FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
WHAT IS NUTRITIONAL ASSESSMENT?
Determining the body’s ability to convert food into body components. When the body can no longer convert food into body components we get skin breakdown.
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
WHAT IS NUTRITIONAL ASSESSMENT?
Your residents need sufficient amounts of carbohydrates, vitamins/minerals,and proteins in their diet to facilitate wound healing.
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
HOW DOES STRESS RESPONSE CHANGE METABOLIC PROCESSES?
Residents in long term care facilities experience physical and emotional stressors. The body’s response to this stress can result in:
Energy depletion Loss of protein Increase risk for skin breakdown Muscle wasting Decrease in energy needed for wound healing
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
GOAL-PREVENTION OF PROTEIN - CALORIE
MALNUTRITION & PRESSURE ULCERS
How does proteincalorie malnutrition impact wound healing?
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
WOUND HEALING PROCESS AND NUTRITION
INFLAMATION Cellular proliferation Connective tissue formation Wound contraction Wound remodeling
You have to have adequate nutrition or this does not occur.
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
Adequate energy&protein
Adequate energy&protein
Adequate energy&protein
Adequate energy&protein
ACTION!!!
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
NUTRITIONAL ASSESSMENT FOR PATIENTS AT RISK FOR SKIN BREAKDOWN
Anthropometric ( i.e. weight/height) Physical assessment Biochemical indexes Dietary intake
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
ANTHROPOMETRIC ASSESSMENT
Unusual weight loss over a short period of time
Downward trend in weight Low body mass index < 20 (look at relation between weight and height)
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
PHYSICAL SIGNS OF MALNUTRITION
Involuntary weight loss Muscle wasting Presence of edema (no cardiac disease) Poor wound healing, chronic wounds, pressure ulcers
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
PHYSICAL SIGNS OF MALNUTRITION
Glossitis,cracking at edges of mouth Hair loss, lack of luster Chronic infections Listless, apathetic Your CENA’s should be looking for these signs.
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
BIOCHEMICAL MARKERS OF POOR PROTEIN STATUS
Index
Albumin g/dL
Mild
Moderate
Severe
2.8-3.5 10-15
2.1-2.7 5-10
<2.1 <5
Prealbumin mg/dL (Better
measure than albumin)
Retinol Binding Protein mg/dL
4-6
2-4
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
<2
BIOCHEMICAL MARKERS OF POOR PROTEIN STATUS
It takes 60-90 days for an elderly person’s protein to increase after surgery. The retinol binding protein marker is the best indicator that your nutrition program is working
BIOCHEMICAL MARKERS OF NUTRITIONAL ANEMIAS
INDEX FE DEFICIENCY ANEMIA OF CHRONIC DISEASE FOLATE DEFICIENCY B12 DEFICIENCY
H/H
MCV
LOW
LOW
LOW
NORMAL
LOW
ELEVATED
LOW
ELEVATED
FOLATE
NA
NA
LOW
NORMAL OR ELEVATED
LOW
B12
NA
NA
NORMAL
FERRTIN
LOW
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
LOW
ELEVATED
ELEVATED
INDICATORS OF POOR NUTRITIONAL INTAKE
Eating less than 50-75% of foods served Eating primarily carbohydrates Fluid intake instead of food Low fluid intake S/S chewing or swallowing problems
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
3 METHODS TO DETERMINE RESIDENT CALORIE NEEDS
Needs based on activity Needs based on ideal body weight and activity
Needs based on basal energy expenditure and activity
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
HOW MUCH PROTEIN DOES THE PERSON NEED ?
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
CALCULATING TOTAL PROTEIN NEEDS
Adults 0.8gm/kg body wt
Elderly Poor Protein status
1.0gm/kg body wt 1.2-2.0gm/kg body wt
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
CALCULATING TOTAL PROTEIN NEEDS
If your resident has a compromised liver or kidney function you need to monitor the amount of protein in the diet more closely.
HOW MUCH FLUID DOES THE PERSON NEED?
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
CALCULATING FLUID NEEDS
Adults 30-35 cc/kg body wt Elderly 25-30cc/kg body wt If > 130% ideal body weight calculate an adjusted fluid need: 1500 + (patient’s weight-20 kg) X 15 ml * If greater than 100years old give 20cc/kg body wt
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
HOW DO NUTRIENT NEEDS CHANGE WITH SKIN BREAKDOWN?
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
CHANGES WITH A PRESSURE ULCER
Calorie needs increase from 1.2-2.0 times basal energy expenditure Protein needs increase from 1.2-2.5gm/kg body weight Fluid needs increase if fluid losses from ulcer are significant
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
NUTRIENTS NEEDED FOR WOUND HEALING IN THE ELDERLY
55% Carbohydrates 30% Fat (There is a decreased risk for heart disease with age so fat is not as much of a concern) 1.5-2.0 Protein/kg (If renal or liver status is poor can not tolerate 2.0 gm Protein) 10-20gm/d Glutamine (most prominent amino acid found in the body and the first one lost) 10-20gm/d Arginine (Important amino acid due to it’s tendency to facilitate wound healing faster) Arginine and Glutamine used for stage 3&4 ulcers
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
SUPPLEMENTS USED TO ENHANCE HEALING
Multivitamin/mineral supplement (Can use baby vitamins)
500 mg Vitamin C(Females 75mg/daily/Males 90mg daily) If kidney stones/ kidney problems may want to use just multi-vitamins. 50 mg elemental Zinc (Zinc competes with Iron and Copper. Too much can effect absorption of Iron and Copper resulting in increase skin breakdown. Stop Zinc when you have wound closure. Don’t exceed 50mg/day FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
HOW DO YOU GET ANOREXIC RESIDENTS WITH WOUNDS TO EAT?
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
STRATEGIES FOR WEIGHT GAIN AND WOUND HEALING
Small frequent amounts of food (use small bowl/plates presenting only small amount of food at a time). Favorite foods (Can liberalize diet as long as there are no adverse effects). Foods that are easy to chew & swallow Use fortified foods
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
STRATEGIES FOR WEIGHT GAIN AND WOUND HEALING
Nutrient dense beverages for medication pass Vitamin/mineral supplements Pharmacological intervention Appetite stimulants (Can be very expensive) Anabolic steroids (Promotes protein build up and weight gain)
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING
PUTTING THE PUZZLE TOGETHER TAKES: Total patient assessment
Long-range vision
Communication
FALL2000 JOINT PROVIDER/SURVEYOR TRAINING