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NutritionalNutritional AssessmentAssessment
IDENTIFICATION OF NUTRITIONAL IDENTIFICATION OF NUTRITIONAL DEFICIENCIESDEFICIENCIES
CLASSIFICATION OF MALNUTRITIONCLASSIFICATION OF MALNUTRITION
ESTIMATION OF NUTRITIONAL ESTIMATION OF NUTRITIONAL REQUIRMENTSREQUIRMENTS
Nutritional AssessmentNutritional Assessment
S.O.A.P.S.O.A.P.
SUBJECTIVE DATASUBJECTIVE DATA
OBJECTIVE DATAOBJECTIVE DATA
ASSESSMENTASSESSMENT
PLANPLAN
Nutritional AssessmentNutritional AssessmentNutrition Support TeamNutrition Support Team
PhysicianPhysician Dietitian Dietitian- - DiagnosisDiagnosis - Nutritional Assessment - Nutritional Assessment
- Placement of CVC- Placement of CVC - Enteral Nutrition - Enteral Nutrition- Team Leader- Team Leader - Transitional Feedings - Transitional Feedings
NurseNurse Pharmacist Pharmacist- Maintenance of CVC- Maintenance of CVC - Admixture Preparation - Admixture Preparation- Physical Assessment - Admixture Formulation- Physical Assessment - Admixture Formulation- Patient Training- Patient Training - Drug-Nutrient - Drug-Nutrient
InteractionsInteractions
Nutritional Nutritional AssessmentAssessmentSUBJECTIVE DATASUBJECTIVE DATA
• USUAL WEIGHTUSUAL WEIGHT
• RECENT CHANGES IN WEIGHTRECENT CHANGES IN WEIGHT
• FOOD ALLERGIES/ INTOLERANCESFOOD ALLERGIES/ INTOLERANCES
• SPECIAL DIETSPECIAL DIET
• 24 HOUR DIETARY RECALL24 HOUR DIETARY RECALL
Nutritional Nutritional AssessmentAssessmentSUBJECTIVE DATASUBJECTIVE DATA
• FOOD DRUG INTERACTIONSFOOD DRUG INTERACTIONS
• ALCOHOL / DRUG ABUSEALCOHOL / DRUG ABUSE
• VITAMIN / MINERAL SUPPLIMENTSVITAMIN / MINERAL SUPPLIMENTS
• ECONOMICSECONOMICS
• ACTIVITYACTIVITY
Nutritional Nutritional AssessmentAssessmentBODY COMPARTMENTSBODY COMPARTMENTS
SKELETON 10%
EXTRACELLULAR 20%
PLASMA PROTEIN 3%
VISCERAL PROTEINS 8%
SOMATIC PROTEINS 30%
ADIPOSE TISSUE 25%
Nutritional Nutritional AssessmentAssessmentBODY COMPARTMENTSBODY COMPARTMENTS
Serum Albumin, Transferrin
Arm Muscle CircumferenceBody WeightCreatinine Height Index
ASSESSED BYTriceps SkinfoldBody Weight
SKELETON 10%
EXTRACELLULAR 20%
PLASMA PROTEIN 3%
VISCERAL PROTEINS 8%
SOMATIC PROTEINS 30%
ADIPOSE TISSUE 25%
Nutritional AssessmentNutritional AssessmentOBJECTIVE DATAOBJECTIVE DATA
SOMATIC COMPARTMENTSOMATIC COMPARTMENT
• WEIGHT (ACTUAL)WEIGHT (ACTUAL)
• HEIGHTHEIGHT
• IDEAL BODY WEIGHT (IBW)IDEAL BODY WEIGHT (IBW)
FEMALE:IBW=100 LB +(5 LB X EVERY INCH >5 FT)FEMALE:IBW=100 LB +(5 LB X EVERY INCH >5 FT)
MALE: IBW=106 lb +(6 lb FOR EVERY INCH >5 FT)MALE: IBW=106 lb +(6 lb FOR EVERY INCH >5 FT)
