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Unit 4 NS270 Nutritional Assessment and Management

Unit 4 NS270 Nutritional Assessment and Management. Amy Habeck, RD, MS, LDN. Recognition. Presentation download Good sources Excellent writing skills. Unit 4 Learning Objectives:. Practice Calculations Review- Nutrition and Diet Therapy Chapter 7 – Assessment of the Hospitalized Patient

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Unit 4 NS270 Nutritional Assessment and Management

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  1. Unit 4NS270 Nutritional Assessment and Management Amy Habeck, RD, MS, LDN

  2. Recognition • Presentation download • Good sources • Excellent writing skills

  3. Unit 4 Learning Objectives: • Practice Calculations • Review- Nutrition and Diet Therapy • Chapter 7 – Assessment of the Hospitalized Patient • Answer your questions

  4. Assessing Nutritional Status • 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?

  5. Examples of diagnoses that indicate nutritional risk • Dysphagia • Bowel resection • FTT • COPD • Pressure ulcers • Cancer • HIV/AIDS • Stroke or hemiparesis • GI bleeding • Crohn’s disease • Organ transplant • CAD • DM • Pancreatitis • SBO • Short bowel syndrome

  6. Nutritional Assessment • Ht • Wt • UBW • History • Diagnosis • Test results • Anthropometric measurements • Biochemical measures • REE • Specialized nutritional assessment

  7. Case Study • Helen is a 72 y.o. • Hx: osteoporosis with compression fx KH=knee height=16.5 inches A= age=72 • How can you estimate her height? table 7.1, page 219 Same type of question as #1

  8. Case Study • Helen is a 72 y.o. • Hx: osteoporosis with compression fx • How can you estimate her height? Table 7.1 page 219 S=75.00 +(1.91 KH)-(0.17A) S=stature KH=knee height A= age

  9. Case Study-Estimate Stature S=75.00 +(1.91 KH)-(0.17A) S=stature KH=knee height in cm KH=16.5 inches KH=16.5 in x 2.54cm/in=41.91cm A= age=72 S=75.00+(1.91x41.91)-(0.17x72) S=75.00+80-12.2 S=142.8 cm

  10. Evaluating Desirable Body Weight- • Hamwi equations • 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?

  11. Let’s Practice-Number 4 • 48 year old patient, Ms. Geneva • Female • Height: 5’6” • Actual body weight: 155# • What is her desirable or ideal body weight? • Use the Hamwi equation • Page 170-171

  12. Let’s Practice • 48 year old patient, Ms. Geneva • Female • Height: 5’6” • What is her desirable or ideal body weight? • Women: 5’=100 + (5x6) +/- 10% • 130+/- 10% or 130x.9 to 130x1.1 • 117-143#

  13. %IBW • 48 year old patient , Ms. Geneva • Female • Height: 5’6” • Actual body weight: 155# • Calculate her percent IBW using the IBW determined by the Hamwi equation on previous slide.

  14. %IBW • 48 year old patient , Ms. Geneva • Female • Height: 5’6” • Actual body weight: 155# • Calculate her percent IBW using the IBW determined by the Hamwi equation. • IBW: 117-143# • Actual body weight/IBW x 100= • 155/117-143 x100=132-108% IBW

  15. Amputation Adjustments-number 2 • Page 225, table 7.5 • 48 year old patient, R BKA (right leg, below knee amputation) • Female • Height: 5’6” • Actual body weight: 155# • What percentage of her body weight would the right below knee amputation represent? • How would you adjust her IBW to account for the loss of the partial limb?

