MICA · CARE LEARNING NOTES
Observe, keep care safe and communicate
Nutritional support begins with recognising difficulties, observing intake and arranging competent assessment. It combines respect for preferences, swallowing safety and monitoring of the prescribed plan.
Recognise concerning change
Record usual and current weight, unintentional loss, reduced meals and illness context. Note loosening clothes, weakness and functional difficulties without judging by appearance alone. An apparently normal or high weight does not exclude malnutrition. Screening must lead to clinical assessment; albumin alone cannot summarise nutritional diagnosis or the patient’s needs.
[1][2]Identify barriers to eating
Ask about pain, nausea, oral and dental condition, chewing or swallowing difficulties, fatigue, mood and social barriers. Position the person comfortably and provide planned assistance while respecting privacy and preferences. Record actual intake rather than simply delivery of the meal. Coughing during meals, voice changes or suspected aspiration require swallowing assessment by a competent professional.
[1][2]Support an individual plan
Food fortification, supplements, texture adaptation and feeding route follow assessment, prescription and local professional scope. Do not arbitrarily change textures or add products through a feeding tube. Prolonged very low or absent intake prompts assessment for refeeding risk: increasing intake and biochemical monitoring then require a medical and nutritional plan rather than improvised replacement.
[1]Weight alone can hide malnutrition, particularly with oedema. Record intake actually consumed, swallowing problems, nausea and assistance needs. Following very low intake, nutritional restoration may require specific monitoring; do not abruptly increase targets outside the responsible team’s plan.
- Distinguish food served from food consumed in records.
Record intake and tolerance
Monitor agreed intake, interpretable weight trends, digestive symptoms, hydration and respiratory tolerance according to the plan. Oedema can complicate weight interpretation. Escalate persistent vomiting, inability to swallow, impaired consciousness, breathlessness or deterioration after feeding resumes. Share difficulties with the medical and dietetic teams, then check the patient and family understand goals and symptoms requiring further care.
[1][2]A learning situation
FICTIONAL SITUATION · REFLECTION WITHOUT A SCORE
Fictional situation: a patient has barely eaten for a prolonged period. On admission, a relative wants to bring several meals immediately to “catch up”.
What should be communicated to the team and relative?
Read the reasoning
Describe the duration and extent of reduced intake and request assessment of refeeding risk. Explain that restarting nutrition requires an organised, monitored approach for the context rather than a large catch-up intake. The relative can contribute dietary history and preferences. Document the agreed plan and observations to report without independently setting therapeutic quantities.
References and scope
- Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition — CG32 recommendations ↗
- Nutrition support in adults — Quality standard QS24 ↗
Original documentary teaching summary for adult care. Procedures and medicines depend on professional competence, prescription and institutional procedures. International references do not establish an Algerian protocol. Independent human scientific review remains to be confirmed.