🍽️Nutrition Assessment

Unit 8 Overview: Nutritional Screening Tools
8.1 Overview of Nutrition Screening Tools
8.2 Mini Nutritional Assessment (MNA)
8.3 Malnutrition Universal Screening Tool (MUST)
8.4 Nutrition Risk Screening (NRS-2002)

🍽️nutrition assessment review

8.4 Nutrition Risk Screening (NRS-2002)

3 min read•Last Updated on July 30, 2024

Nutrition Risk Screening (NRS-2002) is a vital tool for assessing malnutrition risk in hospitalized adults. It helps healthcare professionals quickly identify patients who need nutritional support, using a simple scoring system based on nutritional status and disease severity.

The NRS-2002 consists of initial and final screening steps, evaluating factors like BMI, weight loss, and illness severity. Scores range from 0 to 7, with higher scores indicating greater nutritional risk. This tool guides interventions and ensures timely nutritional care for at-risk patients.

Target Population and Setting for NRS-2002

Adult Inpatients in Hospital Settings

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Top images from around the web for Adult Inpatients in Hospital Settings

  • Frontiers | Modified Nutrition Risk in Critically ill is an effective nutrition risk screening ... View original

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  • Frontiers | Prognostic performance of the NRS2002, NUTRIC, and modified NUTRIC to identify high ... View original

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  • The NRS-2002 screens adult patients in the hospital setting for malnutrition risk within the first 48 hours of admission
  • Applies to most adult inpatients, but certain groups may need specialized screening (critically ill patients, obese individuals, or those with fluid overload)

Populations Not Validated for NRS-2002

  • The tool is not validated for use in pediatric patients, outpatients, or long-term care residents
  • These populations require alternative screening methods tailored to their specific needs and settings
  • Using NRS-2002 in non-validated populations may lead to inaccurate risk assessments and inappropriate interventions

Components and Scoring System of NRS-2002

Initial and Final Screening Steps

  • The NRS-2002 consists of an initial screening and a final screening
  • Initial screening assesses four criteria:
    • BMI < 20.5 kg/m²
    • Weight loss in the past 3 months
    • Reduced dietary intake in the preceding week
    • Presence of severe illness
  • If "Yes" to any initial screening question, the final screening is performed

Final Screening: Impaired Nutritional Status and Disease Severity

  • Final screening evaluates impaired nutritional status and severity of disease as a reflection of increased nutritional requirements
  • Impaired nutritional status is scored from 0 (absent) to 3 (severe) based on:
    • Percent weight loss
    • BMI
    • General condition
  • Severity of disease is scored from 0 (absent) to 3 (severe) based on:
    • Patient's medical condition
    • Nutritional requirements
  • An additional point is added for patients aged ≥70 years to represent elderly frailty

Total NRS-2002 Score Calculation

  • The final NRS-2002 score is the sum of:
    • Impaired nutritional status score (0-3)
    • Severity of disease score (0-3)
    • Age adjustment (0 or 1)
  • Total scores range from 0 to 7, with higher scores indicating greater nutritional risk

Assessing Nutritional Risk with NRS-2002

Proper Application by Trained Professionals

  • NRS-2002 should be completed by trained healthcare professionals (nurses or dietitians) within 48 hours of hospital admission
  • Requires accurate anthropometric measurements (height and weight) and thorough medical history

Assessing Weight Loss and Dietary Intake Changes

  • Weight loss history should be obtained from patient, relatives, or medical records
    • Severity evaluated as percentage of usual body weight
  • Dietary intake changes assessed compared to patient's normal pre-hospitalization intake
    • Significant reductions may indicate impaired nutritional status

Scoring Disease Severity and Special Considerations

  • Disease severity scoring requires knowledge of primary diagnosis, comorbidities, and anticipated nutritional requirements
    • Examples of severe diseases: head injury, bone marrow transplantation, intensive care patients (APACHE score > 10)
  • Special considerations for patients with altered body composition or fluid balance (obese, edema, ascites)
    • May require adjustments to BMI interpretation or weight loss assessment

Interpreting NRS-2002 Scores for Intervention

Identifying Patients at Nutritional Risk

  • NRS-2002 score ≥3 indicates nutritional risk, requires intervention and weekly rescreening
    • Score of 3: moderate risk
    • Scores ≥4: high risk
  • Patients with score <3 should be rescreened weekly during hospitalization to monitor changes

Guiding Nutritional Intervention Based on Score

  • Higher scores indicate greater need for prompt, aggressive nutritional therapy
    • Scores ≥5 may require intensive interventions (enteral or parenteral nutrition)
  • Interventions should be tailored to individual patient based on:
    • Specific nutritional deficits
    • Disease state
    • Tolerance
  • NRS-2002 score alone does not dictate the type of nutritional therapy required

Collaborative Care Planning and Monitoring

  • Nutritional care plans should be developed with a registered dietitian and interdisciplinary medical team
  • Regular monitoring and reassessment crucial to:
    • Evaluate effectiveness of interventions
    • Adjust care plans as needed
  • Ongoing communication and documentation ensure continuity of care and optimal outcomes