Monitoring nutritional status

To ensure that individual nutritional and hydration needs are sufficiently met some clients may need close and accurate monitoring. Nutritional assessment, as with other assessments, should not be a one-off process but continuous, especially those clients who are at risk of malnutrition. Simple indicators such as regular weighing and BMI calculations may be sufficient as long as the equipment used is accurate and of course available. It must be remembered, however, that short-term losses and gains will only reflect body fluid changes.

Figure 5.3 The tilted plate

Another way of checking whether a client is eating a balanced diet is to get them to keep a food diary and then compare it to the ideal ‘tilted plate’ (see Figure 5.3). The more information that can be gained, the more accurate the resulting baseline will be. Food intake charts (see Figure 5.4) can be used. They are completed over several days to allow for any dayto- day fluctuations. Everything a client eats or drinks should be recorded, no matter how small the amount, for example three teaspoons of omelette. The important thing is that they are completed accurately and that they are evaluated by someone with sufficient knowledge to interpret the findings and ensure they are acted upon.

Figure 5.4 Food intake chart
Time	Food intake	Amount taken	Dietician’s use
Breakfast	• Water • Tea, milk, 1 sugar, 2 scoops Polycal • White bread, butter & marmalade • Fruit juice	150 ml                                      kcal 175 ml 1 slice 200 ml	Protein
Mid-morning	• Tea, milk, 1 sugar, 3 scoops Polycal	150 ml
Lunch	• Corn-beef hotpot • Mash potatoes • Bread & jam • Tea, milk, 1 sugar • Sponge & custard	1 teaspoon 2 teaspoons ½  slice 150 ml 4 teaspoons
Midafternoon	• Tea, milk, 1 sugar, 3 scoops Polycal	175 ml 100 ml
Evening meal	• Fortisip • Omelette • Fortified soup • Water	100 ml 3 teaspoons 100 ml 100 ml
Bedtime	• Fortisip	100 ml
TOTAL

The key features to check are the protein and calorie intakes, for example:

• Male clients aged 19–50 years should receive 2550 kilocalories and 55.5 g of protein daily.

• Female clients aged 19–50 years should receive 1940 kilocalories and 45 g of protein daily.