Nutritional assessment of the hospitalized patient.

While some symptoms of the malnourished state are obvious, others may be subtle. In either case, assessment is indicated to uncover any inconspicuous symptoms and secondly to quantitate those that are apparent. Such procedures are pertinent because immune competence and other organ systems related to survival are dependent on the adequately nourished state. It is also important to remember that certain vitamin and mineral deficiencies may accompany protein calorie malnutrition and thus their attention would be especially needed during the repair of this condition. The deficiencies seen most often include vitamins C, A, and D, as well as zinc, copper, and calcium. Furthermore, the refeeding process may also precipitate shortages of potassium, phosphate, and magnesium, unless adequate amounts of these nutrients are included in the diet. From this and earlier discussed situations, it is suggested that nutritional assessment should be the initial step in nutritional therapy. It should be approached with concern not only for what the collective assessment tools will reveal, but also with consideration for the patient's clinical problem, the current metabolic situation and the projected therapeutic regimen which will be formulated.