Nutritional Screening & Assessment
Overview
Nutritional screening is a rapid, standardized, nurse-driven process completed within 24 hours of admission to triage who is at nutritional risk — it does NOT diagnose malnutrition. A positive screen (validated tools: Malnutrition Screening Tool, NRS-2002) triggers a comprehensive assessment performed by or with a registered dietitian. Screen first, assess second.
Technique
Sequence of care: the nurse screens; a positive screen escalates to the dietitian-led full assessment.
Screen first, assess second
- Admission screen within 24 hoursnurse-driven; MST or NRS-2002
- Positive screenrecent unintentional weight loss or poor appetite
- Comprehensive assessmentregistered dietitian collaboration
- Nutrition plan + monitoringrecheck prealbumin for early response
Interpretation
The full assessment integrates four domains — anthropometric, biochemical, clinical exam, and dietary history. Prealbumin reflects the short game (days); albumin reflects the long game (weeks). Both are negative acute-phase reactants: inflammation, infection, or fluid shifts lower them independent of intake, so no single lab confirms malnutrition.
Prealbumin vs albumin
Prealbumin
- Normal range
- 15-36 mg/dL
- Half-life
- ~2-3 days
- Reflects
- Acute / current status
- Best use
- Recheck recent intervention response
Albumin
- Normal range
- 3.5-5.0 g/dL
- Half-life
- ~20 days
- Reflects
- Chronic status over weeks
- Best use
- Baseline chronic protein status
During — Monitoring
The nurse's monitoring role drives the data the team relies on.
Patient Teaching
Escalate to the provider and refer to the dietitian — do not wait for overt physical wasting before acting.
Clinical Pearl
Screen first, assess second. Prealbumin is the short game (days), albumin the long game (weeks) — and unintentional weight loss is the simplest red flag of all.