UNIT 4NS270 NUTRITIONAL ASSESSMENT AND MANAGEMENT

Amy Habeck, RD, MS, LDN

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Unit 4 Learning Objectives:

1) Practice Calculations1) Unit 4 project calculations

2) Review- Nutrition and Diet Therapya) Chapter 7 – Assessment of the Hospitalized

Patient

3) Answer your questions

Nutrition Screening

Screening of hospitalized patients Completed within first 24-48 hours Identifies characteristics known to be

associated with nutrition problems Malnutrition Nutritional risk What are some diagnoses that put a patient at

increased nutritional risk? Patients at nutritional risk should have a

nutrition assessment

Diagnoses Associated with Increased Nutritional Risk

Trauma: fracture, burn, closed head injury, GSW, spinal cord injury, MVA

Dysphagia Bowel resection Short bowel syndrome Small bowel obstruction Hypoglycemia FTT Congenital heart disease COPD Anorexia Cancer

HIV/AIDS V/D Anemia CVA or hemiparesis GI bleed Crohn’s disease Dumping syndrome Pressure ulcers Organ transplant DM CAD pancreatitis

Case Study-Question 1

How can you estimate her height?Table 7.1 page 219S=75.00 +(1.91 KH)-(0.17A)Equation for white female >60 y.o.

= (substitute numbers and complete calculation)

S=statureKH=knee height (cm)A= age

72 year old femaleHistory of osteoporosis with compression fractureKH = 16.5 inches

Case Study- Question 1

KH=16.5 in x 2.54cm/in=41.91cm

A= age=72S=75.00 +(1.91x KH)-(0.17xA)S=75.00+(1.91x41.91)-

(0.17x72)S=75.00+80-12.2S=142.8 cm

S=statureKH=knee height (cm)A= age

72 year old femaleHistory of osteoporosis with compression fractureKH = 16.5 inches

Case Study – Question 2

Calculate adjusted body weight (ABW) Equation and example on page 225 Table 7.5 : % of body weight contributed by

body parts =% of body weight = lower leg + foot = (substitute numbers and complete

calculation)

HelenWt = 115Amputation =Lower leg and foot

Case Study – Question 2

Calculate adjusted body weight (ABW) Equation and example on page 225 Table 7.5 - % of body weight contributed by

body parts ABW= current wt/(100-% of amputation)x 100 = (substitute numbers and complete

calculation)

HelenWt = 115Amputation =Lower leg and foot = 5.3 + 1.8= 7.1%

Case Study – Question 2 Calculate adjusted body weight Equation and example on page 225 Table 7.5 - % of body weight contributed by body parts

Adjusted wt = current wt/(100-% of amputation)x 100

Adjusted wt = 115/(100 - 7.1) x 100 Adjusted wt = 115/(92.9) x 100 Adjusted wt = 123.79 pounds

HelenWt = 115Amputation =Lower leg and foot = 5.3 + 1.8= 7.1%

Calculate BMI based on adjusted body weight-Question 3P176 Lee and Nieman, classification table 6.6 BMI based on adjusted body weight==ABW(pounds)/ht(in)/ht(in)x703== (substitute numbers and complete

calculation)

JustinEntire right leg amputationHt: 5’6” = 66”ABW: 178 pounds

Calculate BMI based on adjusted body weight-Question 3P176, classification table 6.6 Ht= 5’6”=66” BMI based on adjusted body weight==ABW(pounds)/ht(in)/ht(in)x703==178/(66)2x703=28.7

JustinEntire right leg amputationHt: 5’6”ABW: 178 pounds

Evaluating Desirable Body Weight-Question 4 Hamwi equations

Hamwi equation is found on page 170-171 of Lee and Nieman

Men 5’ = 106# + 6# for every additional inch +/-

10% Women

5’=100# + 5# for every additional inch +/- 10%

Height-weight tables What are some of the limitations of the

height-weight tables?

IBW-Number 4

What is her desirable or ideal body weight? Use the Hamwi equation = (substitute numbers and complete

calculation) Page 170-171

48 year old patient, Ms. GenevaFemaleHeight: 5’6”Actual body weight: 155#

Let’s Practice – Question 4

What is her desirable or ideal body weight?

