Your SlideShare is downloading. ×
Nutritional Assessment
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Nutritional Assessment

9,387

Published on

NUTRITIONAL ASSESSMENT

NUTRITIONAL ASSESSMENT

0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
9,387
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
236
Comments
0
Likes
4
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Nutritional Assessment
    • IDENTIFICATION OF NUTRITIONAL DEFICIENCIES
    • CLASSIFICATION OF MALNUTRITION
    • ESTIMATION OF NUTRITIONAL REQUIRMENTS
  • 2.  
  • 3.  
  • 4. Nutritional Assessment
    • S.O.A.P.
      • SUBJECTIVE DATA
      • OBJECTIVE DATA
      • ASSESSMENT
      • PLAN
  • 5. Nutritional Assessment Nutrition Support Team
    • Physician Dietitian
    • - Diagnosis - Nutritional Assessment
    • - Placement of CVC - Enteral Nutrition
    • - Team Leader - Transitional Feedings
    • Nurse Pharmacist
    • - Maintenance of CVC - Admixture Preparation
    • - Physical Assessment - Admixture Formulation
    • - Patient Training - Drug-Nutrient Interactions
  • 6.  
  • 7.  
  • 8. Nutritional Assessment SUBJECTIVE DATA
      • USUAL WEIGHT
      • RECENT CHANGES IN WEIGHT
      • FOOD ALLERGIES/ INTOLERANCES
      • SPECIAL DIET
      • 24 HOUR DIETARY RECALL
  • 9. Nutritional Assessment SUBJECTIVE DATA
      • FOOD DRUG INTERACTIONS
      • ALCOHOL / DRUG ABUSE
      • VITAMIN / MINERAL SUPPLIMENTS
      • ECONOMICS
      • ACTIVITY
  • 10. Nutritional Assessment BODY COMPARTMENTS SKELETON 10% EXTRACELLULAR 20% PLASMA PROTEIN 3% VISCERAL PROTEINS 8% SOMATIC PROTEINS 30% ADIPOSE TISSUE 25%
  • 11. Nutritional Assessment BODY COMPARTMENTS Serum Albumin, Transferrin Arm Muscle Circumference Body Weight Creatinine Height Index ASSESSED BY Triceps Skinfold Body Weight SKELETON 10% EXTRACELLULAR 20% PLASMA PROTEIN 3% VISCERAL PROTEINS 8% SOMATIC PROTEINS 30% ADIPOSE TISSUE 25%
  • 12. Nutritional Assessment OBJECTIVE DATA SOMATIC COMPARTMENT
      • WEIGHT (ACTUAL)
      • HEIGHT
      • IDEAL BODY WEIGHT (IBW)
      • FEMALE:IBW=100 LB +(5 LB X EVERY INCH >5 FT)
      • MALE: IBW=106 lb +(6 lb FOR EVERY INCH >5 FT)
  • 13. Nutritional Assessment OBJECTIVE DATA SOMATIC COMPARTMENT
      • ANTHROPOMETIRICS
        • MID ARM CIRCUMFERENCE (MAC)
        • TRICEPS SKIN FOLD (TSF)
        • MID ARM MUSCLE CIRUMFERENCE (MAMC)
      • MAMC=MAC cm – (TSF mm X 0.314)
  • 14. Nutritional Assessment OBJECTIVE DATA SOMATIC COMPARTMENT < 800 800-1199 1200-2000 > 2000 Total Lymphocyte Count (TLC) 2-3 d <5 5-10 10-15 >15 Prealbumin 8 d <100 100-150 151-200 >200 Transferrin 20 d < 2.1 2.1-3.0 3.1-3.5 > 3.5 Albumin t 1/2 Severe Moderate Mild Normal MARKER
  • 15. Nutritional Assessment CLASSIFICATION OF MALNUTRITION
      • MARASUS
      • -DEPLETION IN THE SOMATIC COMPARTMENT
      • KWASHIORKOR
      • -DEPLETION IN THE VISCERAL COMPARTMENT
      • MARASMUS-KWASHIORKOR MIX
      • -DEPLETION IN BOTH COMPARTMENTS
  • 16. Nutritional Assessment CASE STUDY
      • Ms. A. is a 35-Y-O female that has been trapped in
      • chocolate factory for the past five months. She is 5 ft. tall
      • and weighs 200 lbs. She has been admitted to the hospital
      • for evaluation, following this traumatic experience. On
      • admission her albumin is 2.0 and transferrin is 100.
      • What is her IBW?
      • Calculate her % of IBW
      • What is her nutritional diagnosis?
  • 17. Nutritional Assessment CASE STUDY
      • Ms. A. is a 35-Y-O female that has been trapped in
      • chocolate factory for the past five months. She is 5 ft. tall
      • and weighs 200 lbs. She has been admitted to the hospital
