Poor Oral Intake, Appetite Diminished, Ate Less
Also Consider: Abdominal Discomfort, Constipation, Dehydration, Diarrhea, Nausea/Vomiting, Vomiting Blood
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Causes
Common: Constipation, depression, delirium, dental problems, dysphagia, restricted diet, pain, medications
Less common: cancer, CHF, COPD, infection, urinary retention, thyroid problems, increase assistance needed with meals
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
If Pain: exact locations, pain scale, description (sharp, dull, burning), persistent or intermittent
Acute mental status change, including alertness, orientation, mood, behavior
Acute decline in ADL abilities
Signs of dehydration
mouth or dental pain
Sore throat, thrush
Respiratory: New cough, abnormal lung sounds
GI: Heartburn, Nausea, vomiting, diarrhea, constipation, abdominal distention or tenderness, rebound tenderness, bowel sounds
GU: New or worsened incontinence, pain with urination, blood in urine, scrotal pain, urinary retention / Bladder scan
Rectal check for impaction, appearance of stool
Fingerstick glucose (patients with diabetes)
3. Take Action using SBAR Report:
Notify medical staff & resident representative within the next 16 hours.
No fluid intake for 24 hours
Notify medical staff on the next business day
Significant decline in food and fluid intake of someone with marginal hydration and nutritional status
Notify medical staff at the next regular rounds
Frequent or persistent poor appetite with gradual weight loss
SBAR Report
Situation: “Poor Oral Intake” (No fluid intake in 24 hours) “in a patient with” (marginal nutritional status) (other acute symptoms)
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
When the problems started, how severe they are, getting worse or staying the same, alleviating or aggravating factors, what treatments have been used.
Abnormal Vital Signs based on patient’s previous values
MOLST / Advance Directives
Current weight and weight trend
Recent illness, surgery, antibiotics, medication changes
General observation of patient condition
Diet restrictions, Fluid restriction, thickened liquids
Medications that cause anorexia: ACE inhibitors, SSRI antidepressants, digoxin, metformin, warfarin, phenytoin
Availability of IV or clysis hydration (i.e., PICC line)
Assessment: I am concerned about: __________
Recommendations/Requests:
Labs: CBC with diff, CMP/Chem14, Amylase, Lipase, Drug levels
TSH if not done in the last 6 months
Start or stop a medication
IV or SC (clysis) fluids
Diet liberalization / removal of restrictions
Dietitian / Clinical Nutrition consult
Dental consult
Swallowing evaluation
Frazier water protocol
Nausea Medication
Laxative Medication, tap water enema
Antibiotic for infection
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor vital signs, fluid intake/urine output every 8 hrs.
Offer fluids and food frequently
Place on Intake & Output monitoring
Place on 24-hour report
Obtain lab results (if ordered), and notify medical as needed of:
Significantly abnormal values in blood count or metabolic panel (refer to appropriate Situation)
Abnormal drug levels
WBC > 12,000 or neutrophils > 90%
Monitor meal acceptance
Assure bowel regularity
Update care plan regarding fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative
Update advance directives if appropriate
2025-04-20
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