A common misconception by nurses is sometimes predicting nutritional status based on a resident's weight. Weight is not always a good predictor of nutritional status. Nutritional status is determined by many factors and by looking at the big picture.
What is nutrition? Nutrition or nutritional status is the process by which our body obtains food, vitamins, and minerals for proper growth and healing. Nutrition is also needed to maintain health and overall function. Good nutrition is needed for strong bones, teeth, and skin. Poor nutrition or dehydration can put someone at risk for pressure injuries, skin tears, and multiple other issues. As per the Braden Scale for Predicting Pressure Sore Risk®, nutrition can be obtained in several ways, orally (PO), intravenously (IV), or by total parenteral nutrition (TPN). Also, a resident may be allowed nothing by mouth (NPO) because of an upcoming test or procedure, for bowel rest, or if the condition is unstable or doesn’t permit oral intake at the present time (e.g., intubated, sedated).
The categories of the Braden Scale pertaining to nutrition can be seen below, but similar to the other categories, residents receive a score from 1 to 4, with 1 being very poor and 4 being excellent. It is important to read the definition of the subcategories and gain an understanding of what each subcategory is really saying. Some important points are:
When looking at nutrition, it is also important to take into account laboratory values, specifically albumin and pre-albumin. Additionally, it is important to look at C-reactive protein because if it is elevated, pre-albumin can be falsely low. Looking at weight trends and fluid fluctuations is also important; is the resident on a diuretic? Is the resident weighed consistently on the same scale? At the same time of day? Is the resident eating more? Less? These are all important questions to explore when completing an accurate Braden scale. After examining the big picture and determining that the resident is at risk for poor nutrition, how can we fix this? When completing a Braden Scale, it is important not only to assign a score accurately to each category, but also to look at what interventions should be put into place based on that score. Some things to start with are to determine whether the resident is having a true weight loss or decline. if it is determined that, yes, the resident is losing a significant amount of weight or slowly declining over time, interventions are needed.
Although nutrition is just one small part of the Braden Scale, it plays a huge role in the resident's overall health status, ability to heal wounds, and likelihood of acquiring a hospital-acquired pressure injury. It is important to assess and reassess nutritional needs accurately and frequently via the Braden scale and with follow-up and recommendations from a registered dietitian. Early intervention and frequent follow-up on nutritional issues and concerns can definitely lead to more positive outcomes nutritionally and contribute to prevention of pressure injuries.
About the Author
Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.