Weight management goals in care planning

When care planning, the goals or objectives developed for each aspect of care need to be measurable.  This ensures you’re able to evaluate progress and determine whether the goal has been met or not.  The concern is making sure an appropriate goal is set.  While we look at this from a clinical perspective, we must always remember the resident as the central focus and director where they are able to provide input into what the care plan relays.  People have choice within their capacity and sometimes as nurses, we may not agree with a choice made by our patients / residents in aged care.

When guiding weight management goals from a clinical perspective, Liz Beaglehole, Registered Dietitian has offered the below guide.

Ideal weight range in the care process

Body mass index is still helpful in determining healthy weights for older adults.  A healthy BMI range for adults over 65 actually shifts upwards as compared to adults. So a healthy BMI for older adults has been found to be BMI – 22 – 27kg/m2. A BMI above 32kg/m2 would suggest obesity, a BMI below 20 suggests underweight, and below 18.5 is malnourished.

To work out the BMI: (weight/height²).  Example case:  height = 1.5m and weight = 45kg

  1. We need the height in metres and the weight in Kg.
  2. The height needs to be squared. So a height of 1.5m = 2.25 when squared.
  3. Then the BMI is the weight in Kg divided by the height²

Example:  weight = 45kg divided by 2.25 = BMI of 20kg/m².  This is regarded as the lower end of ideal body weight and suggests the resident is underweight for optimal health.

An ideal body weight for some who is 1.5m tall would be a BMI range of 22 – 27 so a weight range of min 50kg up to around 60kg.  Basically to work out ideal body weight just enter different weights into the BMI calculation until you get to the BMI of at least 22 and then again to a BMI of around 27.

The ideal body weight may differ to the GOAL weight.  The goal weight may be something that is set when the BMI is outside the ideal range but some weight changes are desirable.  The goal weight is more useful and practical as it considers the weight history of the resident and the ability to achieve changes in weight.  For example, a resident may be underweight with a weight of 42kg (BMI= 18.6) but they have been this weight for the past year.  Ideally they would gain weight to 50kg, but this is unrealistic.  The goal weight therefore becomes either weight stabilisation at 42kg or a slight weight gain to 44kg.  This would still mean the resident is underweight but is realistic in what can be achieved.  If the initial goal weight is achieved, a second goal weight may be identified.  This may be to stabilise weight at 44kg or to gain to 45kg.  etc…

This can work for overweight residents too.  Using the same example height of 1.5m.  Someone who weighs 78kg has a BMI of 34.6, and is obese.  However, realistic weight loss to within the ideal body weight range would suggest the resident would need to lose around 18 – 28kg, which is completely unrealistic and would never be suggested for aged care.  A more realistic GOAL weight would be weight stabilisation and then some weight loss.  5% weight loss can improve many health outcomes and this would be a realistic target.  Weight loss of 5% is still around 4kg, which is possible but still difficult.

Article contributed by: Liz Beaglehole (NZ Registered Dietitian), Canterbury Dietitians

