NS 270 Unit 4 Seminar Nutrition Screening & Assessment of the Hospitalized Patient.

NS 270 Unit 4 Seminar

Nutrition Screening & Assessment of the

Hospitalized Patient

Reminders

Your unit 4 project is due at the end of this unit: Tuesday, 6/14/11, 11:59 pm EST

Nutrition Assessment - Hospital

Purposes Identify persons with malnutrition Protein-energy malnutrition (PEM): 20-50%

of hospitalized patients. Elderly and acutely ill more likely than

younger and less acutely ill. Helps nutritionist prioritize care/time

Lee and Nieman, 2007

Protein – Energy Malnutrition

Patients with PEM have Greater risk of post operative infection Increased length of hospital stay Higher risk of mortality Greater likelihood of hospital readmission

Nutrition Screening - Hospital

4 Step Process to Assess Nutrition

Lee and Nieman, 2007

Level I Screen

Completed by support staff, nursing, MD, dietary technician

Short, easy to complete checklist Often incorporated into a hospital of facility

admission form Usually completed 24 – 48 hours JCAHO “timely, effective and efficient

manner”

Level II Screen

BMI Mid-Arm

Circumference Triceps Skin Fold Mid-Arm Muscle

Circumference Albumin Cholesterol Drug use

Level II Screen

Clinical Features mouth, teeth, gums

chewing, swallowing, stomatitits

glossitis, bone pain, bone fractures, skin changes

Eating Habits Living Environment ADL’s Mental, cognitive

status

QUESTIONS??

Stature and Body Weight

Stature and body weight are important measures to be obtained from hospitalized patients

We need the patient’s stature and body weight in order to determine their energy needs

Estimating Stature – Knee Height

Knee Height – correlates highly with stature

Example AB is a 58 year old black femaleHer knee height is 48 cmUsing the equation on page 227,

what is AB’s estimated stature?

Estimating Stature – Knee Height

S = 68.10 + (1.86 * Knee Height) – (0.06 x Age)

S = 68.10 + (1.86 X 48cm) – (0.06 X 58)

S = 153.9 cm

S = 153.9 cm / 2.54 = 60.59 inches

Estimating Stature – Another alternative

If the patient is bedridden but has not skeletal abnormalities

In supine position, align their body so their lower extremities, trunk, shoulders and head are in a straight line

Mark the bed sheet at the base of the heels and the top of the crown

Measure the distance with a tape measure

QUESTIONS??

Estimating Body Weight Tools

Midarm Circumference (MAC)

Calf Circumference (CC)

Subscapular Skinfold Thickness (SSF)

Midarm Circumference (MAC)

MAC can be used in equations to estimate body weight in nonambulatory patients

Patient in the supine position Can use left or right arm Find the midpoint of the upper arm With palm facing up, measure around the

midpoint of the midarm This measurement is recorded to the

nearest 0.1 cm

Calf Circumference (CC)

CC can be used in equations to estimate body weight

In nonambulatory patients – supine position with knee bent at a 90 degree angle

Measure around the greatest circumference of the lower leg

The circumference should be recorded to the nearest 0.1cm

Subscapular Skinfold Thickness (SSF)

Obtaining subscapular skinfold thickness in the nonambulatory patient are taken with the patient lying on their left or right side

The techniques are still the same as discussed in Chapter 6

Measured in mm

QUESTIONS??

Estimating Body Weight

Body weight can be estimated from various anthropometric measures

Table 7.3 shows some equations

Estimating Body Weight - Example

AB is a 65 year old black femaleHer knee height is 48 cmHer MAC is 30 cmHer CC is 35Her SSF is 28.5 mmWhat is her estimated body

weight?

Estimating Body Weight - Example

Weight = (MAC X 0.98) + (CC X 1.27) + (SSF X 0.40) + (KH X 0.87) – 62.35

Weight = (30 X 0.98) + (35 X 1.27) + (28.5 X 0.40) + (48 X 0.87) – 62.35

Weight = 29.4 + 44.45 + 11.4 + 41.76 – 62.35

Weight = 64.66 kg X 2.2 = 142 pounds

Estimating Body Weight - Amputations

Body Part Contribution to Body Weight (%)

Entire Arm 6.5%

Upper Arm 3.5%

Forearm 2.3%

Hand 0.8%

Entire Leg 18.5%

Upper Leg 11.6%

Lower Leg 5.3%

Foot 1.8%

Adjusted Weight = Current Weight x 100

100 - % of amputation

Estimating Body Weight - Amputations

BC has a current weight of 165 pounds

Amputation at the right knee

What is the patient’s adjusted weight?

Estimating Body Weight - Amputations

Adjusted Weight = Current Weight x 100

100 - % of amputation

Adjusted Weight = 165 x 100

100 – 7.1

Adjusted Weight = 177 pounds

QUESTIONS??

Energy Needs

Based on an individual’s 24-hour expenditure

Determined by resting energy expenditureThermic effect of foodEnergy expended in physical activityWhether disease or injury is present

Energy Needs – Resting Energy Expenditure (REE)

Harris Benedict Equation

Females: REE = 655.1 + 9.6W + 1.9S – 4.7A

Males: REE = 66.5 + 13.8W + 5.0S – 6.8A

W = weight in Kg

S = stature in cm

A = age in years

Energy Needs – Resting Energy Expenditure (REE)

Harris Benedict Equation

CD is a 35 year old maleHis weight is 87 kgHis stature is 182 cmWhat is CD’s Resting Energy

Expenditure (REE) based on the Harris Benedict Equation?

Energy Needs – Resting Energy Expenditure (REE)

Harris Benedict Equation

66.5 + (13.8x87) + (5.0x182) – (6.8x35)

66.5 + 1200.6 + 910 – 238

1939 Kcal

Energy Needs – Thermic Effect of Exercise

Activity Factors Used to Account for the Thermic Effect of Exercise

Confined to Bed: 1.2

Ambulatory: 1.3

Average Activity: 1.5 – 1.75

Highly Active: 2.0

What Increases 24-hour Energy Expenditure?

Surgery

Trauma

Infection

Burns

Various diseases

Energy Needs – Injury Factors

Condition Injury Factor

Minor Surgery 1.0 – 1.1

Major Surgery 1.1 – 1.3

Mild Infection 1.0 – 1.2

Moderate Infection 1.2 – 1.4

Severe Infection 1.4 – 1.8

Skeletal or Blunt Trauma 1.2 – 1.4

Skeletal or Blunt Trauma (steroid treated) 1.6 – 1.8

Burns involving < 20% BSA 1.2 – 1.5

Burns involving 20% - 40% BSA 1.5 – 1.8

Burns involving >40% BSA 1.8 – 2.0

BSA = Body Surface Area

QUESTIONS??

Thanks for attending seminar!