Student ______________________________________________________ Instructor ____________________________________________________

Date _________________________ Date _________________________

PERFORMANCE CHECKLIST SKILL 30-1 PERFORMING NUTRITIONAL ASSESSMENT

S
ASSESSMENT

NP

Comments

1. Assessed patient for usual body weight changes. 2. Obtained complete history, including social, economic, and psychological factors. 3. Performed physical assessment. 4. Reviewed laboratory results. 5. Determined medications and other supplements patient is taking. 6. Measured actual height and weight. 7. Calculated IBW and BMI. 8. Assessed risk factors affecting adequate diet and appetite. Noted food intolerances and allergies. 9. Assessed present nutritional intake. Asked patient to maintain a 24-hour intake diary. 10. Determined patients ability to manipulate eating utensils and self-feed. 11. Explained completed assessment to patient. 12. Notified the nutrition department of prescribed diet and patients food (cultural) preferences.
NURSING DIAGNOSIS

1. Developed appropriate nursing diagnoses based on assessment data.

EVALUATION

1. Reviewed history and physical examination. 2. Compared patients height and weight versus ideal height and weight for age-group. 3. Compared patients laboratory data versus expected values. 4. Identified unexpected outcomes.
RECORDING AND REPORTING

1. Documented findings and made recommendations on nutritional assessment form.

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