IDENTIFICATION OF NUTRITIONAL
DEFICIENCIES
CLASSIFICATION OF MALNUTRITION
ESTIMATION OF NUTRITIONAL
REQUIRMENTS
Identification Nutrition-Related Conditions
Nutritional Assessment
S.O.A.P.
SUBJECTIVE DATA
OBJECTIVE DATA
ASSESSMENT
PLAN
Nutrition Support Team
Physician Dietitian
- Diagnosis - Nutritional Assessment
- Placement of CVC - Enteral Nutrition
- Team Leader - Transitional Feedings
Nurse Pharmacist
- Maintenance of CVC - Admixture Preparation
- Physical Assessment - Admixture Formulation
- Patient Training - Drug-Nutrient
Interactions
Nutritional Assessment
method
Estimated food record
10.00-12.00
Snack
12.00-13.00
Lunch
13.00-18.00
Snack
18.00-
Dinner
Addition questions:
Was intake unsual in any way? Yes/No
If yes, in what way?
Multi vitamin:_________________________________________
Other (list):
Qualitative Foods Dietary
Assessment
Food History
EXTRACELLULAR 20%
SKELETON 10%
Anthropometric Measurement
Definition:
Measurement various dimension of the
human body, and its composition, in all
level of ages and nutritional status.
(Jelliffe, 1966).
Functions of Anthropometrical
Data
1. Measure the Growth Rate ( in Children)
Sex (m/f)
Height (H)(cm)
Weight (W)(kg)
Usual weight (UW)(kg)
W as (%) of UW
Ideal Body weight (IBW)(kg)
W as (%) of IBW
Anthropometrics
FEMALE:
IBW=100 LB +(5 LB X EVERY INCH >5 FT)
MALE:
IBW=106 lb +(6 lb FOR EVERY INCH >5 FT)
IDEAL BODY WEIGHT (IBW).
Hamwi Equetion
* H in cm
Anthropometrics
Height:
Body Mass Index (BMI)
BMI= Weight (kg)/Height2 (m2)
Body Measure:
Mid Arm Circumference (MAC)
Triceps skinfold (TSF)
MAMC = MAC - {3.14XTSF}
Nutritional status based on BMI
and IBW
BMI (kg/m2) Nutritional state BW/IBW (%)
>30 Obese >120
25.1 29.9 Overweight 111 -119
18,5 25.0 Normal 90 110
17,0 -18,4 Mild PEM 80 - 89
16.0 16.9 Moderate PEM 70 -79
<16.0 Severe PEM <70
CALSSIFICATION OF OVERWEIGHT
AND OBESITY (WHO)
Obese 6 - -
(BMI >29)
Expected Weight Gain
Grafik pertambahan berat pada kehamilan
Trimaster I Trimaster II Trimaster III
10 kg 10 kg
5 kg 5 kg
0 0
Biochemical Test
Plasma Protein:
albumin,
hemoglobin,
hematocrit;
Additional:
prealbumin,
Thyroxin binding protein,
serum transferrin, or TIBC,
ferritin
Urinary
Protein metabolism: 24 hour urine test
Creatinin High Index (CHI)
CHI = Urinary Creatinine 24 hours X 100%
Expected Creatinin urine in IBW
Expected creatinin urine:
- men = 23 mg/kg IBW/24 hours
- women= 18 mg/kg IBW/24 hours
Interpretation:
- CHI > 80% : normal
-CHI 60-80% : moderate depletion skeletal muscle
-CHI 40-50% : Severe depletion of skeletal muscle
Urinary
N Balanced =
(protein intake:6.25) (urinary urea Nitrogen+4)
Interpretation:
+ : Anabolic state
0 : Balanced state
- : catabolic state
Biochemical Test (continued)
Laboratory Determinations:
Serum albumin (g/dL)
TIBC (g/dL)
Serum transferrin (TFN) (g/dL)
White blood cell count (No/mm3)
Total Lymphocyte count (No/mm3)
24-h urinary urea Nitrogen (g)
24-h urinary creatinine(mg)
CHI (%) standard
OBJECTIVE DATA
SOMATIC COMPARTMENT
MARKER Normal Mild Moderate Severe t 1/2
MALE
BEE = 66 + (13.7 X Wt) + (5 X Ht) (6.8 X Age)
FEMALE
BEE=655 + (9.6 X Wt) + (1.7 X Ht) (4.7 x Age)
Wt in Kg Ht in cm Age in years
ESTIMATION OF CALORIC REQUIRMENTS
ACTIVITY FACTORS
1.2 CONFINED TO BED
1.3 AMBULATORY
1.4 ACTIVE
ESTIMATION OF CALORIC REQUIRMENTS
MAINTENANCE : 30 KCAL/KG
MODERATE STRESS : 35 KCAL/KG
SEVERE STRESS : 40 KCAL/KG
Indicates:
Normal : >100
Mild malnutrition : 97.5-99.9
Moderat to severe malnutrition : <97.5
Hospital Prognostic Index
(HPI)
HPI=
(0.91*ALB)-(1.00*DCH)-(1.44*SEP)+(0.98*DX)-1.09
Nutritional diagnosis
Primary and Secondary Nutritional
Disease
Nutrition-Related Conditions
Problem list
Select appropriate categories with a check mark. Numerical value are
assigned and used for secoring. Patient may self-report the section 1-4;
medical or nutritional staff will complete number 5,6 and the SGA score.
