Which patient is at highest risk for nutritional compromise?

A patient with recent unplanned weight loss is at the highest risk for nutritional compromise. Unplanned weight loss can be a significant indicator of underlying health issues, such as malnutrition, illness, or a decrease in caloric intake. This weight loss can impact the body’s ability to heal, especially in individuals with wounds, as proper nutrition is crucial for tissue repair and recovery.

In this scenario, the other options do not present the same level of risk. A prealbumin level of 22 is typically within normal range and suggests adequate nutritional status. A patient who gained 5 lbs may indicate an overall improvement in nutritional intake, or at least stability, rather than a decline. Being NPO (nothing by mouth) for 24 hours may pose some risk, but it is a relatively short duration, and most patients can manage brief periods without oral intake without significant nutritional compromise, particularly if they have adequate reserves. Therefore, the patient with recent unplanned weight loss stands out as needing the most immediate nutritional assessment and intervention to mitigate risks associated with malnutrition.