Women: 5’=100 + (5x6) +/- 10% IBW=130+/- 10% or 130x.9 to 130x1.1 IBW=117-143#

48 year old patient, Ms. GenevaFemaleHeight: 5’6”Actual body weight: 155#

Using Anthropometric Measures to estimate weight-Number 5 Equation: page 224, table 7.3 Female: (MAC x 1.63)+(CCx1.43)-37.46 Male: (MACx2.31)+(CCx1.5)-50.10 Estimated weight = = (substitute numbers and complete

calculation)

MarjorieMAC = 30 cmCC = 34 cm

Using Anthropometric Measures to estimate weight-Number 5 Equation: page 224, table 7.3

Female: (MAC x 1.63)+(CCx1.43)-37.46 Estimated weight = (MAC x 1.63)+(CCx1.43)-

37.46 Estimated weight =(30 x 1.63)+(34x1.43)-

37.46= Estimated weight = 48.9+48.62-37.46=60kg Estimated weight = 60kgx2.2pounds/kg=132

poundsMarjorieMAC = 30 cmCC = 34 cm

Using Anthropometric Measures to estimate weight-Number 6 Known: KH and MAC (both in cm) Equation: page 225, table 7.4 Convert your answer to pounds

Est. weight = (KHx1.09)+(MAC x 3.14)-83.72

= (substitute numbers and complete calculation) 50 y.o. black male

KH = 42 cmMAC = 30 cm

Using Anthropometric Measures to estimate weight-Number 6 Known: KH and MAC (both in cm) Equation: page 225, table 7.4 Convert your answer to pounds

Est. weight = (KHx1.09)+(MAC x 3.14)-83.72 Est. weight = (42x1.09)+(30 x 3.14)-83.72 Est. weight = (45.78)+(94.2)-83.72 Est. weight = 55.96 kg 55.96 kg x 2.2 pound/kg = 123 pounds

50 y.o. black maleKH = 42 cmMAC = 30 cm

Calculating REEQuestion 7 Calculate the REE for Ms. Geneva

What results do you get with each of the methods below? Mifflin-St. Jeor Harris-Benedict WHO National Academy of Sciences

How do they compare? Which method do you like better and why? Apply an activity factor for average activity

to each of your results. List the answer separately.

48 year old patient, Ms. GenevaFemale with right below-knee amputationHeight: 5’6”Actual body weight: 155#

Ms. Geneva- Mifflin-St. Jeor

48 year old female patient, s/p R BKA Height: 5’6”=66inx2.54cm/in=167.6cm Actual body weight: 155# x

1kg/2.2#=70.5kg Female: REE = 10×weight + 6.25×height -

5×age - 161 REE= (10x70.5)+(6.25x167.6)-(5x48)-161 REE= (705)+(1047.5)-(240)-161 REE= 1351.5 kcal/day

Ms. Geneva-Harris Benedict

48 year old female patient, s/p R BKA Height: 5’6”=66inx2.54cm/in=167.6cm Actual body weight: 155#x1kg/2.2#=70.5kg p 232, table 7.7 REE=655.1+9.6W+1.9S-4.7A REE=655.1+(9.6x70.5)+(1.9x167.6)-(4.7x48) REE=655.1+676.8+318.4-225.6 REE=1425 kcal/day

Ms. Geneva- WHO

48 year old female patient, s/p R BKA Height: 5’6”=66inx2.54cm/in=167.6cm Actual body weight:

155#x1kg/2.2#=70.5kg p 232, table 7.7 REE=8.7W+829 REE=8.7x70.5+829 REE=613.4+829 REE=1442kcal/d

Ms. Geneva- NAS

48 year old female patient, s/p R BKA Height:

5’6”=66inx2.54cm/inx1m/100cm=1.68m Actual body weight: 155#x1kg/2.2#=70.5kg p 233, table 7.8 REE=247-(2.67xA)+(401.5xht)+(8.6xwt) REE=246-

(2.67x48)+(401.5x1.68)+(8.6x70.5) REE=245-128.2+674.5+606.3 REE=1398kcal/d

Compare

Mifflin-St. Jeor REE=1351 kcal/d

Harris Benedict REE=1425 kcal/d

WHO REE=1442 kcal/d

NAS REE=1398 kcal/d

How do you think these equations compare?

