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If Yes To Any Question, Go To STEP 2: Table 2

This document contains two nutritional screening tools: 1) A 2-step initial screening that identifies patients at nutritional risk based on factors like BMI, weight loss, dietary intake, and illness severity. 2) A more comprehensive subjective global assessment of a patient named Herman Cramer that evaluates criteria like weight loss, food intake, functional status, disease stress, physical exam findings, lab results, and nutritional status to determine his nutritional risk level. 3) Herman was found to have a high nutritional risk level of 3, requiring follow-up from the nutritional support team.

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Chelo Jan Geronimo
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112 views2 pages

If Yes To Any Question, Go To STEP 2: Table 2

This document contains two nutritional screening tools: 1) A 2-step initial screening that identifies patients at nutritional risk based on factors like BMI, weight loss, dietary intake, and illness severity. 2) A more comprehensive subjective global assessment of a patient named Herman Cramer that evaluates criteria like weight loss, food intake, functional status, disease stress, physical exam findings, lab results, and nutritional status to determine his nutritional risk level. 3) Herman was found to have a high nutritional risk level of 3, requiring follow-up from the nutritional support team.

Uploaded by

Chelo Jan Geronimo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Nutritional Risk Screening 2002

Table 2

Step-1 Initial Screening


Question Yes No
Is BMI < 20.5? ✓
Has the patient lost weight within the last three months? ✓
Did the patient have a reduced dietary intake in the last ✓
week?
Is the patient severely ill (e.g intensive theraphy)? ✓
__ Current Status: No Nutritional risk
If yes to any question, go to STEP 2

STEP 2-Final Screening

Nutritional Status Indicators (choose one only) Score Place score


if YES
Normal Nutritional Status 0 0
Weight loss >5% in 3 months/ or food intakes below 50-75% 0 1
of normal requirement in preceding week
Weight loss > 5% in 2 months / or BMI 18.5-20.5 + impaired 2 0
general condition / or food intake 25-60% or normal
requirement in preceding week
Weight loss > 5% in one month (or > 15% in 3 months) / or 3 0
BMI < 18.5 + impaired general condition / or food intake 0-
25% of normal in preceding week
Clinical condition (may choose than one)
Hip fracture chronic patients, in particular with acute 1 1
complications; cirrhosis, COPD, chronic hemodialysis,
diabetes, oncology
Major abdominal surgery, stroke, severe pneumonia, 2 2
hematologic malignancy
Head injury, bone marror transplantation, intensive care 3 3
patients (APACHE >10)
TOTAL SCORE 6
ACTION TO BE TAKEN
Total Score ≥ 3: The patient is nutritionally at risk and nutritional care plan is initiated
□ Total score <3: Weekly rescreening of the patient/ if the patient is scheduled for major
operation a preventive care plan is considered to avoid aasociated risk status
SUBJECTIVE GLOBAL ASSESSMENT
Table 3 Assessment nutritional status of Patient Herman
Name: Herman Room: 312
Surname: Cramer Date Admitted: October 23, 2019
Middle: Rivera Age: 65 y/o
Attending MD: Dr. Santos Sex: Male

HT MTR: 5’5 WT KG: 47kg BMI: 17.2kg/ OB UW IBW 59kg

Diagnosis: PTB ST4, Asthma, Secondary Bronchitis, Anemia

CRITERIA NORMAL/MILD MODERATE SEVERE


Weight loss None 10% of usual weight >10 of usual weight
Food intake (last 1- No change Suboptimal Starvation
2months)
Gastro Symptoms None Nausea, Vomiting Anorexia, diarrhea
>2 weeks
Functional capacity No change Dysfunction: < 3wks Bedridden > 2wks
Bedridden <2 wks
Disease and relation No or low stress Moderate Stress
Severe Stress
to nutritional req.
Physical Subcutaneous fat and /or Subcutaneous fat and Subcutaneous fat and /or
Examination muscle loss 0 /or muscle loss +1 or +2 muscle loss
Edema/Ascites None None +1 or +2
SGA Grade 0 B1 C3
BMI 18.5-25.0 25.1-30.1 <18.5 or > 30.2
Albumin g/dL >3.4 2.5-3.41 <2.52
TLC >15000 900-1500 <9002
Total Score NUTRITION 0 Low risk 1-2 Moderate Risk (level >3 High Risk(level 3)
RISK (level 1) 2)
LEVEL
Nutritional Status Normal Moderate Malnutrition Severe Malnutrition
Risk level 1 or 2, would you like to refer your patient to the nut. support team for follow up?
Yes
No
Risk level 3: Req. to be followed up by the Nut. Support Team

Dr. Santos Name of Attending MD


October 23, 2019 Date Signed

Assessment performed by(Name & Signature): Chelo Jan Geronimo

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