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Unit 4 NS270 Nutritional Assessment and Management

You’ll need: Calculator Presentation (found in Doc Sharing). Unit 4 NS270 Nutritional Assessment and Management. Amy Habeck, RD, MS, LDN. Unit 4 Learning Objectives:. Practice Calculations Unit 4 project calculations Review- Nutrition and Diet Therapy

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Unit 4 NS270 Nutritional Assessment and Management

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  1. You’ll need: • Calculator • Presentation (found in Doc Sharing) Unit 4NS270 Nutritional Assessment and Management Amy Habeck, RD, MS, LDN

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

  3. 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

  4. 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

  5. Case Study-Question 1 S=stature KH=knee height (cm) A= age • How can you estimate her height? Table 7.1 page 219 S=75.00 +(1.91 KH)-(0.17A) Equation for white female >60 y.o. = (substitute numbers and complete calculation) 72 year old female History of osteoporosis with compression fracture KH = 16.5 inches

  6. Case Study- Question 1 S=stature KH=knee height (cm) A= age KH=16.5 in x 2.54cm/in=41.91cm A= age=72 S=75.00 +(1.91x KH)-(0.17xA) S=75.00+(1.91x41.91)-(0.17x72) S=75.00+80-12.2 S=142.8 cm 72 year old female History of osteoporosis with compression fracture KH = 16.5 inches

  7. 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) Helen Wt = 115 Amputation =Lower leg and foot

  8. 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) Helen Wt = 115 Amputation =Lower leg and foot = 5.3 + 1.8= 7.1%

  9. 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 Helen Wt = 115 Amputation =Lower leg and foot = 5.3 + 1.8= 7.1%

  10. Calculate BMI based on adjusted body weight-Question 3 P176 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) Justin Entire right leg amputation Ht: 5’6” = 66” ABW: 178 pounds

  11. Calculate BMI based on adjusted body weight-Question 3 P176, 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 Justin Entire right leg amputation Ht: 5’6” ABW: 178 pounds

  12. 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?

  13. 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. Geneva Female Height: 5’6” Actual body weight: 155#

  14. 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. Geneva Female Height: 5’6” Actual body weight: 155#

  15. 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) Marjorie MAC = 30 cm CC = 34 cm

  16. 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 pounds Marjorie MAC = 30 cm CC = 34 cm

  17. 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 cm MAC = 30 cm

  18. 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 male KH = 42 cm MAC = 30 cm

  19. 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. Geneva Female with right below-knee amputation Height: 5’6” Actual body weight: 155#

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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?

  25. EER-Number 8 • P 233-234, table 7.9 • EER for males >19 years • EER= (substitute numbers and complete calculation) 29 y.o. male PA=physical activity factor Ht in m= 1.78m wt in kg=90.5 PA=1.11 (low active) age=45

  26. 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

  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. • 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)

  28. 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

  29. 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)

  30. 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 surgery Ht: 5’4” Actual body weight: 176# BMI = 30.2

  31. 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 surgery Ht: 5’4” Actual body weight: 176# BMI = 30.2

  32. 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 surgery Ht: 5’4” Actual body weight: 176#

  33. 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. Geneva Female Height: 5’6” Actual body weight: 155#

  34. 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

  35. 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

  36. Questions About Assessment of Hospitalized Patients?

  37. Farewell • Thank you for your kind attention and participation! • Email any time - ahabeck@kaplan.edu • Follow me on Twitter • @ProfAmyH

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