Nutritional Assessment

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NUTRITIONAL ASSESSMENT

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Nutritional Assessment

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

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