NUTRITIONAL ASSESSMENT
II. Clinical observations (used to support laboratory data; not diagnostic)
A. Skin free of color irregularities, smooth
B. Mucous membranes smooth, pink, and moist
C. Hair shiny, not easily plucked
D. Musculature toned, some fat present
E. Skeleton: erect posture
F. Nails regularly shaped, free of ridges; rapid cellular turnover is noted in the above areas; nutritional deficiencies become obvious earlier
IDEAL BODY WEIGHT (IDBW) CALCULATIONS
I. Men
A. 106 pounds allowed for first 5 feet of height
B. 6 pounds added for each inch over 5 feet
C. Adjust 10% of total for frame (skeleton) size
1. Add 10% for large frame
2. Subtract 10% for small frame
3. No adjustment for medium or average frame
II. Women
A. 100 pounds allowed for first 5 feet of height
B. 5 pounds added for each inch over 5 feet
C. Adjust for frame size by 10% as for men
III. Individuals less than 5 feet in height
A. Consult published tables for appropriate weight for height
DETERMINING NUTRITIONAL NEEDS
Stressed patients first receive nutritional support in the “flow” or second stage of the stress response; correct fluid and electrolyte imbalances only in the first or “ebb” phase
I. Kilocalories per kilogram of body weight; use actual or desired weight depending on goal of therapy; consult dietitian for additional information
A. Average adult requirement is 30 kcal/kg or 13 kcal/pound of body weight/24 hours
B. Usually, stressed individuals require 25-30 kcal/kg
C. For weight gain, 35 or more kcal/kg is appropriate
E. Elevated body temperature
1. 7% increase in kcal/24 hours required for each degree above 98.6° F
2. 13% increase in kcal for each degree above 98.6° F (37° C)
II. Fluid requirements
A. One milliliter of fluid/kcal/24 hours (30 to 35 ml/kg of body weight) is usual; water, decaffeinated beverages, popsicles, flavored gelatin, and so forth, are good sources; milk is 50% water
B. Needs increase with elevation in vital signs, use of drains, nausea/vomiting, diarrhea, and so forth; increase by 150 ml/24 hours for each degree rise in body temperature above normal
III. Protein requirements
A. Protein required per day ranges from 0.8 to 2 g/kg of body weight
B. Most stressed patients require 1.5 g or more per kilogram of body weight
C. Renal and hepatic diseases usually necessitate lower levels of protein because of inability of the body to convert ammonia to urea in the liver or to excrete urea via the kidneys; protein is the primary source of all nitrogenous waste products
D. Consult a dietitian for the optimal amount
IV. Carbohydrate needs
A. Account for largest proportion of kilocalories in most diets: approximately 50% of daily need
B. More oxygen (and release of more carbon dioxide) is required than for protein or fat; patients with compromised respiratory function would benefit from less than average carbohydrate content
V. Fat or lipid needs
A. Fat has the lowest respiratory quotient (RQ) or uses the least amount of oxygen and produces the least amount of carbon dioxide
B. Substituting fat for carbohydrate can reduce stress on the respiratory system, particularly if the patient has minimal lung capacity
VI. Vitamin and mineral requirements
A. Use the Recommended Dietary Allowance (RDA) as a guide; consult a dietitian for individual needs
B. Beware of oversupplementation; the liver and kidneys must “process” and excrete excessive vitamins; ten times the RDA is a megadose, and this amount should be regarded as a medication rather than a supplement
VII. Electrolyte needs
A. Replace deficits
B. Beware of excessive amounts (exceeding the RDA), especially in renal disease, or during the first or “ebb” stage of the stress response when acute renal failure may be present
I. Pattern of adhering to dietary guidelines for Americans
II. Schematic pyramid of six food groups and recommended numbers of daily servings for each group
Get Clinical Tree app for offline access
A. Bread, cereal, rice, and pasta
1. 6 to 11 servings
2. Provide fiber to help prevent constipation and complex carbohydrates for sustained energy release
B. Vegetables
