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Posted: September 11th, 2022

NUTRITIONAL ASSESSMENT AND INTERVENTION

Interview this person using the Nutritional Assessment and Intervention Guide. You will need access to a scale and a tape measure.
Use this information to complete the Mini Nutritional Assessment (MNA). Consider the MNA score and the assessment data when identifying the nutritional health problems and nursing interventions.
Complete the completed attached Nutritional Assessment and Intervention Guide form based on a patient or a volunteer family member/friend.
Use the MNA guide to learn about the different components of the Mini Nutritional Assessment.
Complete the Mini-Nutritional Assessment scoring tool.
Based on your assessment, identify
1. The malnutrition indicator Score 2. Four nutrition-related health problems identified 3. Four Nursing interventions to improve nutrition status and overall health.
Upload copies of the Nutritional Assessment and Intervention Guide and the Mini-Nutritional Assessment scoring tool – fully complete.
Use APA 7e formatting. Include a reference page.

NUTRITIONAL ASSESSMENT AND INTERVENTION GUIDE*
Biophysical Indicators of Nutritional Status
Height (cm): Age: Mid-arm Circumference (in centimeters):
Weight (kg): Calf Circumference (in centimeters):
Indicator Yes No Description
Unplanned weight loss > 10 lbs in 6 months
Recent weight gain
Change in taste of foods
Loss of appetite
Increased appetite
Food allergies
Food intolerance
Difficulty chewing
Difficulty swallowing
Poorly fitted dentures
Sore mouth
Toothache
Choking
Dietary restrictions
Problems with food preparation ability
Fatigue
Diarrhea
Constipation
Nausea
Vomiting
Dry mouth
Belching
Heartburn
Flatulence
Pregnancy
Decubiti
Recent surgery
Crohn’s disease or ulcerative colitis
Chronic renal failure
Chronic liver disease
Cancer
Diabetes
Hypertension
Cardiovascular disease
Anemia
Hypercholesterolemia
*Guide adapted from Clark’s Community Assessment Reference Guide (2008)
Physical Environmental Indicators of Nutritional Status
Indicator Yes No Description
Inadequate facilities for food preparation
Inadequate facilities for food storage
Lack of access to grocery store

Psychological and Sociocultural Indicators of Nutritional Status
Indicator Yes No Description
Depression
Mental illness
Confusion or disorientation
Alzheimer’s disease
Social isolation
Inadequate food budget
Religious food prescriptions

Cultural food preferences:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Behavioral Indicator of Nutritional Status
Fluid intake (amount, type, frequency):

Favorite foods:

Foods disliked:

Use of laxatives:

Food preparation practices:

Meal patterns (frequency, timing, amount eaten):
Medications
List all prescribed medications, dose, and frequency taken:

List all over-the-counter vitamins, herbs, supplements taken:

Malnutrition Indicator Score (From MNA Screening Tool):

Nutrition-Related Health Problems Identified:
1.
2.
3.
4.

Nursing Interventions to Improve Nutritional Status and Overall Health
1.
2.
3.
4.

Diet History – Day 1 – List all foods and beverages consumed in a 24 hour period.
Food and Liquids (include portion size) Time
Breakfast

Lunch

Dinner

Snacks

Diet History – Day 2 – List all foods and beverages consumed in a 24 hour period.
Food and Liquids (include portion size) Time
Breakfast

Lunch

Dinner

Snacks

Diet History – Day 3 – List all foods and beverages consumed in a 24 hour period.
Food and Liquids (include portion size) Time
Breakfast

Lunch

Dinner

Snacks

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