Keeping the Numbers Simple: Bedside Tips for the Liver Patient

Keeping the Numbers Simple: Bedside Tips for the Liver PatientELIZABETH M. LIMOS, RN-DPHILIPPINE GENERAL HOSPITALUNIVERSITY OF THE PHILIPPINES MANILA

Mini Nutritional Assessment MNALast Name: ____________First Name: ______________Sex: Age: Weight kg: Height cm: Date:_______

Complete the screen by filling in the boxes with the appropriate numbers. Add the numbers for the screen. If score is 11 or less, continue with the assessment to gain a Malnutrition Indicator Score.

Mini Nutritional Assessment MNALast Name: ____________First Name: ______________Sex: Age: Weight kg: Height cm: Date:_______

Complete the screen by filling in the boxes with the appropriate numbers. Add the numbers for the screen. If score is 11 or less, continue with the assessment to gain a Malnutrition Indicator Score.

Diet RecommendationsHigh calorie (35 kcal/kg)Protein: Restricted at 0.6g to 0.8 g/k/d Normal at 1.0 to 1.2 g/k/dSodium restrictionFluid restrictionIncrease dietary fiberSmall frequent meals with bedtime snack

MEASURING YOUR FOOD To make sure your food servings are the right size, you can use: Food scale, Measuring cups, Measuring spoons

This muchis the same as 3 ounces 1 serving of meat, chicken, turkey or fish

1 cup 1 serving of cooked vegetables salads casseroles or stews, such as chili with beans milk cup 1 serving of fruit or fruit juice starchy vegetables, such as potatoes or corn pinto beans and other dried beans rice or noodles cereal 1 ounce 1 serving of snack food

cheese (1 slice) 1 tablespoon 1 serving of salad dressing cream cheese 1 teaspoon 1 serving of

margarine or butter oil mayonnaise

11 3 ounces 1 serving of meat, chicken, turkey or fish

1 cup 1 serving of cooked vegetables salads casseroles or stews, such as chili with beans milk

cup 1 serving of fruit or fruit juice starchy vegetables, such as potatoes or corn pinto beans and other dried beans rice or noodles cereal

1 ounce 1 serving of snack food

cheese (1 slice)

11

Case ScenarioCASE I45 year old male, diagnosed to have chronic hepatitis B carrier with decompensated cirrhosis admitted due to body weakness and anorexiaVital signs: BP = 90/60HR = 109RR = 28T = 37.3CHeight = 56 (1.67meters)Weight = 45kgs

Physical ExaminationPertinent findings:Dry skin, Pale conjunctivae, Icteric sclerae+ spider angiomataAbdomen is globularly tense, +caput medusae, + ascites- + Grade 2 bipedal edema with skin hyperpigmenation

Laboratory ExaminationsCBC: Hgb = 9.7mg % Hct = 36Albumin = 2.3 g/dlProtime = >3 sec prolongedTotal Bilirubin = 7.6 gm/dlSodium = 3.0Potassium = 3.1What is the nutritional status of the patient?What is the nutritional status of the patient?Ht = 5 6 = 66 inches x 2.54 = 167.64 cmDBW = Ht 100 = 167.64 100 = 67.64DBW = 67.64 6.764 = 60.87 or 61 kgWhat is the nutritional status of the patient?% DBW = Actual body weight x 100 Desirable body weight

= 45 kg x 100 61 kg = 74 % Moderate Malnutrition How will you manage the nutritional status of the patient?How will you manage the nutritional status of the patient?High calories (35 kcal/kg/d)Protein restriction (0.6g to 0.8g/kg/d)Sodium restrictionSmall frequent meals and bedtime snackVitamin and mineral supplements as neededHow will you maintain the ideal weight of the patient despite her clinical condition?How will you maintain the ideal weight of the patient despite her clinical condition?DIETCALORIESPROTEIN(g)Low CHON diet 185549Aminoleban Oral32020 (1-1/2 sachet)TOTAL 217569 (35kcal) (1.1g)CASE 252 year old female, diabetic for more than 20 years, hypertensive, admitted due to poor appetite Vital signs:BP = 150/90 mm HgHR = 105RR = 30T = 37.0Height = 55 (1.64 meters) Weight = 40kgs

Physical ExaminationPertinent findings:Pale conjunctivae, dry skin, anicteric sclerae+ spider angiomaAbdomen is flabby and soft, liver edge is nodular+ grade 1 bipedal edema, +palmar erythema

Laboratory ExaminationsCBC: Hgb = 10.9 mg %Serum albumin = 2.8 gmSodium = 2.8 gm/dlPotassium = 3.8 gm/dlFBS = 8.0Creatinine = 2.3 mg/dlUltrasound of the whole abdomen showed incidental finding of liver cirrhosis with ascites

What is the current nutritional status of the patient?What is the current nutritional status of the patient?Ht = 5 5 = 65 inches x 2.54 = 165.1 cmDBW = Ht 100 = 165.1 100 = 65.1DBW = 65.1 6.51 = 58.59 or 59 kg

What is the current nutritional status of the patient?% DBW = Actual body weight x 100 Desirable body weight

= 40 kg x 100 59 kg = 68 % Severe MalnutritionHow will you manage the nutritional derangement of the patient?How will you manage the nutritional derangement of the patient?High calorie (35 kcal/kg)No protein restriction (1.1 g/kg/d)No simple sugar, complex carbohydratesIncrease fiber intakeSodium restrictionFrequent small mealsHow will you maintain the ideal weight of the patient despite her clinical condition?How will you maintain the ideal weight of the patient despite her clinical condition?Calories = 2065 (35 kcal/kg) CHON = 65 gm (1.1g/k/d)CHO = 295 gm (65% NPC)Fat = 70 gm (35% NPC)