Clinical Guidelines (Nursing)

Nutrition screening

  • Introduction

    Aim 

    Definition of Terms

    Assessment

    Management

    Companion Documents

    Links

    Evidence Table

    References


    Introduction

    On admission, the paediatric nutrition screening tool (PNST) should be completed for all paediatric patients and is a requirement for compliance to NSQHS Standards, Comprehensive Care. The screening tool comprises of 4 ‘yes/no’ questions used to identify those patients that require nutritional assessment and interventions. Information can be obtained from parents/carers, medical records and by examining the child.  

    Aim

    The aim is to identify inpatients at nutritional risk. 

    Definition of Terms 

    • Screening: process of identifying patients who are at; or already have a disease or injury. Screening requires enough knowledge to make a clinical decision
    • Risk Assessment: assessment, analysis and management of risks. It recognises which events may lead to harm in the future and minimises their consequences
    • Poor nutrition: is the decrease in the intake of food, considered in relation to the body’s dietary needs

    Assessment

    The PNST is intended to be used on hospital admission of all inpatients. The screening tool consists of 4 “yes/no” which is embedded in the nursing workflow practices within the Electronic Medical Record (EMR) under Admission, Discharge, Transfer (ADT) Navigators within the Admission assessment. 

    1. Has the child lost weigh lately? 
      Children should gain weight as they grow and only lose weight if clinically indicated. This questions identifies if the child has lost weight and requires further investigation. If there is no weight history, a subjective assessment can be made as to whether the parent/carer/health professions is of the opinion that the child looks like they have lost weight.

    2. Has the child had poor weight gain over the last few months? 
      The rate of weight gain of children depends on their age. Refer to growth standards to determine if weight gain is appropriate

    3. Has the child been eating/feeding less in the last few weeks?
      Assess whether the child has reduced nutritional intake compared to their usual intake. Nutritional intake can be provided via various routes including oral, tube or parenteral. Gastrointestinal symptoms such as vomiting and loose stools can effect oral intake and should be considered.

    4. Is the child obviously underweight? 
      Examine the child for physical indicators of malnutrition such as loss of fat stores and muscle wasting. Protruding or prominent bones of clavicle and scapular, depression along the inner thigh and small calf are evidence of muscle wasting.

    Management 

    Nutrition screening management flowchart

    Companion Documents

    Links

    Evidence Table

    See attached evidence table

    References


    Please remember to read the disclaimer.


    The development of this nursing guideline was coordinated by Jacqui McCall, Improvement Manager, Improvement National Standards and approved by the Nursing Clinical Effectiveness Committee. First published September 2019.