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NUTRITION GUIDELINE FOR

NEURO-PSYCHIATRY
PRACTICE

Nurpudji A.Taslim
Andi Faradilah
NUTRITION DEPARTMENT SCHOOL OF MEDICINE
HASANUDDIN UNIVERSITY

Define

:
The interpretation of information obtained
form dietary, biochemical anthropometric
and clinical studies
Form :
Surveys

(Cross Sectional Survey)


Surveillance (Monitoring of Nutritional Status)
Screening (Determined Risk Level)

Methods

Used in Nitritional Assesment :

Dietary

Methods
Laboratory Methodes
Antropometric Methods
Clinical Methods

DIETARY METHODS

Food

history
Food Frequency
Food Recall 24 hours
Food Habit/Pattern

LABORATORY ASSESSMENT
ROUTINE

URINE
ROUTINE BLOOD
CHEMICAL BLOOD

ANTHROPOMETRIC
METHODS

Body Weight (Kg)


Height (cm)
Mid arm upper circumference (LLA)
Skin fold Thickness
Body Mass Index (BW/HT2)
Ideal Body Weight

CLINICAL METHODS
Clinical

symptom
e.g. edema, pallor, hemiparese
hypoalbuminemia, etc

BODY MASS INDEKS using BODY WEIGHT (BW)


and HEIGHT (HT) Parameter on adult people
BMI = BW (kg) / HT2 (cm)2
BMI (Kg/m2)
Under nutrition

RISK
Co-morbidity

< 18,5

lower

Normal

18,5 22,9

Normal

Risk

23 24,9

mild

Obes I

25 29,9

Moderat

Obes II

> 30

severe

HARRIS BENEDICT equation

FEMALE :
BEE = 655 + (9,6 x BW) + (1,7 x HT) (4,7 x
A)

MALE :
BEE = 66 + (13,7 x BW) + (5 x HT) (6,8 x A)
BW = Body weight (kg)
HT = Height (cm)

A = Age ( year)

Activity Factors
1,2
for pt confined in bed
1,3
for ambulatory pt
1.2 1,75 most normally active person
2,0
extremely active person

Injury factors
1,2 minor surgery
1,35
skeletal trauma
1,44
elective surgery
1,6 1,9 mayor sepsis
1,88
trauma plus steroid
2,1 2,5 severe thermal burn

ANTHROPOMETRIC ASSESSMENT
MID UP ARM CIRCUMFERENCE (MUAC)
or LLA

Standard for MUAC :

male : 29,5 cm
female : 28,5 cm
MUAC assessment
% SG = MUAC Standard x 100

Nutrition value :
good : > 85 %
mild
: 75,1 % - 85 %
severe : 75 %

Key points
of Nutritional Assessment
Three specific aspects
Body

weight compared to ideal body


weight

Side

effects associated with diuretic


therapy, potassium balance

Sodium

intake and nitrogen balance

Body weight
Obese

Reduction of calories
Decreased BW to optimal BW
Adjusted body weight (ABW)
BBA/BBI = > 120%
ABW : BBI + (0.25 x (BBA-BBI)
Low fat diet

ELECTROLYTE BALANCE

Monitored

Na, K, Cl , Hco3, Ca

Blood Gas

Nutritional Approach
1.
2.
3.
4.

oral Suplementation
Nagogastric Feeding
Elemental Diet
Intra Venous Feeding

oral Suplementation
Supplementation of Food
content high dense nutrition
to increased healing
processed
Mixed food with sugar and
fat emulsion
Nutritional approach
Nasogastric feeding (NGF)

Nagogastric Feeding

adequote Supplementation
Consistency liquid, or tender -- drug
Easy for prepared , high tolerance
Contra indication
l Disease on mouth or oesophagus
l endotracheal pipe/canule
l Intestinal disease
l Severe vomiting

Indication of Elemental Diet


1.
2.
3.
4.
5.
6.
7.
8.

