The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [260]
Methods for measuring height and weight of an adult patient
Taking an accurate height and weight of a patient is an essential part of nutrition screening. Accurate measurements of bodyweight may also be required for estimating body surface area and calculating drug dosages, such as for chemotherapy. All patients should have height and weight measured on admission to hospital and weight should be taken at regular intervals during their hospital stay according to local policy and individual clinical need.
Preprocedural considerations
Check that the patient is able to stand or sit on the appropriate scales. The patient should remove outdoor clothing and shoes before being weighed and having height measured.
When obtaining a height measurement, check that the patient is able to stand upright whilst the measurement is taken. For patients who are unable to stand then height may be determined by measuring ulna length and using conversion tables (BAPEN 2003a).
It may not be possible to weigh patients who cannot be moved or are unable to sit or stand. Alternative methods to obtain weight should be explored, for example bed scales which can be placed under the wheels of the bed, scales as an integral part of a bed or a patient hoist with weighing facility.
Equipment
Scales
Scales (either sitting or standing) must be calibrated and positioned on a level surface. If electronic or battery scales are used then they must be connected to the mains or have appropriate working batteries prior to the patient getting on the scales.
Stadiometer
These are devices for measuring height and may be mounted on weighing scales or wall mounted.
Tape measure
Required if estimating height from ulna length. The tape measure should use centimetres, be disposable or made of plastic that can be cleaned with a detergent wipe between patient uses.
Assessment tools
Identification of patients who are malnourished or at risk of malnutrition is an important first step in nutritional care. There are a number of screening tools available which consider different aspects of nutritional status. National screening initiatives have demonstrated that 28% of patients admitted to hospital were found to be at risk of malnutrition – high risk (22%) and medium risk (6%) (BAPEN 2009). Particular diagnoses, such as cancer, increase the risk of malnutrition.
All patients who are identified as at risk of malnutrition should undergo a nutritional assessment. Subjective global assessment (SGA) is a comprehensive assessment but necessitates more time and expertise to carry out than most screening tests. Some more simple screening tools, including the malnutrition universal screening tool (MUST) (BAPEN 2003a), based on the patient’s Body Mass Index, weight loss and illness score, are less time consuming. Other tools may be specific to the patient’s age or diagnosis (Kondrup et al. 2003). The most important feature of using any screening tool is that patients identified as requiring nutritional assessment or intervention have a nutritional care plan initiated and are referred to the dietitian for further advice if appropriate.
Procedure guideline 8.8 Measuring the weight and height of the patient
Essential equipment
Scales
Stadiometer (preferably fixed to the wall)
Optional equipment
Tape measure
Preprocedure
Action Rationale
1 Position the scales for easy access and apply the brakes (if appropriate).
To ensure that the patient can get on and off the scales easily and to avoid accidents should the scales move. E
2 Ask the patient to remove shoes and outdoor garments. The patient should be wearing light indoor clothes only (see Action Figure 2).
Outdoor clothes and shoes will add additional weight and make it difficult to obtain an accurate bodyweight. E
Procedure
3 Ensure that the scales record zero then ask the patient to stand on scales (or sit if using sitting scales). Ask the patient to remain still and check that the patient is