WHAT IS NUTRITIONAL ASSESSMENT

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WHAT IS NUTRITIONAL ASSESSMENT?

• Determining the bodys ability to convert food
  into body components.
• When the body can no longer convert food into
  body components we get skin breakdown.

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WHAT IS NUTRITIONAL ASSESSMENT?

• Your residents need sufficient amounts of
  carbohydrates, vitamins/minerals,and proteins in
  their diet to facilitate wound healing.

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HOW DOES STRESS RESPONSE CHANGE METABOLIC
PROCESSES?

• Residents in long term care facilities experience
  physical and emotional stressors.
• The bodys response to this stress can result in
• Energy depletion
• Loss of protein
• Increase risk for skin breakdown
• Muscle wasting
• Decrease in energy needed for wound healing

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GOAL-PREVENTION OF PROTEIN - CALORIE MALNUTRITION
PRESSURE ULCERS

• How does protein-calorie malnutrition impact
  wound healing?

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WOUND HEALING PROCESS AND NUTRITION

• INFLAMATION
• Cellular proliferation
• Connective tissue formation
• Wound contraction
• Wound remodeling
• You have to have adequate nutrition or this does
  not occur.

• Adequate energyprotein
• Adequate energyprotein
• Adequate energyprotein
• Adequate energyprotein

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ACTION!!!
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NUTRITIONAL ASSESSMENT FOR PATIENTS AT RISK FOR
SKIN BREAKDOWN

• Anthropometric ( i.e. weight/height)
• Physical assessment
• Biochemical indexes
• Dietary intake

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ANTHROPOMETRIC ASSESSMENT

• Unusual weight loss over a short period of time
• Downward trend in weight
• Low body mass index between weight and height)

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PHYSICAL SIGNS OF MALNUTRITION

• Involuntary weight loss
• Muscle wasting
• Presence of edema (no cardiac disease)
• Poor wound healing, chronic wounds, pressure
  ulcers

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PHYSICAL SIGNS OF MALNUTRITION

• Glossitis,cracking at edges of mouth
• Hair loss, lack of luster
• Chronic infections
• Listless, apathetic
• Your CENAs should be looking for these signs.

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BIOCHEMICAL MARKERS OF POOR PROTEIN STATUS
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BIOCHEMICAL MARKERS OF POOR PROTEIN STATUS

• It takes 60-90 days for an elderly persons
  protein to increase after surgery. The retinol
  binding protein marker is the best indicator that
  your nutrition program is working

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BIOCHEMICAL MARKERS OF NUTRITIONAL ANEMIAS
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INDICATORS OF POOR NUTRITIONAL INTAKE

• Eating less than 50-75 of foods served
• Eating primarily carbohydrates
• Fluid intake instead of food
• Low fluid intake
• S/S chewing or swallowing problems

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3 METHODS TO DETERMINE RESIDENT CALORIE NEEDS

• Needs based on activity
• Needs based on ideal body weight and activity
• Needs based on basal energy expenditure and
  activity

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HOW MUCH PROTEIN DOES THE PERSON NEED ?
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CALCULATING TOTAL PROTEIN NEEDS
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CALCULATING TOTAL PROTEIN NEEDS

• If your resident has a compromised liver or
  kidney function you need to monitor the amount of
  protein in the diet more closely.

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HOW MUCH FLUID DOES THE PERSON NEED?
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CALCULATING FLUID NEEDS

• Adults 30-35 cc/kg body wt
• Elderly 25-30cc/kg body wt
• If 130 ideal body weight calculate an adjusted
  fluid need
• 1500 (patients weight-20 kg) X 15 ml
• If greater than 100years old give 20cc/kg body
  wt

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HOW DO NUTRIENT NEEDS CHANGE WITH SKIN BREAKDOWN?
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CHANGES WITH A PRESSURE ULCER

• Calorie needs increase from 1.2-2.0 times basal
  energy expenditure
• Protein needs increase from 1.2-2.5gm/kg body
  weight
• Fluid needs increase if fluid losses from ulcer
  are significant

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NUTRIENTS NEEDED FOR WOUND HEALING IN THE ELDERLY

• 55 Carbohydrates
• 30 Fat (There is a decreased risk for heart
  disease with age so fat is not as much of a
  concern)
• 1.5-2.0 Protein/kg (If renal or liver status is
  poor can not tolerate 2.0 gm Protein)
• 10-20gm/d Glutamine (most prominent amino acid
  found in the body and the first one lost)
• 10-20gm/d Arginine (Important amino acid due to
  its tendency to facilitate wound healing faster)
• Arginine and Glutamine used for stage 34 ulcers

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SUPPLEMENTS USED TO ENHANCE HEALING

• Multivitamin/mineral supplement (Can use baby
  vitamins)
• 500 mg Vitamin C(Females 75mg/daily/Males 90mg
  daily) If kidney stones/ kidney problems may want
  to use just multi-vitamins.
• 50 mg elemental Zinc (Zinc competes with Iron and
  Copper. Too much can effect absorption of Iron
  and Copper resulting in increase skin breakdown.
  Stop Zinc when you have wound closure. Dont
  exceed 50mg/day

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HOW DO YOU GET ANOREXIC RESIDENTS WITH WOUNDS TO
EAT?
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STRATEGIES FOR WEIGHT GAIN AND WOUND HEALING

• Small frequent amounts of food (use small
  bowl/plates presenting only small amount of food
  at a time).
• Favorite foods (Can liberalize diet as long as
  there are no adverse effects).
• Foods that are easy to chew swallow
• Use fortified foods

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STRATEGIES FOR WEIGHT GAIN AND WOUND HEALING

• Nutrient dense beverages for medication pass
• Vitamin/mineral supplements
• Pharmacological intervention
• Appetite stimulants (Can be very expensive)
• Anabolic steroids (Promotes protein build up and
  weight gain)

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PUTTING THE PUZZLE TOGETHER TAKES

• Total patient assessment
• Long-range vision
• Communication