# N13 · Nutrition at the Chair

Nutrition assessment connects intake, illness, weight, function, and practical access to food.

![Infographic: N13 · Nutrition at the Chair](https://urinenephrology.org/visual-reference/images/nursing-n13.png?v=20261003c)

## Ask the same five questions

Appetite? Meals missed? Nausea or mouth/swallowing pain? Food available at home? What changed after dialysis? Record the patient’s answer and connect them directly with the dietitian or social worker rather than handing out a generic restriction list.

## Separate tissue loss from fluid

Compare reliable post-weights and function over time. Unintentional loss of 5% over 3 months or 10% over 6 months warrants nutrition review. Repeated below-target weights need assessment, but are not proof of tissue loss; fluid status can mask or mimic it.

## Read laboratory clues carefully

Albumin is influenced by inflammation and illness as well as intake. Falling potassium, phosphorus, or urea can accompany poor eating; a lower result is not automatically a sign of better dietary management.

## Make meals during dialysis safe

Follow the individualized eating plan and unit policy. Consider blood-pressure tolerance, alertness, swallowing, positioning, and access protection; avoid offering food when the patient is unstable or cannot swallow safely.

## Use food labels, not blanket bans

Support the prescribed protein/energy plan. Review sodium and ingredients containing “phos,” then ask how binders are taken with food. Do not restrict protein or remove all fruit/vegetables to fix one lab. Check supplements with the dietitian and prescriber.

## Escalate and handoff

Report persistent poor intake, unintended weight loss, swallowing problems, food insecurity, or inflammatory symptoms. Include the patient’s priorities, weight and lab trends, current restrictions, accepted support, and a named follow-up owner.

## Supporting evidence

- [Supporting guideline or source](https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/healthy-eating-adults-chronic-kidney-disease)

## Source lessons

- [N13 Nutrition at the Chair](https://urinenephrology.org/mastery/maintenance-hd/nursing/N13-Nutrition-at-the-Chair.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.