NUTRITIONAL ASSESSMENT

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NUTRITIONAL ASSESSMENT
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Nutritional Assessment

• IDENTIFICATION OF NUTRITIONAL DEFICIENCIES
• CLASSIFICATION OF MALNUTRITION
• ESTIMATION OF NUTRITIONAL REQUIRMENTS

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Nutritional Assessment

• S.O.A.P.
• SUBJECTIVE DATA
• OBJECTIVE DATA
• ASSESSMENT
• PLAN

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Nutritional AssessmentNutrition Support Team

• Physician Dietitian
• - Diagnosis - Nutritional Assessment
• - Placement of CVC - Enteral Nutrition
• - Team Leader - Transitional Feedings
• Nurse Pharmacist
• - Maintenance of CVC - Admixture
  Preparation
• - Physical Assessment - Admixture Formulation
• - Patient Training - Drug-Nutrient
  
  Interactions

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Nutritional AssessmentSUBJECTIVE DATA

• USUAL WEIGHT
• RECENT CHANGES IN WEIGHT
• FOOD ALLERGIES/ INTOLERANCES
• SPECIAL DIET
• 24 HOUR DIETARY RECALL

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Nutritional AssessmentSUBJECTIVE DATA

• FOOD DRUG INTERACTIONS
• ALCOHOL / DRUG ABUSE
• VITAMIN / MINERAL SUPPLIMENTS
• ECONOMICS
• ACTIVITY

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Nutritional AssessmentBODY COMPARTMENTS
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Nutritional AssessmentBODY COMPARTMENTS
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Nutritional AssessmentOBJECTIVE DATASOMATIC
COMPARTMENT

• WEIGHT (ACTUAL)
• HEIGHT
• IDEAL BODY WEIGHT (IBW)
• FEMALEIBW100 LB (5 LB X EVERY INCH gt5 FT)
• MALE IBW106 lb (6 lb FOR EVERY INCH gt5 FT)

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Nutritional AssessmentOBJECTIVE DATASOMATIC
COMPARTMENT

• ANTHROPOMETIRICS
• MID ARM CIRCUMFERENCE (MAC)
• TRICEPS SKIN FOLD (TSF)
• MID ARM MUSCLE CIRUMFERENCE (MAMC)
• MAMCMAC cm (TSF mm X 0.314)

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Nutritional AssessmentOBJECTIVE DATASOMATIC
COMPARTMENT
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Nutritional AssessmentCLASSIFICATION OF
MALNUTRITION

• MARASUS
• -DEPLETION IN THE SOMATIC COMPARTMENT
• KWASHIORKOR
• -DEPLETION IN THE VISCERAL COMPARTMENT
• MARASMUS-KWASHIORKOR MIX
• -DEPLETION IN BOTH COMPARTMENTS

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Nutritional AssessmentCASE STUDY

• Ms. A. is a 35-Y-O female that has been trapped
  in
• chocolate factory for the past five months. She
  is 5 ft. tall
• and weighs 200 lbs. She has been admitted to the
  hospital
• for evaluation, following this traumatic
  experience. On
• admission her albumin is 2.0 and transferrin is
  100.
• What is her IBW?
• Calculate her of IBW
• What is her nutritional diagnosis?

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Nutritional AssessmentCASE STUDY

• Ms. A. is a 35-Y-O female that has been trapped
  in
• chocolate factory for the past five months. She
  is 5 ft. tall
• and weighs 200 lbs. She has been admitted to the
  hospital
• for evaluation, following this traumatic
  experience. On
• admission her albumin is 2.0 and transferrin is
  100.
• What is her IBW?
• IBW 100 lb (5 X EVERY in OVER 5 ft)
• IBW 100 lb
• Calculate her of IBW
• ACTUAL WT / IBW IBW
• 200 lb / 100 lb 200 IBW
• What is her nutritional diagnosis? KWASHIORKOR

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Nutritional AssessmentCASE STUDY

• Mr. B is a 24-Y-O male that has recently been
  returned
• from captivity on a south sea island, where he
  was held
• prisoner by 15 women. He is 6 ft. tall and
  weighs 125 lbs.
• Upon admission to the hospital his serum albumin
  is 3.5
• and his transferring is 175.
• B. What is his IBW?
• Calculate his of IBW
• What is his nutritional diagnosis?

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Nutritional AssessmentCASE STUDY

• Mr. B is a 24-Y-O male that has recently been
  returned
• from captivity on a south sea island, where he
  was held
• prisoner by 15 women. He is 6 ft. tall and
  weighs 125 lbs.
• Upon admission to the hospital his serum albumin
  is 3.5
• and his transferring is 175.
• B. What is his IBW?
• IBW 106 lb (6 X EVERY in OVER 5 ft)
• IBW 178 lb
• Calculate his of IBW
• ACTUAL WT / IBW IBW
• 200 lb / 100 lb 200 IBW
• What is his nutritional diagnosis? MARASMUS

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Nutritional AssessmentESTIMATION OF CALORIC
REQUIRMENTS

• HARRIS BENEDICT EQUATIONS
• MALE
• BEE 66 (13.7 X Wt) (5 X Ht) (6.8 X Age)
• FEMALE
• BEE655 (9.6 X Wt) (1.7 X Ht) (4.7 x Age)
• Wt in Kg Ht in cm Age in years

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Nutritional AssessmentESTIMATION OF CALORIC
REQUIRMENTS

• HARRIS BENEDICT EQUATIONS
• CAL REQBEE X ACTIVITY FACTOR X INJURY FACTOR
• ACTIVITY FACTORS
• 1.2 CONFINED TO BED
• 1.3 AMBULATORY
• 1.4 ACTIVE

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Nutritional AssessmentESTIMATION OF CALORIC
REQUIRMENTS

• HARRIS BENEDICT EQUATIONS
• CAL REQBEE X ACTIVITY FACTOR X INJURY FACTOR
• INJURY FACTORS
• 1-1.2 MINOR SURGERY
• 2.1 SEVERE THERMAL BURN
• 1.2-1.5 PERITONITIS
• 1.35 SKELETAL TRAUMA
• 1.4-1.8 SEPSIS
• 1.75 AIDS
• 1.14-1.37 SOFT TISSUE TRAUMA

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Nutritional AssessmentESTIMATION OF CALORIC
REQUIRMENTS

• SHORT CUT METHOD
• MAINTENANCE 30 KCAL/KG
• MODERATE STRESS 35 KCAL/KG
• SEVERE STRESS 40 KCAL/KG

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Nutritional AssessmentESTIMATION OF PROTEIN
REQUIRMENTS

• CALORIE TO NITROGEN RATION 1501
• (1 GM NITROGEN 150 KCAL)
• 1 GM NITROGEN 6.25 GM PROTEIN
• PROTEIN
• CAL X 1GM N/150 KCAL X 6.25 GM PRO/GM N
• EXAMPLE
• 2000 KCAL /150 X 6.25 83.3 GM PRO

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Nutritional AssessmentESTIMATION OF PROTEIN
REQUIRMENTSBASED ON WEIGHT
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