; clinical examination; and anthropometric,
biochemical, and functional status. The objective
is to gather enough information to establish the likelihood of malnutrition due to poor dietary intake or other causes to assess whether nutritional
therapy is indicated (Chap. 76).
Simple observations may suffice to suggest inadequate oral intake. These include dietitians' and nurses' notes, the amount of food eaten on trays,
frequent tests and procedures that are likely to cause meals to be skipped, nutritionally inadequate diet orders such as clear liquids or full liquids for
more than a few days, fever, gastrointestinal distress, vomiting, diarrhea, a comatose state, and diseases or treatments that involve any part of the
alimentary tract. Acutely ill patients with diet-related diseases such as diabetes need assessment because an inappropriate diet may exacerbate these
conditions and adversely affect other therapies. Abnormal biochemical values [serum albumin levels <35 cholesterol="cholesterol" dl="dl" g="g" levels="levels" mg="mg" p="p" serum="serum"><3 .9=".9" a="a" also="also" are="are" assessment.="assessment." but="but" dl="dl" for="for" further="further" indicate="indicate" may="may" mg="mg" mmol="mmol" need="need" nonspecific="nonspecific" nutritional="nutritional" p="p">Most therapeutic diets offered in hospitals are calculated to meet individual nutrient requirements and the RDA if they are eaten . Exceptions include
clear liquids, some full-liquid diets, and test diets (such as preparation for gastrointestinal procedures), which are inadequate for several nutrients and
should not be used, if possible, for more than 24 h. As much as half of the food served to hospitalized patients is not eaten, and so it cannot be
assumed that the intakes of hospitalized patients are adequate. Dietary assessment should compare how much and what food the patient has
consumed with the diet that has been provided. Major deviations in intakes of energy, protein, fluids, or other nutrients of special concern for the
patient's illness should be noted and corrected.
Nutritional monitoring is especially important for patients who are very ill and who have extended lengths of stay. Patients who are fed by special
enteral and parenteral routes also require special nutritional assessment and monitoring by physicians and/or dietitians with certification in nutrition