The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [261]
To record an accurate weight (NMC 2009, C).
4 Note the reading on the scale and record immediately, taking care that it is legible. Check with the patient that the weight reflects their expected weight and that the weight is similar to previous weights recorded. This may require conversion of weight from kg to stones and pounds or vice versa.
To check that the weight is correct. If the weight is not as expected then the patient should be re-weighed. E
5 Ensure that the patient has removed their shoes and then ask them to stand straight with heels together. If the stadiometer is wall mounted, the heels should touch the heel plate or the wall. With a freestanding device the person’s back should be toward the measuring rod.
Shoes will provide additional height and make the measurement inaccurate. E
To ensure that the patient is standing upright. If the person does not have their back against the measuring rod then the measuring arm may not reach the head. E
6 The patient should look straight ahead and with the bottom of the nose and the bottom of the ear in a parallel plane. The patient should be asked to stretch to reach maximal height.
To ensure an accurate height is measured. E
7 Record height to the nearest millimetre.
To record an accurate measurement of the patient’s height (NMC 2009, C).
8 To estimate the height of a patient from ulna length, ask the patient to remove long-sleeved jacket, shirt or top.
To be able to access their left arm for measurement purposes. E
9 Measure between the point of the elbow (olecranon process) and the midpoint of the prominent bone of the wrist (styloid process) on the left side if possible.
To obtain measurement of the length of the ulna. E
10 Estimate the patient’s height to the nearest centimetre, using a conversion table.
To estimate the patient’s height. (BAPEN 2003a, C)
Postprocedure
11 Document height and weight in patient’s notes.
To record the accurate measurement of patient’s height and weight (NMC 2009, C).
Action Figure 2 Weighing a patient.
Problem-solving table 8.2 Prevention and resolution (Procedure guideline 8.8)
Postprocedural considerations
Consideration must be given to the patient’s weight and whether this reflects a change in their clinical condition. The weight may be being used as part of a nutritional screening or assessment or for planning of treatment, for example medication. Any significant changes should be interpreted in the light of potential changes in body composition and incorporated into the patient’s care plan. For example, a loss of weight may require further questioning about dietary intake and the commencement of a nutritional care plan.
After taking a measurement of height it is useful to check with the patient that the figure obtained is approximately the height that is expected. However, it is important to consider that patients may report a loss in height with increasing years. A cumulative height loss from age 30 to 70 years may be about 3 cm for men and 5 cm for women and by age 80 years it increases to 5 cm for men and 8 cm for women (Sorkin et al. 1999).
Provision of nutritional support: oral
Evidence-based approaches
Rationale
An essential part of providing diet for a patient is to ensure that the patient is able to consume the food and fluid in a safe and pleasant environment. Some patients may require assistance with feeding or drinking and a system should be in place to ensure that these patients receive the required attention at each meal time and beverage service provided.
It is essential that meals are appetizing and strictly comply with any dietary restriction that is relevant to the patient. For example, those with food allergies, texture modifications, religious or cultural dietary requirements need to be clearly identified with the senior ward nurse, before assistance with feeding commences. Eating and drinking are pleasurable experiences and the psychosocial aspect of this cannot be overestimated. The