Unit 4 NS270 Nutritional Assessment and Management
description
Transcript of Unit 4 NS270 Nutritional Assessment and Management
![Page 1: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/1.jpg)
UNIT 4NS270 NUTRITIONAL ASSESSMENT AND MANAGEMENT
Amy Habeck, RD, MS, LDN
You’ll need:•Calculator•Presentation (found in Doc Sharing)
![Page 2: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/2.jpg)
Unit 4 Learning Objectives:
1) Practice Calculations1) Unit 4 project calculations
2) Review- Nutrition and Diet Therapya) Chapter 7 – Assessment of the Hospitalized
Patient3) Answer your questions
![Page 3: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/3.jpg)
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
![Page 4: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/4.jpg)
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
![Page 5: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/5.jpg)
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
![Page 6: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/6.jpg)
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
![Page 7: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/7.jpg)
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
![Page 8: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/8.jpg)
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%
![Page 9: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/9.jpg)
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%
![Page 10: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/10.jpg)
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
![Page 11: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/11.jpg)
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
![Page 12: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/12.jpg)
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?
![Page 13: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/13.jpg)
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#
![Page 14: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/14.jpg)
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#
![Page 15: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/15.jpg)
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
![Page 16: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/16.jpg)
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
![Page 17: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/17.jpg)
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
![Page 18: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/18.jpg)
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
![Page 19: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/19.jpg)
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#
![Page 20: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/20.jpg)
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
![Page 21: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/21.jpg)
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
![Page 22: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/22.jpg)
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
![Page 23: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/23.jpg)
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
![Page 24: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/24.jpg)
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?
![Page 25: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/25.jpg)
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
![Page 26: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/26.jpg)
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
![Page 27: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/27.jpg)
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)
![Page 28: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/28.jpg)
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
![Page 29: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/29.jpg)
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)
![Page 30: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/30.jpg)
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
![Page 31: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/31.jpg)
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
![Page 32: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/32.jpg)
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#
![Page 33: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/33.jpg)
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#
![Page 34: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/34.jpg)
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
![Page 35: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/35.jpg)
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
![Page 36: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/36.jpg)
Questions About Assessment of Hospitalized Patients?
![Page 37: Unit 4 NS270 Nutritional Assessment and Management](https://reader030.fdocuments.in/reader030/viewer/2022012914/56815a08550346895dc7567c/html5/thumbnails/37.jpg)
Farewell Thank you for your kind attention
and participation! Email any time - [email protected] Follow me on Twitter
@ProfAmyH