SUBJECTIVE GLOBAL
ASSESSMENT (SGA)
SUBJECTIVE GLOBAL ASSESSMENT
(SGA)
1. Weight
2. Food Intake (over past month)
3. Symptoms (longer than 2 weeks)
4. Functional capacity (activity over the past
mounth)
5. Disease and its relation to nutritional
requirement
6. Physical
1. Weight
Weight ________ kg Height _________ cm
Overall loss in past 6 months: Amt.=#______kg
% loss= _______
20%+ = 4 pts;
10-19.9% = 3 pts;
6-9.9% = 2 pts;
2-5.9% =1 pts;
0-1.9% = 0 pts
Overall loss in past 1 month: Amt.+# ______kg;
%loss= _______
10%+ 4 pts;
5-5.9% 3 pts;
3-4.9% 2 pts;
2-2.9% 1 pts;
0-1.9% 0 pts
Change in past 2 weeks:
_____increased (0)
______ no change (0)
_____decreased (1).
2. Food Intake (over past month)
______ No change recently (0)
______ Change:
_____More than usual (0)
_____ less than ususal (1)
Now taking :
_____ normal food but less than normal (1)
_____ litle solid food (2)
_____only liquids (3)
_____only nuytritional supplement (3)
_____very litle of anything (4)
____ only tube feeding or nutrition by vein (5)
Supplement (Circle) : nil, vitamin, mineral # _______freq. Per
week
3. Symptoms (longer than 2 weeks)
____ No problems eating (0)
____ nausea (1)
____ vomiting (3)
____ diarrhea (3)
____ constipasi (1)
____ mouth sore (2)
____ dry mouth (1)
____ Anorexia (3)
____pain(3) ____ (where_____)
____things taste funny or have no taste (1)
____ smells bother (1)
____Other (1) _____________(depression, financial worries,
dental problems, etc).
4. Functional capacity (activity over the past
mounth)
__ Normal with no limitation (0)
__ not ususal, but up and about with normal activity (1)
__ No feeling up to most thing, but in bed less than half the day
(2)
__ able to do little activity and spend most of the day in bed or
chair (3)
__ seldom out of the bed (4)
5. Disease and its relation to nutritional
requirement:
Primary diagnosis (specify) ________stage______
cancer (1),
AIDS (1),
Pulmonary or cardiac cachexia (1),
pressure ulcers/wound/fistula (1),
trauma (1),
age greater than 65 y (1)
Metabolic demand (stress):
___ no stress --- no stress, fever, steroid (0)
___low stresstemp 99-101 less than 72 hours,
low dose steroids (0)
6. Physical (for each trait specify : 0=normal,
1+=mild, 2+= moderate, 3+=severe)
___loss of subcutaneous fat (triceps, chest)
___ascites
___muscle wasting (quadriceps, deltoid)
___mucosal lession
___ankle edema
___cutanous lessions
___sacral edema
___Hair change
SGA rating (select one):
A
B
C
Nutrient deficiencies
Underlying disease requiring modified
nutrient or food plan
Personal culture and ethnic needs
Economic need
Drugs information that interact with food and
nutrient
Primary and Secondary
Nutritional Disease
Primary deficiency disease:
Lack of essential nutrient on the diet
Secondary deficiency disease:
Results from one or more barriers to
use of the nutrient after consumed
food.
Nutrition-Related Conditions
THANK YOU