Chapter 27: Living with and beyond cancer
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Pre‐procedural considerations
Methods for measuring height and weight of an adult patient
Taking an accurate height and weight of a patient is an essential part of nutrition screening. In addition, for those who are overweight it is helpful to have an accurate measurement of waist circumference (Figure 27.8).
Figure 27.8 Measurement of waist circumference.
Check that the patient can stand or sit on the appropriate scales. The patient should remove outdoor clothing and shoes before being weighed and having height measured. When obtaining a height measurement and waist circumference, check that the patient can stand upright while the measurement is taken. For patients who are unable to stand, height may be determined by measuring ulna length and using conversion tables. If neither height nor weight can be measured or obtained, BMI can be estimated using the mid upper arm circumference (MUAC) (BAPEN [30]). It may not be possible to weigh patients who cannot be moved or are unable to sit or stand. Alternative methods to obtain weight should be explored, for example bed scales that can be placed under the wheels of the bed, scales as an integral part of a bed, or a patient hoist with weighing facility.
Equipment
Scales
Scales (either sitting or standing) must be calibrated and positioned on a level surface. If electronic or battery scales are used, then they must be connected to the mains or have appropriate working batteries prior to the patient getting on the scales.
Stadiometer
This is a device for measuring height. It may be mounted on weighing scales or wall mounted.
Tape measure
A tape measure is required if estimating height from ulna length or MUAC and for measurement of waist circumference. The tape measure should measure in centimetres and either be disposable or made of plastic that can be cleaned with a detergent wipe between patient uses.
Assessment tools
Identification of patients who are malnourished or at risk of malnutrition is an important step in nutritional care. There are a number of screening tools available that consider different aspects of nutritional status. National screening initiatives demonstrated that 28% of patients admitted to hospital were found to be at risk of malnutrition – high risk (22%) and medium risk (6%) (BAPEN [31]). Particular diagnoses, such as cancer, increase the risk of malnutrition (Shaw et al. [256]).
Procedure guideline 27.9
Measuring the weight, height and waist circumference of the patient
Figure 27.9 Weighing a patient. Source: Dougherty and Lister ([91]).
Figure 27.10 Measure between the point of the elbow (olecranon process) and the midpoint of the prominent bone of the wrist (styloid process). Source: Dougherty and Lister ([91]).
Table 27.7 Prevention and resolution (Procedure guideline 27.9)
| Problem | Cause | Prevention | Action |
|---|---|---|---|
| Patient unable to stand on scales. | Poorly positioned scales.
Patient balance not sufficient. | Check with patient prior to asking them to stand on scales if they are able to do so. Offer sitting scales if necessary. | Ensure both sitting and standing scales are available in the hospital. |
| Weight obtained appears too low. | Patient may have put pressure on scales prior to them reaching zero. | Ensure zero is visible before patient touches scales. | Check weight with patient once obtained.
Re‐weigh patient to check correct weight. |
| Weight obtained appears too high. |
| Ensure that the patient is wearing light indoor clothes before standing on the scales.
Ask patient to empty any drainage bags. Check whether patient has fluid retention. | Check weight with patient once obtained.
Re‐weigh patient to check correct weight. |
| Patient is unable to stand. | Patient is unwell or has physical disability. | Discuss the procedure with patient before undertaking height measurement. | Consider estimating height from ulna measurement. |
| Difficulty measuring waist circumference in obese patients. | Tape measure may not be long enough.
Difficulty identifying the correct position to measure waist circumference. | Calculate BMI and if it exceeds 35 kg/m2 then do not measure waist circumference. | Use BMI alone. |
