A 78-year-old client recovering from a hip fracture tells the home health nurse, "I haven't had much of an appetite lately and have been really tired. I'm worried I'm not eating enough." Which question is the priority for the nurse to ask?

Question

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Malnutrition occurs when there is insufficient nutrient intake to meet body needs and relates to multiple factors (eg, poor diet, chronic illness, physical or cognitive impairments). Malnutrition may impair critical physiologic processes (eg, organ and immune system function, wound healing) and can have rapid and potentially lethal implications. Therefore, nurses should frequently assess clients for malnutrition, particularly those at increased risk (eg, advanced age, altered functional status). Assessing for malnutrition involves collecting dietary data (eg, 24-hour diet recall), laboratory values (eg, albumin or prealbumin), physical measurements (eg, BMI), and history of recent weight loss (Option C). Reports of weight loss, especially unintentional, are critical findings often indicative of malnutrition. In addition, weight loss of ≥5% in 1 month or ≥10% in 6 months may indicate serious conditions (eg, cancer, tuberculosis, failure to thrive). (Option A) Impaired functional status may contribute to a client's malnutrition. The nurse should prioritize assessing for the presence of malnutrition before assessment of contributing factors. (Option B) Assessment of psychologic factors (eg, depression, loneliness) is important to determine possible reasons for malnutrition but should be performed only after determining the extent of malnutrition. (Option D) Meal frequency, eating habits, and recent diet changes are possible contributing factors leading to malnutrition that should be assessed after determining malnutrition risk. Educational objective: Malnutrition occurs when nutrient intake is insufficient for body requirements. Nurses evaluating clients for malnutrition should first assess for unintentional weight loss, an important indicator of malnourishment. Afterwards, contributing factors of malnutrition (eg, functional status, mood alteration, diet) should be evaluated.

A 78-Year-Old Client Recovering from a Hip Fracture Tells the Home