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

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

3. 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

4. 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

5. Nutrition Screening - Hospital Nutrition Screening Nutritionist develop support plan Faster Recovery Shorter Stay Save Health Care $$

6. 1 Nutrition Screening to determine risk status. If yes, referral to nutritionist 2 Nutritionist completes an in-depth Nutritional Assessment to determine level of risk 3 Nutritionist develops a support plan 4 Nutritionist monitors patient’s nutritional status 4 Step Process to Assess Nutrition Lee and Nieman, 2007

7. 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”

8. Level II Screen BMI Mid-Arm Circumference Triceps Skin Fold Mid-Arm Muscle Circumference Albumin Cholesterol Drug use

9. 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

10. QUESTIONS??

11. 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

12. Estimating Stature – Knee Height Knee Height – correlates highly with stature Example AB is a 58 year old black female Her knee height is 48 cm Using the equation on page 227, what is AB’s estimated stature?

13. 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

14. 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

15. QUESTIONS??

16. Estimating Body Weight Tools Midarm Circumference (MAC) Calf Circumference (CC) Subscapular Skinfold Thickness (SSF)

17. 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

18. 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

19. 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

20. QUESTIONS??

21. Estimating Body Weight Body weight can be estimated from various anthropometric measures Table 7.3 shows some equations

22. Estimating Body Weight - Example AB is a 65 year old black female Her knee height is 48 cm Her MAC is 30 cm Her CC is 35 Her SSF is 28.5 mm What is her estimated body weight?

23. 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

24. Estimating Body Weight - Amputations Body PartContribution to Body Weight (%) Entire Arm6.5% Upper Arm3.5% Forearm2.3% Hand0.8% Entire Leg18.5% Upper Leg11.6% Lower Leg5.3% Foot1.8% Adjusted Weight = Current Weight x 100 100 - % of amputation

25. Estimating Body Weight - Amputations BC has a current weight of 165 pounds Amputation at the right knee What is the patient’s adjusted weight?

26. 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

27. QUESTIONS??

28. Energy Needs Based on an individual’s 24-hour expenditure Determined by resting energy expenditure Thermic effect of food Energy expended in physical activity Whether disease or injury is present

29. 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

30. Energy Needs – Resting Energy Expenditure (REE) Harris Benedict Equation CD is a 35 year old male His weight is 87 kg His stature is 182 cm What is CD’s Resting Energy Expenditure (REE) based on the Harris Benedict Equation?

31. 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

32. 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

33. What Increases 24-hour Energy Expenditure? Surgery Trauma Infection Burns Various diseases

34. Energy Needs – Injury Factors ConditionInjury Factor Minor Surgery1.0 – 1.1 Major Surgery1.1 – 1.3 Mild Infection1.0 – 1.2 Moderate Infection1.2 – 1.4 Severe Infection1.4 – 1.8 Skeletal or Blunt Trauma1.2 – 1.4 Skeletal or Blunt Trauma (steroid treated) 1.6 – 1.8 Burns involving < 20% BSA1.2 – 1.5 Burns involving 20% - 40% BSA1.5 – 1.8 Burns involving >40% BSA1.8 – 2.0 BSA = Body Surface Area

35. QUESTIONS??

36. Thanks for attending seminar!