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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 - PowerPoint PPT Presentation
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UNIT 4NS270 NUTRITIONAL ASSESSMENT AND MANAGEMENT
Amy Habeck, RD, MS, LDN
You’ll need:•Calculator•Presentation (found in Doc Sharing)
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
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
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
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
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
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
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%
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%
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
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
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?
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#
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#
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
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
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
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
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#
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
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
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
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
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?
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
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
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)
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
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)
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
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
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#
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#
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
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
Questions About Assessment of Hospitalized Patients?
Farewell Thank you for your kind attention
and participation! Email any time - [email protected] Follow me on Twitter
@ProfAmyH