Recommendations Summary

CI: Monitoring and Evaluation 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: Monitoring and Evaluation of Critically Ill Adults

  Following the nutrition intervention, to check progress, the Registered Dietitian (RD) should monitor and evaluate at each visit the nutrient intake of critically ill adult patients and compare to desired individual outcomes relevant to the nutrition diagnosis and intervention. This may include, but is not limited to the following:

  Food/Nutrition-Related History:

  • Adequacy and appropriateness of nutrient intake/nutrient delivery
  • Actual daily intake from enteral nutrition (EN) and parenteral nutrition (PN) and other nutrient sources
  • Bioactive substances (prebiotics/probiotics, antioxidants, glutamine).

  Anthropometric Measurements:

  • Weight
  • Weight change.

  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:

  • Clinical status
  • Medications.

  Monitoring and evaluation of the above factors is needed to correctly diagnose nutrition problems that should be the focus of further nutrition interventions. Inability to achieve optimal nutrient intake may contribute to poor outcomes.

  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

    • Registered Dietitians (RD) 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.