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
Methods
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
CLINICAL METHODS
Clinical
symptom
e.g. edema, pallor, hemiparese
hypoalbuminemia, etc
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
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
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
Side
Sodium
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
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
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.
CASE STUDY
CASE:
men 45 y.o, admission to hospital with
Step to be done
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
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
UUN
= (550)(2000) = 11.000MG=11 gr
100
NB = 56 (11+4) =
6,25
Mr.
day
How many calories he has it?
Answer
500
Mixed=
= (0.25)(1000)(3,4)+(0.0425)(1000)(4)
=
=
=
250x3.4 + 4.25x4
850 + 170
1020 kalori
Interpretation
1020kcal
: inadequate food
instead of 2100kcal