Nutritional AssessmentNutritional AssessmentOBJECTIVE DATAOBJECTIVE DATA
SOMATIC COMPARTMENTSOMATIC COMPARTMENT
• ANTHROPOMETIRICSANTHROPOMETIRICS
• MID ARM CIRCUMFERENCE (MAC)MID ARM CIRCUMFERENCE (MAC)
• TRICEPS SKIN FOLD (TSF)TRICEPS SKIN FOLD (TSF)
• MID ARM MUSCLE CIRUMFERENCE (MAMC)MID ARM MUSCLE CIRUMFERENCE (MAMC)
MAMC=MAC MAMC=MAC cmcm – (TSF – (TSF mm mm X 0.314)X 0.314)
Nutritional AssessmentNutritional AssessmentOBJECTIVE DATAOBJECTIVE DATA
SOMATIC COMPARTMENTSOMATIC COMPARTMENT
< 800800-11991200-2000> 2000Total Lymphocyte Count (TLC)
2-3 d<55-1010-15>15Prealbumin
8 d<100100-150151-200>200Transferrin
20 d< 2.12.1-3.03.1-3.5> 3.5Albumin
t 1/2Severe ModerateMildNormalMARKER
Nutritional Nutritional AssessmentAssessmentCLASSIFICATION OF MALNUTRITIONCLASSIFICATION OF MALNUTRITION
• MARASUS MARASUS -DEPLETION IN THE SOMATIC -DEPLETION IN THE SOMATIC
COMPARTMENTCOMPARTMENT
• KWASHIORKORKWASHIORKOR -DEPLETION IN THE VISCERAL -DEPLETION IN THE VISCERAL
COMPARTMENTCOMPARTMENT
• MARASMUS-KWASHIORKOR MIXMARASMUS-KWASHIORKOR MIX -DEPLETION IN BOTH COMPARTMENTS-DEPLETION IN BOTH COMPARTMENTS
Nutritional Nutritional AssessmentAssessmentCASE STUDYCASE STUDY
Ms. A. is a 35-Y-O female that has been trapped in Ms. A. is a 35-Y-O female that has been trapped in chocolate factory for the past five months. She is 5 ft. tallchocolate factory for the past five months. She is 5 ft. talland weighs 200 lbs. She has been admitted to the hospitaland weighs 200 lbs. She has been admitted to the hospitalfor evaluation, following this traumatic experience. Onfor evaluation, following this traumatic experience. Onadmission her albumin is 2.0 and transferrin is 100.admission her albumin is 2.0 and transferrin is 100.
• What is her IBW?What is her IBW?
• Calculate her % of IBWCalculate her % of IBW
• What is her nutritional diagnosis?What is her nutritional diagnosis?
Nutritional Nutritional AssessmentAssessmentCASE STUDYCASE STUDY
Ms. A. is a 35-Y-O female that has been trapped in Ms. A. is a 35-Y-O female that has been trapped in chocolate factory for the past five months. She is 5 ft. tallchocolate factory for the past five months. She is 5 ft. talland weighs 200 lbs. She has been admitted to the hospitaland weighs 200 lbs. She has been admitted to the hospitalfor evaluation, following this traumatic experience. Onfor evaluation, following this traumatic experience. Onadmission her albumin is 2.0 and transferrin is 100.admission her albumin is 2.0 and transferrin is 100.F.F. What is her IBW?What is her IBW?
