Nutrition Risk Score

The Nutrition Risk Score (NRS) was developed in 1992 to assess a patient's nutritional risk at hospital admission [32]. The NRS contains variables of weight loss, BMI, food intake and physiologic stress (Table 1.4). The NRS is obtained on hospital admission and re-assessed weekly. In one validation study, the NRS correlated well with the 16-item nutrition risk index [33]. There was little variance in scores between dietitians or between dietitians and nurses when evaluating the same patient. The NRS has been adopted as the national nutrition assessment standard in the United Kingdom [34].

Table 1.2 Subjective global analysis

Scared Patient-Generated Subjective Global Assessment (PG-SGA)

History (Boies 1-4 arc designed to be completed by the patient.)

Palier* ID Inform* tori

In summary of my current and recent weight:

I currently weigh about_

_ pounds _tall

One month ago I weighed about _ Six months ago I weighed about

_ pounds _ pounds

During the past two weeks my weight has:

□ decreased w □ not changed <<( □ increased

Boxl I f

2. Food Intake: As comparedtomynormal iriake, I would rale my food intake during the past month as:

□ less IJtui usual 0J I am now taking.1

□ normal food but (ess than normal amount ^ p little solid food ^

□ only nutritonal supplements p very little of anything (1)

p only tube feedings or only nutrition by vein ^ _Box 2 f 1'

3. Symptoms: I haw had the following problem s that have kept me from eating enough during the past two weeks (check all that apply): p no problem s eat ing p no appetite, just did not feel like eating^, p nausea. p vomiting^

□ constipation ^ Q diarrltea p mouth sores ^ p dry moudia) p things taste funny or have no taste Q smells bother me p problems swallowing p feci full quickly^ p pain; where? ^_

* * Examples: dapfeMtop, rnoney, or JeiiL»! pröblejin

Bax3I I

4. Activities and Function; Over (lie past month, I would generally rate my activity as: □ noimal with no 1 im itat ions n p not my normal self, but able to be up and about with (airly noimal activities a) p not feeling up to m ost things, but in bed or chair less than half the Jay m p able to do little activity and spend most of the day in bed or duir p pretty much bedridden, rarely out of bed

Bm4l i

Additiv« Score of the Boxes i-4 f IA

The rem a i ltd er of this form will be completed by your doctor, nurse, or therapist. Thank you-

5, Dùease and its relation to nutritional requirements I See IVorksheetZ) All relevant diagnoses (specify) _

Primary disease stage (circle if known or appropriate)

Age_

6. Metabolie Demand {See Worksheet 3)

7. Physical (Sec Worksheet 4)

U HI IV Other

Numerical score f»m Works beet 2 [ I B Numerical score Trout Worksheet 31 I C Numerical score from Worksheet 41 | D

Global Assessment (See WbrteheetS)

P Well-nourished or anabolic (SGA-A) □ Moderate or suspected malnutrition (SGA-B) p Severely malnourished (SGA-C)

Total PG-SGA seore

(Total numerical seore of A+B+C+D above) I I

(See triage recommendations below)

Clinician Signature _

Date

Nutritional Triage Recommendations: Additive score is used to define specific nutritional interventions including patient & family education, symptom management including pharmacologic intervention, and appropriate nutrient intervention (food, nutritional supplements, enteral, or parenteral triage). First tine nutrition intervention includes optimal symptom management 0-1 No intervention required at this time. Reassessment on routine and regular basis during treatment. 2-3 Patient & family education by dietitian, nurse, or other clinician with pharmacologic intervention as indicated by symptom survey (Box 3) and laboratory values as appropriate. 4-8 Requires intervent ion by dietitian, in conjunction with nurse or physic ian as indicated by sym ptom s survey (Box 3). >9 Indicates a critical need for improved symptom management and/ot nutrient intervention options,

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Good Carb Diet

Good Carb Diet

WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.

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