What Role Does the Nutrition Assessment Play in Patient Recovery?
Nutritional assessment of an individual is one of the most underestimated and important factors to be considered before admission of a patient into a hospital setting before any surgical procedure or before an operative procedure. The Nutritional status of the individual is highly interlinked with the recovery rate of patients who undergo hospitalization or before a surgical procedure or intervention.
What Are the Factors to Be Assessed for Determining Nutritional Status and Intervention?
The Nutritional status is usually obtained or based on the findings of the individual's routine medical and medication history and physical examination. Factors assessed for nutritional intervention in an individual are:
1. Assessment of Preoperative Weight:
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First and foremost, the factor that needs to be assessed by an interdisciplinary team or the professional healthcare provider in question -for analyzing the nutritional status of the individual is mainly the history of the preoperative weight of the individual. This is especially useful because it would provide the operator or surgeon with a reference regarding their recent weight loss or any recent weight gain (before the procedure). The preoperative weight of the individual would be based on many other factors in their recent medical considerations, such as the experience of a loss of appetite, inability to swallow properly, history of chronic systemic diseases like hypothyroidism (a condition where the thyroid gland does not produce enough thyroid hormone) or diabetes or hypertension (high blood pressure), history of recent infections, recent hospitalization history and many more. For example, patients who may have a recent history of gastrointestinal surgery before another surgery or procedure show that the preoperative weight of the individual has declined only recently.
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Similarly, patients with a prolonged stay of hospitalization may be suffering from weight loss before again undergoing any other surgical procedure or intervention. Hence, nutritional status takes into account fundamentally the preoperative weight of an individual that is based on systemic and local factors that may have made them gain or lose weight.
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Further, the benefit of assessing preoperative weight is that physicians can gain insight into their nutrition monitoring post-surgery and establish their nutrition goals to be accomplished with ease. In some patients who undergo an unintentional weight loss that is of more than 10 percent of their body weight within less than six months, this would mean that they may be suffering from an underlying systemic disease. Nutritional intervention in such individuals has to be dealt with with great care and proper medical research and history by the physician.
2. Obtaining the Dietary History:
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Patients may often be on some dietary supplements or they may have a specific diet to which they would adapt. Hence, obtaining the diet history from the patient or their family members is important to provide the affected individuals requiring hospitalization with proper dietary and nutritional support.
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Further, the history of any food sensitivity or allergies needs to be known to the physician in charge, as nutritional alternatives need to be arranged for hospitalized patients.
3. Assessment of Vital Signs:
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The four main vital signs that need to be noted by the physician or professional healthcare provider in charge before hospitalization or that need to be continuously monitored even during surgery and post-operatively are-
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Temperature.
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Pulse Rate.
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Respiration Rate.
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Individual Blood Pressure.
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In addition to vital signs, the general physical examination plays an important role in assessing nutritional requirements for an individual. The body mass index or BMI calculated using height (in meters) and weight (in kgs) can be measured or a nomogram can be used alternatively. Based on the individual's BMI, physicians can take a call regarding the nutrition requirements to be met for the category they fall in (like underweight, normal weight, overweight, or obese).
4. General Physical Examination:
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This includes an assessment of all the general features, including the organ system functions of the individual. A general physical examination by the professional healthcare provider would further include noting the loss of subcutaneous tissue fat, or any generalized fluid accumulation or water weight in the body as well.
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Head and Neck Exam: In this hair loss, bitemporal measurements like wasting, conjunctiva pallor, oral manifestations such as gingival bleeding or sores on the gums or oral mucosal membranes, xerosis (dry skin), glossitis (inflammation of the tongue), angular cheilosis (redness and fissures at the corner of the mouth), stomatitis (inflammation of the mucous membranes of the mouth), the health of the dentition are taken into consideration.
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Cardiovascular System: Any evidence or possibility such as a predisposition to cardiovascular diseases or heart failure or high-output states can be measured.
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Neck: The possibility of thyromegaly is cross-checked.
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Extremities: These are checked to examine edema or any possible loss of muscle mass.
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Neurologic: Examination is done to determine peripheral neuropathies, reflexes of the individual, the patients' handgrip strength, and many more. The mental status of the individual is also assessed.
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Skin: An examination is done by the physician to detect any possible ecchymoses (discoloration of the skin due to underneath broken blood vessels), petechiae (small red or purple spots over the skin), possible pressure, and ulcers. The assessment of previous scars or surgical sites, as well as the extent of wound healing or any remnant post postoperative infections that have been left untreated, should be examined.
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5. Anthropometric Measurements:
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This is the science of anthropometry that deals with the determination of physical measures of an individual based on their size, form, and functional capacity. Tricep measurements, mid-arm measurements, rate of weight loss, muscle circumference, body weight, weight loss, and others need to be determined by the physician or nutritionist in charge.
6. Protein Status Assessment:
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This is one of the crucial factors in deciding the nutritional intervention for the patients. Assessment should include the calorie-nitrogen ratio using the daily dietary intake of the patient and serum albumin levels. Ideally, protein requirements for hospitalized individuals can vary greatly, so it must be monitored constantly.
7. Laboratory Data:
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These can provide valuable insight for determining nutrition requirements. for example, the level of electrolytes, serum proteins, trace elements, blood urea nitrogen or creatinine, random blood glucose levels, etc help in the overall assessment of the patient's immunity and clinical and fluid volume status.
Conclusion
It is crucial that the nutritional aspect of a patient be taken into consideration and that their requirements are met daily by professional healthcare providers in patients before surgeries or before hospitalization. Implementing nutritional assessments on a social or community scale can not only help the patients recover faster post-surgical intervention or hospitalization, but it may also reduce the mortality rates globally.