IBW = 100 lb + (5 X EVERY in OVER 5 ft)IBW = 100 lb + (5 X EVERY in OVER 5 ft)
IBW = IBW = 100 lb100 lb
I.I. Calculate her % of IBW Calculate her % of IBW ACTUAL WT / IBW = % IBWACTUAL WT / IBW = % IBW
200 lb / 100 lb = 200 lb / 100 lb = 200% IBW200% IBW• What is her nutritional diagnosis? What is her nutritional diagnosis? KWASHIORKORKWASHIORKOR
Nutritional Nutritional AssessmentAssessmentCASE STUDYCASE STUDY
Mr. B is a 24-Y-O male that has recently been returnedMr. B is a 24-Y-O male that has recently been returnedfrom captivity on a south sea island, where he was heldfrom captivity on a south sea island, where he was heldprisoner by 15 women. He is 6 ft. tall and weighs 125 lbs.prisoner by 15 women. He is 6 ft. tall and weighs 125 lbs.Upon admission to the hospital his serum albumin is 3.5 Upon admission to the hospital his serum albumin is 3.5 and his transferring is 175.and his transferring is 175.
H.H. B. What is his IBW?B. What is his IBW?
J.J. Calculate his % of IBW Calculate his % of IBW
• What is his nutritional diagnosis?What is his nutritional diagnosis?
Nutritional Nutritional AssessmentAssessmentCASE STUDYCASE STUDY
Mr. B is a 24-Y-O male that has recently been returnedMr. B is a 24-Y-O male that has recently been returnedfrom captivity on a south sea island, where he was heldfrom captivity on a south sea island, where he was heldprisoner by 15 women. He is 6 ft. tall and weighs 125 lbs.prisoner by 15 women. He is 6 ft. tall and weighs 125 lbs.Upon admission to the hospital his serum albumin is 3.5 Upon admission to the hospital his serum albumin is 3.5 and his transferring is 175.and his transferring is 175.F.F. B. What is his IBW?B. What is his IBW?
IBW = 106 lb + (6 X EVERY in OVER 5 ft)IBW = 106 lb + (6 X EVERY in OVER 5 ft)
IBW = IBW = 178 lb178 lb
I.I. Calculate his % of IBW Calculate his % of IBW ACTUAL WT / IBW = % IBW ACTUAL WT / IBW = % IBW
125 lb / 178 lb = 125 lb / 178 lb = 70% IBW70% IBW• What is his nutritional diagnosis? What is his nutritional diagnosis? MARASMUSMARASMUS
Nutritional Nutritional AssessmentAssessmentESTIMATION OF CALORIC REQUIRMENTSESTIMATION OF CALORIC REQUIRMENTS
HARRIS BENEDICT EQUATIONSHARRIS BENEDICT EQUATIONS
MALEMALEBEE = 66 + (13.7 X Wt) + (5 X Ht) – (6.8 X Age)BEE = 66 + (13.7 X Wt) + (5 X Ht) – (6.8 X Age)
FEMALEFEMALEBEE=655 + (9.6 X Wt) + (1.7 X Ht) – (4.7 x Age)BEE=655 + (9.6 X Wt) + (1.7 X Ht) – (4.7 x Age)
Wt in Kg Ht in cm Age in yearsWt in Kg Ht in cm Age in years
Nutritional Nutritional AssessmentAssessmentESTIMATION OF CALORIC REQUIRMENTSESTIMATION OF CALORIC REQUIRMENTS
HARRIS BENEDICT EQUATIONSHARRIS BENEDICT EQUATIONS
CAL REQ=BEE X ACTIVITY FACTOR X INJURY FACTORCAL REQ=BEE X ACTIVITY FACTOR X INJURY FACTOR