      • for evaluation, following this traumatic experience. On
      • admission her albumin is 2.0 and transferrin is 100.
      • What is her IBW?
      • IBW = 100 lb + (5 X EVERY in OVER 5 ft)
      • IBW = 100 lb
      • Calculate her % of IBW
      • ACTUAL WT / IBW = % IBW
      • 200 lb / 100 lb = 200% IBW
      • What is her nutritional diagnosis? KWASHIORKOR
  • 18. Nutritional Assessment CASE STUDY
      • Mr. B is a 24-Y-O male that has recently been returned
      • from captivity on a south sea island, where he was held
      • prisoner by 15 women. He is 6 ft. tall and weighs 125 lbs.
      • Upon admission to the hospital his serum albumin is 3.5
      • and his transferring is 175.
      • B. What is his IBW?
      • Calculate his % of IBW
      • What is his nutritional diagnosis?
  • 19. Nutritional Assessment CASE STUDY
      • Mr. B is a 24-Y-O male that has recently been returned
      • from captivity on a south sea island, where he was held
      • prisoner by 15 women. He is 6 ft. tall and weighs 125 lbs.
      • Upon admission to the hospital his serum albumin is 3.5
      • and his transferring is 175.
      • B. What is his IBW?
      • IBW = 106 lb + (6 X EVERY in OVER 5 ft)
      • IBW = 178 lb
      • Calculate his % of IBW
      • ACTUAL WT / IBW = % IBW
      • 125 lb / 178 lb = 70% IBW
      • What is his nutritional diagnosis? MARASMUS
  • 20. Nutritional Assessment ESTIMATION OF CALORIC REQUIRMENTS
      • HARRIS BENEDICT EQUATIONS
      • MALE
      • BEE = 66 + (13.7 X Wt) + (5 X Ht) – (6.8 X Age)
      • FEMALE
      • BEE=655 + (9.6 X Wt) + (1.7 X Ht) – (4.7 x Age)
      • Wt in Kg Ht in cm Age in years
  • 21. Nutritional Assessment ESTIMATION OF CALORIC REQUIRMENTS
      • HARRIS BENEDICT EQUATIONS
      • CAL REQ=BEE X ACTIVITY FACTOR X INJURY FACTOR
      • ACTIVITY FACTORS
            • 1.2 CONFINED TO BED
            • 1.3 AMBULATORY
            • 1.4 ACTIVE
  • 22. Nutritional Assessment ESTIMATION OF CALORIC REQUIRMENTS
      • HARRIS BENEDICT EQUATIONS
      • CAL REQ=BEE X ACTIVITY FACTOR X INJURY FACTOR
      • INJURY FACTORS
      • 1-1.2 MINOR SURGERY
      • 2.1 SEVERE THERMAL BURN
      • 1.2-1.5 PERITONITIS
      • 1.35 SKELETAL TRAUMA
      • 1.4-1.8 SEPSIS
      • 1.75 AIDS
      • 1.14-1.37 SOFT TISSUE TRAUMA
  • 23. Nutritional Assessment ESTIMATION OF CALORIC REQUIRMENTS
      • SHORT CUT METHOD
      • MAINTENANCE: 30 KCAL/KG
      • MODERATE STRESS: 35 KCAL/KG
      • SEVERE STRESS: 40 KCAL/KG
      • (CRITICAL CARE PATIENT – PROVIDE
      • 25 KCAL/KG)
  • 24. Nutritional Assessment ESTIMATION OF PROTEIN REQUIRMENTS
      • CALORIE TO NITROGEN RATION 150:1
      • (1 GM NITROGEN = 150 KCAL)
      • 1 GM NITROGEN =6.25 GM PROTEIN
      • PROTEIN =
      • CAL X 1GM N/150 KCAL X 6.25 GM PRO/GM N
      • EXAMPLE:
      • 2000 KCAL /150 X 6.25 = 83.3 GM PRO
  • 25. Nutritional Assessment ESTIMATION OF PROTEIN REQUIRMENTS BASED ON WEIGHT 0.5 HEPATIC FAILURE 1-1.2 RENAL FAILURE /DIALYSIS 0.8-1 CHRONIC RENAL FAILURE 0.5-0.8 ACUTE RENAL FAILURE 2 MULTIPLE TRAUMA 0.8-1 NORMAL PATIENT GM/KG/DAY PATIENT STATUS
  • 26. Nutritional Assessment Nitrogen Balance
      • N balance = N in – N out
      • = N in – (UUN+3)
      • Goal: Positive nitrogen balance of 4-6 gm/day.
  • 27. Nutritional Assessment Nitrogen Balance
      • What is the nitrogen balance of a patient who takes in 65 gm of protein per day in an enteral feeding and has a measured 24 hr UNN of 7.2gm?
      • N balance = N in – (UUN+3)
      • =(65gm pro x 1gm N ) - ( 7.2gm+3gm)
      • 6.25gm pro
      • = 10.4 gm – 10.2 gm = (-0.2gm)
  • 28.  

×