Short bowel syndrom


Granulomatous dissease on TGI
Fistula TGI
Suppl on burn
Supll on cancer disease therapy
Sydrome malabsorbsi
Preparation of pre-intestinal surgery
pediatrik ---alternative if IV failed

Complication ED / MLP
1.
2.
3.
4.
5.
6.
7.
8.

9.
10.
11.

Feel discomfort
nasopharynx ulceration
Gastric irritation
aspiraton
gastric retention
nausea, vomiting, cramps
diarrhea
Electrolyte balance disturbance :
dehidrasi hipertonik, koma hiperosmolar
non-ketonik, diuresis osmotik
skin rashes
hipoprotrombinemia
defisiensi unsur biologik penting lainnya

Calories intake Pasca Stroke


23

28 kcal/kgBW/day(parese)

Monitored

BW: prevent BW

Dekubitus

increased protein

intake

Food requirement :
Not irritated
Modify color and taste
fresh
Temp equal body temp
Small Portion
Sonde/NGF

PARENTERAL NUTRITION

1.
2.

Post stroke ---- critical ill phase EBB phase


1--3 days
Combined with enteral nutrition liquid diet

CASE STUDY
CASE:
men 45 y.o, admission to hospital with

hemiparese after ate crabs, BW = 70kg, HT =


160 cm MUAC = 29,5 cm, WAIST
circumference 130cm, HIP circumference
120cm ,Laboratorium assessment:
Cholesterol
340
HDL
32
LDL
212
TG
250

Pt have parenteral nutrition K En Mg 2 x

500 cc, RL 500 cc for 24 hours

What should we do???

Step to be done

Step for nutrition approach


1.
2.
2.
3.

Antropometric assessment
Count nutrition needed
Laboratorium assessment
Lab : additional assessment

4.

blood
Urine
Blood gas
Electrolyte

Planning R/

:
:
:
:

protein, albumin
urine rutin
P CO2, P O2
Na, K, Cl.

Medicamentosa
Nutrition therapy
Supporting R/ - Rehabilitation Medik
- when--start?

Nutrition status :

Result of anthropometric
measurement
BW/HT/MUAC/Waist/Hip
Diagnose medic?
Diagnose nutrition?
Calories Requirement ?
Food approach?
Oral/ NGF/Parenteral?
Rehabilitation Medic?
Follow up ???

Nutrition Approach
Indication of

Nutrition Enteral
Indication nutrition Parenteral
Consistencies
Liquid

= MLP

soft
blender
regular

Frequencies

3 x .... or 4 x .... Every ----hours??

how to predict your pt has


adequate food ???

example
Ms.Susi need 1700 kcal, in
practice she has ensure per
NGF 100 cc / 2 hours without
any
additional food, if ensure
density
1.06. How many
kcal she has a
day??

Answer :
calories intake
= 24 hours/2 hours x 100 cc/day x
calories density
= 1200 cc x 1.06
= 1272 kcal
Interpretasion:
inadequate food, she has 1272 kcal
instead of 1700 kcal

Nitrogen Balance Counting

NB= Protein intake - (UUN+4)


6,25

Protein intake =56 gram


UUN 550 mg in 2000 ml urine
NITROGEN BALANCE?
What does it mean positive or
negative???

UUN

= (550)(2000) = 11.000MG=11 gr
100

NB = 56 (11+4) =
6,25

Result (+) = NB positive, adequate protein


(-) = NB negative, degradation
of muscle protein

Mr.

Tony has parenteral


nutrition
Energy Requirement 2100kcal
He has:
500

cc D50w + 500 cc 8,5%AA a

day
How many calories he has it?

Answer
500

cc D50w + 500 cc 8,5%AA

Mixed=

D25w and 4.25 AA

= (0.25)(1000)(3,4)+(0.0425)(1000)(4)
=
=
=

250x3.4 + 4.25x4
850 + 170
1020 kalori

Interpretation
1020kcal

: inadequate food

instead of 2100kcal