EER-Number 8

P 233-234, table 7.9 EER for males >19 years EER= (substitute numbers and complete

calculation)

29 y.o. malePA=physical activity factorHt in m= 1.78m wt in kg=90.5PA=1.11 (low active)age=45

EER-Number 8

P 233-234, table 7.9 EER for males >19 years PA=physical activity factor Ht in m= 1.78m, wt in kg=90.5, PA=1.11 (low active),

age=45 EER=662-9.53(age)+PA x(15.91x wt+539.6 x ht) EER=662-9.53(45y)+1.11 x(15.91x 90.5kg+539.6 x 1.78m) EER=662-428.85+1.11 x( 1439.9+ 960.49) EER=662-428.85+1.11 x( 2400.39) EER=662-428.85+ 2664.4 EER=2897.55 kcal

Calculate TEE for Overweight Adults- Number 9 Complete the calculations for Ms. Geneva

using the TEE equation in Table 7.10 on page 235.

48 year old female patient, s/p R BKA Height: 5’6”=66inx2.54cm/in=167.6cm Actual body weight:

155#x1kg/2.2#=70.5kg Use an activity factor for active adults. = (substitute numbers and complete

calculation)

Calculate TEE for Overweight Adults- Number 9

48 year old female patient, s/p R BKA Height: 5’6”=66inx2.54cm/in=167.6cm Actual body weight: 155#x1#/2.2kg=70.5kg TEE=448-(7.95xage)+PA x(11.4x Wt + 619x ht) TEE=448-(7.95x48)+1.27 x(11.4x70.5+619x1.68) TEE=448-(7.95x48)+1.27 x(803.7+1039.9) TEE=448-384.6+1.27 x 1843.6 TEE=448-384.6+2341.4 TEE=2405kcal/d

Ireton-Jones-number 10

Ireton-Jones recommended for overweight individuals in critical condition

Activity factors (AF): box 7.3, page 233 Injury factors (IF): table 7.11, page 237 Obesity factor: 1=BMI>27, 0=BMI<27 IJEE: 629-11(age)+25(wt)-609(obesity

factor)

Ireton-Jones Energy ExpenditureNumber 10

Ireton-Jones Equation IJEE = 629 - 11 (A) + 25 (W) - 609 (O)

A = age in years, W = weight in kg, O= obesity Obesity : BMI >27 = 1, BMI ≤27 = 0

Kcals = IJEE x AF x IF Activity factors (AF) - Box 7.3, p. 233 Injury factors (IF) -Table 7.11, p. 237 IJEE = (substitute numbers and complete

calculation)50 year old female, confined to bed after minor surgeryHt: 5’4”Actual body weight: 176#BMI = 30.2

Ireton-Jones Energy ExpenditureNumber 10

Ireton-Jones Equation IJEE = 629 - 11 (A) + 25 (W) - 609 (O) IJEE=629 –(11x 50)+(25x80)-609(1) IJEE=629 – 550+2000-609 IJEE=1470 kcal/day

50 year old female, confined to bed after minor surgeryHt: 5’4”Actual body weight: 176#BMI = 30.2

Ireton-Jones Energy ExpenditureNumber 10

Ireton-Jones Equation IJEE = 629 - 11 (A) + 25 (W) - 609 (O) IJEE=629 –(11x 50)+(25x80)-609(1) IJEE=629 – 550+2000-609 IJEE=1470 kcal/day Kcals = IJEE x AF x IF

Activity factors (AF) – confined to bed=1.2 Injury factors (IF) –minor surgery=1.0-1.1

Kcals = 1470 x 1.2 x 1.1 Kcals= 1940 kcal/day 50 year old female, confined to bed after

minor surgeryHt: 5’4”Actual body weight: 176#

Estimating Protein Needs- Number 11 Estimate Ms. Geneva’s protein needs for

an individual who has undergone major surgery.

P 239, table 7.13

48 year old patient, Ms. GenevaFemaleHeight: 5’6”Actual body weight: 155#

Estimating Protein Needs Number 11 Estimate Ms. Geneva’s protein needs for

an individual who has undergone major surgery. Moderate stress level: 1.2-1.8 gm/kg

Estimating Protein Needs Number 11 Estimate Ms. Geneva’s protein needs for

an individual who has undergone major surgery. Moderate stress level: 1.2-1.8 gm/kg

155 # = 70.45 kg 70.45 x 1.2 = 84.54 gm protein/d 70.45 x 1.8 = 126.81 gm protein/d

Questions About Assessment of Hospitalized Patients?

Farewell Thank you for your kind attention

and participation! Email any time - ahabeck@kaplan.edu Follow me on Twitter

@ProfAmyH