Policies and Procedures folders

Policies & Procedures

Policy No. Titles for residential care service policies and procedures
CSM Care Services Manual introduction page
CS1 Admission to hospital for medical emergency
CS2 Adverse Health Policy
CS3 Anti-coagulation monitor
CS4 Warfarin blood monitoring results
CS5
CS6 Bereavement / Termination Care policy
CS6 A Bereavement notification form (and resource material)
CS7 Blood Glucose monitor form
CS7 A Blood sugar levels record sheet
CS7 B Diabetes Testing and Treatment sheet
CS7 C Blood glucose monitor form
CS8 Blood sugar equipment check
CS9 Blood sugar testing
CS10 Case Conference for care plan review forms
CS11 Care Plan Review Schedule
CS11 A Doctors Visits Schedule
CS12 Catheter management policy
CS12 A Catheter change schedule
CS13 Continence management policy
CS13 A Continence assessment form
CS13 B Continence Voiding Chart and Bowel chart
CS14 Clinical Management Policy (includes resource directly and key responsibilities)
CS14 A Robinson’s Resident Acuity & Clinical Risk Assessment
CS15 Challenging behavior assessment form
CS15 A Behavior monitoring chart
CS15 B Challenging behavior assessment form
CS16 Diversional Therapy – Quality of life policy
CS16 A Diversional Therapy – Residential profile
CS16 B Diversional Therapy – Care plan
CS16 C Diversional Therapy – Activities attendance register
CS16 D Diversional Therapy – Care plan evaluation form
CS16 E Sample Activities Calendar
CS17
CS18
CS19 Falls Prevention Programme
CS19 A Falls Risk Assessment – Coombe’s Assessment Form
CS19 B Repeated Falls Analysis – Accident Summary
CS19 C Resident Mobility Assessment Chart
CS19 D Resident Mobility Guide Form
CS19 E Post Falls Investigation Form
CS20 Fluid Balance Chart
CS20 A Daily Fluid Balance Chart (more reflective of hospital level care)
CS21 Handover sheet
CS22 Health status and clinical risk assessment policy
CS22 A Health status and clinical risk assessment form
CS23 ‘Health Promotion’ Initiative Planner
CS24 Lab form – Pathology report storage sheet
CS25
CS26 Long Term Care Plan (Including InterRai prompts and Evaluations)
CS26 A Short term care plan for acute issues
CS26 B Treatment Sheet
CS26 C Daily Care Summary (for inside wardrobe reference in resident room)
CS27 Care Plan multi-disciplinary review policy (and associated form)
CS28 Administration of medication policy – different version supplies for those using Medimap / 1 Chart
CS28 A Administration of medication procedure – different version supplies for those using Medimap / 1 Chart
CS28 B Glucagon Administration
CS28 C Blister pack contents verification
CS28 D Medication competency assessment forms
CS28 E Insulin competency assessment form
CS28 F Medication changes / order notification
CS28 G Medication order sheet – supplied for non-electronic system users
CS28 H Medication Signing sheet – supplied for non-electronic system users
CS28 I PRN medication signing sheet – supplied for non-electronic system users
CS28 J Medication error analysis form
CS28 K  Medication error analysis form
CS28 L  Respite / short term resident medication signing
CS28 M  Self Medication resident initial competency reviews
CS28 N  Self medicating – shift by shift verification
CS28 O Medication Returned to Pharmacy form
CS28 P Medication Key Holder Register
CS28 Q Injection Register form
CS30 Nebulizer usage and maintenance policy
CS31 Neurological Recordings policy
CS31 A Neurological Observation sheet
CS32 Podiatrist Service agreement
CS33 Pain Management policy
CS33 A Pain – Detailed Assessment form
CS33 B Pain – Review Assessment form
CS33 C Pain – ABBEY pain scale (for non-verbal resident)
CS33 D Pain – ABBEY pain scale reviews form
CS34 Personal hygiene and grooming policy
CS35 Pharmacy Service Agreement
CS36 Temp, Pulse and Respirations monitor form
CS36 A General Recordings record (optional use)
CS36 B Weight and Blood Pressure Monitor form
CS36 C Blood Pressure Monitor form
CS37 Pressure Injury Risk policy
CS37 A Pressure Injury Clinical Procedures
CS37 B Pressure Injury risk assessment form
CS38 Nursing (care) progress notes form
CS38 A Pressure Note Writing Guidelines
CS39 Medical Notes progress forms
CS40 Restraint / Enabler use policy and procedure
CS40 A Restraint / Enabler Authorisation form
CS40 B Restraint / Enabler Monitoring record
CS40 C Restraint / Enabler Register
CS40 D Restraint / Enabler Assessment prior to use
CS40 E Restraint / Enabler monitoring guidelines
CS40 F Restraint Approval Group Review meeting
CS40 G Restraint / Enabler Review form
CS41 RN – Medical practitioner communication
CS42 Sleep and Comfort policy
CS42 A Sleep Monitor form
CS43 Turn Chart for bed-ridden resident
CS44 Weight Management policy
CS44 A Weight Monitoring chart
CS45 Wound Management policy
CS45 A Wound care plan / dressing schedule
CS45 B Wound care competency assessment
Policy No. Title for residential care food services policies and procedures
FSM Food Services Manual introduction page
FS1 Admission Food & Nutrition Information
FS1 A Breakfast Order forms
FS2 Food brought into the facility
FS3 Food Safety policy
FS4 Food Services for the Elderly
FS4 A Food & Nutrition guidelines for the older person
FS4 B General tips for helping older persons eat etc.
FS4 C Ageing Process and Care Provisions Issues
FS4 D Eating Difficulties – Dry or Sore Mouth
FS4 E Fluids – Preventing Constipation
FS4 F Food and Medication Interactions
FS4 G Vitamin and Mineral Supplements
FS5 Food Services Questionnaire for Residents
FS6 Safety Checklist for Kitchen Services Areas
FS7
FS7 A Sample Menu – Winter 1
FS7 B Sample Menu – Winter 2
FS7 C Sample Menu – Winter 3
FS8 Microbiological Data Sheets – food Safety
FS9 Food services ordering and monitoring
FS10 Food services preferred suppliers
FS11 Food/fluid Intake Chart
FS12 Resident Food / Fluids Preferences at a glance form
FS13 Food Services Staff Responsibilities
FS14 Food Storage Policy
FS15 Food Thawing Policy
FS16 Meal Service Policy
FS16 A Resident Meal Receipt Verification Form
Policy No. Policy Title for Residential Care Service Delivery policies and procedures
SD1 Acquisitions Order Form
SD2 Common Abbreviations
SD3 Communication Policy
SD3 A   –  Sensory Communication Policy
SD4 Clinical documentation and report writing policy
SD5 Day Care Policy
SD5A Day Care – Client Care Plan
SD6 Family / Whanau / Resident Representative Contact sheet
SD7 Reassessment Referral Policy
SD8 Resident Inquiry for Admission Form
SD8 A Resident Inquiry for Admission Form (alternative form)
SD9 Resident Medical File Checklist
SD10 Transfer / Discharge of Residents Policy
SD10 A Transfer / Discharge Form
SD11 Medical Services Contract
SD12 Authorised Signatures register
SD13 Change of Resident Status Notification
SD14 Internal Telephone Numbers Listing