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Background
Dysphagia often reduces food intake causing malnutrition in long term. Adequate diagnosis of malnutrition is essential to ensure appropriate dietary intervention in order to improve nutrition status and quality of life in patients.
Client History
A 64 year old Chinese male was referred to the outpatient diet clinic for malnutrition. He was diagnosed with dysphagia and fed through nasogastric tube due to injury from a motor-vehicle accident (MVA) 3 months ago.
Nutrition Assessment
He was severely underweight. Nutren Fiber was given through nasogastric tube. However frequency of feeds was reduced due to early sleep patterns which caused inadequate nutrient intake. NFPE indicated muscle and fat loss, and ankle oedema although his handgrip was firm. Intra and extra-oral examination revealed no abnormality except difficulty in dry swallowing. According to the latest malnutrition criteria, he was categorized as moderate malnutrition.
Nutrition Diagnosis
Two nutrition problems were identified including malnutrition and inadequate protein-energy intake. These were related to post-MVA injury and insufficient feeds due to early sleep patterns respectively. Diet history, anthropometric measurement, NFPE and medical history supported the problems.
Objective of Management & Nutrient Prescription
The objective of management was to continue current feeding regime since NFPE showed no contraindication. The frequency of feeding remained as 5 times/day while Nutren Fiber was increased to 8 scoops/feed to meet his nutrient needs.
Outcome and Follow-Up
His energy and protein intake showed improvement. Nevertheless, NFPE was not preformed due to small time gap between two encounters.
Discussion
According to the latest Consensus Statement on Adult Malnutrition, NFPE is essential in diagnosing malnutrition. This case illustrates how NFPE is incorporated in patient assessment in determining the degree of malnutrition, identifying its potential etiologies and subsequently deriving suitable nutrition care plans.
Learning Points/Take Home Messages
• The AND & ASPEN Malnutrition Criteria are a useful guide to identify malnutrition and are applicable in an outpatient setting.
• Incorporating NFPE in patient assessment provide a holistic approach in determining the degree of malnutrition and then beneficial nutrition care plans.
• While designing nutrition care plans, patient’s preference and lifestyle should be considered.