Figure.

Nutrition assessment of critically ill adults.

CIa: Assessment for Critically Ill Patients The registered dietitian nutritionist’s (RDN’s) assessment of critically ill adults should include, but not be limited to, the following: Food and Nutrition–Related History: •History of nutrient intake (eg, energy intake, meal–snack pattern, and macro- and micronutrients) •Adequacy of nutrient intake/nutrient delivery •Bioactive substances (eg, alcohol intake, soy protein, psyllium, and fish oil) •Previous and current diet history, diet orders, exclusions and experience, and cultural and religious preferences •Changes in appetite or usual intake (as a result of the disease process, treatment, or comorbid conditions) •Disease-specific nutrient requirements •Food allergies/intolerances •Appropriateness of nutrition support therapy for the patient •Food and nutrient administration (ie, oral, enteral, or parenteral access) •Physical activity habits and restrictions Anthropometric Measurements: •Weight, height •Weight change •Body mass index (calculated as kg/m2) •Body compartment estimates (fat mass, fat-free mass) Biochemical Data, Medical Tests, and Procedures: •Biochemical indices (ie, glucose, electrolytes, and others as warranted by clinical condition) •Implications of diagnostic tests and therapeutic procedures (ie, indirect calorimetry measurements, radiography for confirmation of feeding tube placement, and other gastrointestinal diagnostic tests) Nutrition-Focused Physical Findings: •Nutrition-focused physical examination that includes, but is not limited to, fluid assessment, functional status, wound status, clinical signs of malnutrition/overnutrition, and/or nutrient deficiencies •Intake and output, including stool and fistula output and wound drainage •Existing or potential access sites for delivery of nutrition support therapy •Abdominal examination •Fluid status (ie, edema, ascites, and dehydration) •Vital signs Client History: •Medical and family history and comorbidities •Surgical intervention •Effect of clinical status on ingestion, digestion, metabolism, and absorption, and utilization of nutrients •Indicators of acute or chronic nutrition support–related complications •Medication management •Factors that might influence existing or potential access sites for delivery of nutrition support therapy Assessment of the above factors is needed to correctly diagnose nutrition problems and plan nutrition interventions. Inability to achieve optimal nutrient intake can contribute to poor outcomes. Rating: Consensus Imperative CI: Reassessment of Critically Ill Adults The RDN’s reassessment of critically ill adults should include: •Changes in nutrient needs •A determination of daily actual intake of enteral nutrition (EN), parenteral nutrition (PN), and other nutrient sources •EN/PN access site •Changes in clinical status, weight, biochemical data, and intake and output •Changes in nutrition-focused physical assessment findings. Rating: Consensus Imperative

^aCI=critical illness. Adapted from the Academy of Nutrition and Dietetics’s Critical Illness guidelines.¹¹