Monitoring weight variance, either loss or gain, is an important factor in keeping Long Term Care (LTC) residents as healthy as possible. Accurate weight measurement is critical to a nutritional assessment. The information is necessary to calculate fluid needs as well as macronutrient amounts and is often used to calculate medication dosages. A patient’s weight measures health and nutritional status over time.
The resident should be weighed as soon as possible after admission to obtain a base weight and provide the dietician with the information prior to the nutritional assessment. The resident should be weighed weekly for the next three weeks and monthly thereafter (follow the facility protocol).
The physician may request a daily weight for some diagnosis (like congestive heart failure) or if the resident is receiving diuretics or is on hyperalimentation. The resident should be weighed at the same time and if possible, by the same person. Having the same caregiver assigned to the weighing process will assure procedural consistency. The resident should be weighed without shoes and with as little clothing as possible.
Scales need to be calibrated monthly and a log maintained of the measurements. Ambulatory residents may use a platform scale. The resident should stand on the center of the platform without hanging on to anything. If the resident wears an adaptive device or a prosthesis, it should be documented if the weight was obtained with or without the device and should be consistent every month.
Chair scales should be used for non ambulatory residents. The wheelchair is weighed separately and then the resident is weighed in the wheelchair. The resident should be seated in the center of the chair and the wheelchair centered on scale for accurate measurement. Subtract the chair weight from the overall weight to obtain the resident’s weight and be sure the math is accurate. Sling scales and bed scales may be used but follow the manufacturer's’ directions for safety and make sure staff receive appropriate training on their use.
There are set parameters for reporting weight gain or loss. These are reported to the physician and documented in the resident’s record.
5% gain or loss in one month
7.5% gain or loss in three months
10% gain or loss in six months
The dietician should also be informed and physician’s orders must be in place to correct any problems. Federal regulation 325 refers to a patient's nutrition, “Receives a therapeutic diet when their is a nutritional problem”.
I love acronyms as they help me remember important facts. The Texas Department of Aging and Disability (DADS) use the following to list the risk factors associated with weight loss.
M- medication
E-emotional problems
A-anorexia
L-late life paranoia
S-swallowing disorders
O-oral problems
N-nosocomial infections
W-wandering
H-hyperthyroidism
E-enteric problems
E-eating problems
L-low salt and low cholesterol diets
S-social problems.
Nurses need to recognise these factors and identify the residents who are at risk. Should a significant weight loss occur, the resident must be reweighed within 72 hours. If the weight loss continues, the physician, family and dietician must be notified and an intervention must be put in place immediately.
Interventions may include:
Reassess the effects of medication.
3 day calorie count, document food intake at each meal for 3 days.
Manage underlying conditions.
Facilitate increased food consumption by providing snacks, nutritional supplements, finger foods and provide socialization by inviting family members to sit with resident at meal times.
Staff may assist with feeding and should offer praise for improved endeavours.
It is very important to document dates and notifications concerning nutrition in the medical record. Results of interventions and a weekly weight needs to be documented until the patient's weight stabilizes.
Many times there is an apparent reason for loss or gain. If the resident is on a diuretic or has had a recent paracentesis, weight loss is the expected outcome. Awareness of the resident’s appetite and food dislikes is important. Certain religious beliefs may interfere with dietary choices (A social service assessment should have picked up on this and should be in the care plan). Cultural choices and dislike of certain foods may also play a role in weight loss. Depression is the most identified cause of weight loss and must be treated. As terminal illness advances and end of life approaches, loss of appetite and weight loss occurs naturally.
Weight gain is expected when a resident recovers from surgery or an infection. Nutritional supplements and mineral and vitamin therapy also help in increasing appetite and gaining weight. In cultural and religious areas, getting family involved in bringing an occasional appropriate meal from home can be helpful.
As always be sure to careplan problems, changes and interventions.
