Recommendations Summary

CI: Nutrition Assessment of Critically Ill Adults 2012

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  CI: Assessment for Critically Ill Patients

  The Registered Dietitian's (RD) assessment of critically ill adults should include, but not be limited to the following:

  Food and Nutrition-Related History:

  • History of nutrient intake (energy intake, meal-snack pattern, macro- and micronutrients, etc.)
  • Adequacy of nutrient intake/nutrient delivery
  • Bioactive substances (alcohol intake, soy protein, psyllium, fish oil)
  • Previous and current diet history, diet orders, exclusions and experience, 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 (oral, enteral or parenteral access)
  • Physical activity habits and restrictions 

  Anthropometric Measurements:

  • Weight, Height
  • Weight change
  • Body mass index (BMI)
  • Body compartment estimates (fat mass, fat-free mass).

  Biochemical Data, Medical Tests and Procedures:

  • Biochemical indices (glucose, electrolytes, others as warranted by clinical condition)
  • Implications of diagnostic tests and therapeutic procedures (indirect calorimetry measurements, radiography for confirmation of feeding tube placement, other gastrointestinal (GI) 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 (I's and O's) including stool and fistula output, wound drainage
  • Existing or potential access sites for delivery of nutrition support therapy
  • Abdominal exam
  • Fluid status (edema, ascites, 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 may 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 may contribute to poor outcomes.

  Rating: Consensus
  Imperative

  CI: Reassessment of Critically Ill Adults

  The Registered Dietitian's (RD) 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 (I's and O's) 
  • Changes in nutrition-focused physical assessment findings.

  Rating: Consensus
  Imperative

  • Risks/Harms of Implementing This Recommendation

    There are no potential risks or harms associated with the application of this recommendation.

  • Conditions of Application

    • Privacy is required for performing a nutrition-focused physical exam
    • Registered Dietitians (RD) should be appropriately trained to conduct a nutrition-focused physical exam
    • If necessary data are not available, the RD should use professional judgment to request or obtain additional data

     

  • Potential Costs Associated with Application

    Accessibility and costs of additional testing should be considered.
     

  • Recommendation Narrative

    Consensus.

  • Recommendation Strength Rationale

    Consensus reached.

  • Minority Opinions

    None.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  • References
  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    Task Force of A.S.P.E.N; American Dietetic Association Dietitians in Nutrition Support Dietetic Practice Group, Russell M, Stieber M, Brantley S, Freeman AM, Lefton J, Malone AM, Roberts S, Skates J, Young LS; A.S.P.E.N. Board of Directors; ADA Quality Management Committee. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and American Dietetic Association (ADA): standards of practice and standards of professional performance for registered dietitians (generalist, specialty, and advanced) in nutrition support. Nutr Clin Pract. 2007 Oct; 22 (5): 558-586. PMID: 17906280.