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Nutritional Assessment
 

Nutritional Assessment

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NUTRITIONAL ASSESSMENT

NUTRITIONAL ASSESSMENT

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    Nutritional Assessment Nutritional Assessment Presentation Transcript

    • Nutritional Assessment
      • IDENTIFICATION OF NUTRITIONAL DEFICIENCIES
      • CLASSIFICATION OF MALNUTRITION
      • ESTIMATION OF NUTRITIONAL REQUIRMENTS
    •  
    •  
    • Nutritional Assessment
      • S.O.A.P.
        • SUBJECTIVE DATA
        • OBJECTIVE DATA
        • ASSESSMENT
        • PLAN
    • 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
    •  
    •  
    • Nutritional Assessment SUBJECTIVE DATA
        • USUAL WEIGHT
        • RECENT CHANGES IN WEIGHT
        • FOOD ALLERGIES/ INTOLERANCES
        • SPECIAL DIET
        • 24 HOUR DIETARY RECALL
    • Nutritional Assessment SUBJECTIVE DATA
        • FOOD DRUG INTERACTIONS
        • ALCOHOL / DRUG ABUSE
        • VITAMIN / MINERAL SUPPLIMENTS
        • ECONOMICS
        • ACTIVITY
    • Nutritional Assessment BODY COMPARTMENTS SKELETON 10% EXTRACELLULAR 20% PLASMA PROTEIN 3% VISCERAL PROTEINS 8% SOMATIC PROTEINS 30% ADIPOSE TISSUE 25%
    • 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%
    • 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)
    • 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)
    • 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
    • Nutritional Assessment CLASSIFICATION OF MALNUTRITION
        • MARASUS
        • -DEPLETION IN THE SOMATIC COMPARTMENT
        • KWASHIORKOR
        • -DEPLETION IN THE VISCERAL COMPARTMENT
        • MARASMUS-KWASHIORKOR MIX
        • -DEPLETION IN BOTH COMPARTMENTS
    • 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?
    • 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
    • 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?
    • 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
    • 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
    • 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
    • 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
    • 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)
    • 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
    • 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
    • Nutritional Assessment Nitrogen Balance
        • N balance = N in – N out
        • = N in – (UUN+3)
        • Goal: Positive nitrogen balance of 4-6 gm/day.
    • 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)
    •