  16. Amputation Adjustments • What percentage of her body weight would the right below knee amputation represent? • Lower leg represents 7.1% (5.3+1.8) of body weight • How would you adjust her IBW to account for the loss of the partial limb? • Adjusted weight= current weight/(100-% amp) x 100 • Adjusted weight=155/(100-7.1) x 100 = 166.8#

  17. Calculate BMI based on adjusted body weight-number 3 P176, classification table 6.6 • Adjusted weight=155/(100-7.1) x 100 = 166.8# • Ht= 5’6”=66” • BMI based on adjusted body weight= BMI=ABW(pounds)/ht(in)/ht(in)x703= BMI=166.8/66/66x703=26.9

  18. Using Anthropometric Measures to estimate weight-practice • Number 5 • Known: MAC and CC (both in cm) • Equation: page 224, table 7.3 • Female: (MAC x 1.63)+(CCx1.43)-37.46 • Male: (MACx2.31)+(CCx1.5)-50.10 • Sample: MAC=30 cm, CC=34cm, female • (MAC x 1.63)+(CCx1.43)-37.46= • (30 x 1.63)+(34x1.43)-37.46= • 48.9+48.62-37.46=60kg • 60kgx2.2pounds/kg=132

  19. Using Anthropometric Measures to estimate weight-practice • Number 6 • Known: KH and MAC (both in cm) • Equation: page 225, table 7.4

  20. 24 Hour Energy Expenditure • What factors make up the energy expended in a 24 hour period? • How is BMR measured?

  21. 24 Hour Energy Expenditure • 24 hour energy expenditure= • Resting energy expenditure • Thermic effect of food • Thermic effect of exercise • Thermic effect of disease or injury • 24 hour EE=REE+TEF+TEE+TED • How is BMR measured? • 6-12 minutes period in post-absorptive state • 30 minutes of quiet rest preceeding testing • Thermally neutral environment • Measure oxygen consumption

  22. Calculating REE • Calculate the REE for Ms. Geneva • What results do you get with each of the methods below? • 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.

  23. 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 • 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

  24. 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 • REE=8.7W+829 • REE=8.7x70.5+829 • REE=613.4+829 • REE=1442kcal/d

  25. 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 • 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

  26. Compare • Harris Benedict • REE=1425kcal/d • WHO • REE=1442kcal/d • NAS • REE=1398kcal/d • How do you think these equations compare? • Which one is easiest to use and remember?

  27. Calculate TEE for Overweight Adults-number 9 • Complete the calculations for Ms. Geneva using the TEE equation in Table 7.10 on page 235. • Use an activity factor for active adults.

  28. Calculate TEE for Overweight Adults • 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

  29. Injury Factors • Assume our same patient, Ms. Geneva, has undergone major surgery. • How does that affect her energy requirements? • What do you estimate her energy requirements to be after the surgical procedure?

  30. Injury Factors – Major Surgery • What do you estimate her energy requirements to be after the surgical procedure? • Major surgery increases energy requirements by a factor of 1.1-1.3 times original TEE • TEE=2405kcal/d x (1.1 to 1.3) • TEE=2646-3127kcal/d

  31. Estimating Protein Needs-number 11 • Estimate Ms. Geneva’s protein needs for an individual who has undergone major surgery. • How can you determine if she is meeting her protein requirements? • P 239, table 7.13

  32. Estimating Protein Needs • Estimate Ms. Geneva’s protein needs for an individual who has undergone major surgery. • Moderate stress level: 1.2-1.8 gm/kg • How can you determine if she is meeting her protein requirements? • UUN • Calorie count assessment

  33. Nitrogen Balance • Ms. Geneva • Protein intake: 84 gm protein • Determined from 24 hour calorie count • UUN = 10 • Measured from 24 hour urine collection • Is she is positive or negative N2 balance? • How did you calculate it?

  34. Nitrogen Balance • Ms. Geneva • Protein intake: 84 gm protein • UUN = 10 • Is she is positive or negative N2 balance? • Negative nitrogen balance • How did you calculate it? • See next slide

  35. Calculating Nitrogen Balance • Ms. Geneva • Protein intake: 84 gm protein • UUN = 10 • How do you calculate N2Balance? • N2 balance = (protein intake/6.25) – UUN-4 • N2 balance=(84 gm/6.25)-10-4 • N2 balance=13.44-10-4 • N2 balance=-0.56

  36. EER-number 8sample • 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

  37. 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)

  38. Questions About Assessment of Hospitalized Patients?

  39. Farewell • Thank you for your kind attention and participation! • Email any time - ahabeck@kaplan.edu

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