NUTRITIONAL ASSESMENT

Question 1

What is the purpose of Nutritional Assessment?

Answer 1

to determine the Nutritional Status of an individual

Question 2

What are the Nutritional Assessment?

Answer 2

Range from Physical (anthropometric) measurements of body and components & dimensions (weights, heights/lengths & circumferences of various tissues compared with predetermined normograms for healthy representatives of the local population)

Question 2

Types of malnutrition

Answer 2

Undernutrition: Macro±Micro(nutrients)
Over-nutrition: (nutritional toxification)
Combined: Over&Undernutrition
Each requires thorough assessment and rehabilitation
Adequate nutritional history, physical examination, laboratory (Chem Path, Hematology) Assesment).

Question 2

Criteria under Nutritional Assessment

Answer 2

Nutritional History & Physical Examination
Anthropometry
Biochemical
Clinical Assessment
Dietary intake surveys
Physical Exercise (energy intake-energy expenditure)

Question 2

General Physical Examination

Answer 2

Physical appearance, the skin, hair, sclera, nails, tongue/buccal mucosa and the anthropometric measurements tell a lot
Body Mass Index
Head Circumference
Mid Upper Arm Circumference
Skin Fold Thicknesses
May reveal malnutrition & rehabilitation needs

Question 3

Composition of nutrional requirements

Answer 3

• Water
  30 to 40 mL/kg/day
• Energy
  30 to 60 kcal/kg/day (depending on energy expenditure)
• Amino acids
  1 to 2.0 g/kg/day (depending on the degree of catabolism)
• Essential fatty acids
• Vitamins, and minerals
  Children needing TPN may have different fluid requirements and need more energy (120 kcal/kg/day) and amino acids (2.5 to 3.5 g/kg/day)

Question 3

What is Parenteral Nutrition?

Answer 3

Supplying nutrients via routes outside the GIT. (rapid correction of deficiencies)

Question 3

What is TPN, PPM and how are they administered?

Answer 3

Total parenteral nutrition (TPN) is when 100% extra GI
TPN administered through a central vein (subclavian)
PPN is given via the brachial vein
PN may reduce morbidity and mortality after major surgery, severe burns, and head trauma, especially in patients with sepsis.
It may be used in hospital long term care, and sub-acute care, and is seldom used in the home care settings

Question 4

List the indications for parenteral nutrition

Answer 4

• Malformed, diseased or non functional GI tract
• Rapid Rehabilitation of undernourished patients who cannot ingest large volumes of oral feeds and are being prepared for surgery, radiation therapy, or chemotherapy
• Disorders requiring complete bowel rest
  Crohn’s disease
  ulcerative colitis
  severe pancreatitis
• Pediatric GI disorders
  congenital anomalies
  prolonged diarrhea (malabsorption)

Question 5

Special Considerations

Answer 5

Patients with renal insufficiency and are not receiving dialysis or with liver failure require solutions with reduced protein content and a high percentage of essential amino acids
For those with renal or heart failure, volume (liquid) intake must be limited
For those with respiratory failure, a lipid emulsion must provide most of non-protein calories to minimize CO2 production by carbohydrate metabolism.
Neonates require lower dextrose concentrations (17 to 18%).