ACTIVITY FACTORSACTIVITY FACTORS• 1.2 CONFINED TO BED1.2 CONFINED TO BED• 1.3 AMBULATORY1.3 AMBULATORY• 1.4 ACTIVE1.4 ACTIVE
Nutritional Nutritional AssessmentAssessmentESTIMATION OF CALORIC REQUIRMENTSESTIMATION OF CALORIC REQUIRMENTS
HARRIS BENEDICT EQUATIONSHARRIS BENEDICT EQUATIONS
CAL REQ=BEE X ACTIVITY FACTOR X INJURY FACTORCAL REQ=BEE X ACTIVITY FACTOR X INJURY FACTOR
INJURY FACTORSINJURY FACTORS 1-1.2 MINOR SURGERY 1-1.2 MINOR SURGERY
2.1 SEVERE THERMAL BURN2.1 SEVERE THERMAL BURN1.2-1.5 PERITONITIS1.2-1.5 PERITONITIS 1.35 SKELETAL TRAUMA1.35 SKELETAL TRAUMA1.4-1.8 SEPSIS1.4-1.8 SEPSIS 1.75 AIDS1.75 AIDS1.14-1.37 SOFT TISSUE TRAUMA1.14-1.37 SOFT TISSUE TRAUMA
Nutritional Nutritional AssessmentAssessmentESTIMATION OF CALORIC REQUIRMENTSESTIMATION OF CALORIC REQUIRMENTS
SHORT CUT METHODSHORT CUT METHOD
• MAINTENANCE: MAINTENANCE: 30 KCAL/KG30 KCAL/KG
• MODERATE STRESS: 35 KCAL/KGMODERATE STRESS: 35 KCAL/KG
• SEVERE STRESS: SEVERE STRESS: 40 KCAL/KG40 KCAL/KG
(CRITICAL CARE PATIENT – PROVIDE (CRITICAL CARE PATIENT – PROVIDE 25 KCAL/KG)25 KCAL/KG)
Nutritional Nutritional AssessmentAssessmentESTIMATION OF PROTEIN REQUIRMENTSESTIMATION OF PROTEIN REQUIRMENTS
CALORIE TO NITROGEN RATION 150:1CALORIE TO NITROGEN RATION 150:1(1 GM NITROGEN = 150 KCAL)(1 GM NITROGEN = 150 KCAL)
1 GM NITROGEN =6.25 GM PROTEIN1 GM NITROGEN =6.25 GM PROTEIN
PROTEIN = PROTEIN = CAL X 1GM N/150 KCAL X 6.25 GM PRO/GM NCAL X 1GM N/150 KCAL X 6.25 GM PRO/GM N
EXAMPLE: EXAMPLE: 2000 KCAL /150 X 6.25 = 83.3 GM PRO2000 KCAL /150 X 6.25 = 83.3 GM PRO
Nutritional Nutritional AssessmentAssessmentESTIMATION OF PROTEIN REQUIRMENTSESTIMATION OF PROTEIN REQUIRMENTS
BASED ON WEIGHTBASED ON WEIGHT
0.5HEPATIC FAILURE
1-1.2RENAL FAILURE /DIALYSIS
0.8-1CHRONIC RENAL FAILURE
0.5-0.8ACUTE RENAL FAILURE
2MULTIPLE TRAUMA
0.8-1NORMAL PATIENT
GM/KG/DAYPATIENT STATUS
Nutritional Nutritional AssessmentAssessmentNitrogen BalanceNitrogen Balance
NNbalancebalance = N = Ninin – N – Noutout
= N= Ninin – (UUN+3) – (UUN+3)
Goal: Positive nitrogen balance of Goal: Positive nitrogen balance of 4-6 gm/day.4-6 gm/day.
Nutritional Nutritional AssessmentAssessmentNitrogen BalanceNitrogen Balance
What is the nitrogen balance of a What is the nitrogen balance of a patient who takes in 65 gm of protein patient who takes in 65 gm of protein per day in an enteral feeding and has a per day in an enteral feeding and has a measured 24 hr UNN of 7.2gm?measured 24 hr UNN of 7.2gm?
NNbalance balance = N= Ninin – (UUN+3) – (UUN+3)
=(65gm pro x =(65gm pro x 1gm N1gm N ) - ( 7.2gm+3gm) ) - ( 7.2gm+3gm) 6.25gm pro6.25gm pro
= 10.4 gm – 10.2 gm = (-0.2gm)= 10.4 gm – 10.2 gm = (-0.2gm)