Curs Evaluare Risc Nutritional Master (1)

8/9/2019 Curs Evaluare Risc Nutritional Master (1)

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Evaluarea riscului nutritional

Dr Maria Nitescu

Sef de lucrari UMF Carol Davila Bucuresti


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De ce screening nutritional?

Pentru a identifica pacientii/persoanele malnutrite

Pentru a identifica pacientii la risc de malnutritie


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Definitie

Malnutritia repreinta starea de nutritie caracteriataprin deficit sau e!ces de energie" proteine si alti nutrienti"ce produce efecte adverse masura#ile asupra stucturii sifunctionarii tesuturilor/corpului" precum si manifestari

clinice$

Desi termenul de malnutritie se foloseste atat pentru

e!ces" cat si pentru deficit ponderal" in acest conte!t sefoloseste pentru subnutritie.


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Consecintele malnutritiei%&'

Efecte Consecinte

(fectarea raspunsului imun )Scaderea reistentei la infectii

*educerea tonusului muscularsi o#oseala musculara

) +nactivitate" scadereacapacitatii de munca si auto)ingri,ire

) risc de cadere

) reducerea e!pectoratiei siintarierea recuperarii dupainfectii respiratorii

Pierderea capacitatii determoreglare

)-ipotermie

(fectarea vindecarii plagilor +nfectii ale plagilor" fracturinesuturate

.ul#urari -idro)electrolitice iper-idratare sau des-idratare


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Consecintele malnutritiei%&'

Efecte Consecinte

(fectarea ciclului menstrual (fectarea functiei dereproducere

(fectarea fatului si copilului mic Malnutritia in sarcina predispunela #oli cronice% #oli cv" avc"dia#et'in viata de adult

(fectarea cresterii Piticismul" intarierea devoltariise!uale" reducerea masei sitonusului muscular

(fectarea functiei psi-o)sociale Malnutritia determina apatie"introversie" autonegli,are"

ipo-ondrie" pierderea li#idouluisi deteriorarea interactiunilorsociale" inclusiv a relatiei mama)copil


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*iscul de malnutritie in U0


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*iscul de malnutritie

+n am#ulator1 &2)3&4 dintre pacienti sunt la risc

de malnutritie

+n adaposturi1 &5)&64

784 dintre pacientii cu risc de malnutritie traiescin comunitate" 94 se afla in camine si 34 in

spitale$


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:rupuri vulnera#ile dpdv al riscului nutritional

Bolnavi cronici

;arstnici

Persoane recent e!ternate din spital

Saraci

Persoane iolate social


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+mpactul social

+n comunitate1) #atranii malnutriti pot fi internati mai des si fac mai multe

viite la medic

) persoanele cu BM+


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Nutrition (ssessment

Components :at-er data" considering

= Dietar> intae

= Nutrition related conse@uences of -ealt- and disease

condition= Ps>c-o)social" functional" and #e-avioral factors

= 0noAledge" readiness" and potential for c-ange

Compare to relevant standards

+dentif> possi#le pro#lem areas


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Example of Nutrition

Assessment ContentNutrition

assessment

what dataare most

effective for

identifying

clients

nutrition

related

problem

of interest

Type of assessment

Content component Nutritional adeuacy

!at and cholesterol inta"eTrans fatty acid inta"e

#ealth status

$ipid profile

%&'

(aist circumference

(hat are the reliable

standards )ideal goals*+how well, how much,

how long

(hat type

of

assessment

data+


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Nutrition Diagnosis

-urpose

'dentify and label the nutrition problem

Nutrition diagnosis

NTmedical diagnosis

E/-$'C'Tstatement of nutrition diagnosis

Note0 Documentation is an on1going process

that supports all the steps in the Nutrition Care

-rocess


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Nutrition 'ntervention

-urpose

-lan and implement purposeful actions toaddress the identified nutrition problem

= bring about change= set goals and expected outcomes= client1driven= based on scientific principles and best available

evidence

Note0 Documentation is an on1going process thatsupports all the steps in the Nutrition Care -rocess


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Nutrition &onitoring 2

Evaluation-urpose Determine the progress that is being made toward t

clients goals or desired outcomes

Monitoring: review and measurement of statu

at scheduled times

Evaluation0 systematic comparison with previous

status, intervention goals, reference standard

Note0 Documentation is an on1going process that

supports all the steps in the Nutrition Care -rocess


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Nutrition Screening

Purpose1 .o @uicl> identif> individuals

A-o are malnouris-ed or at nutritional ris

andto determine if a more detailed

assessment is Aarranted Usuall> completed #> D.*" nurse"

p->sician" or ot-er @ualified -ealt- care

professional (t)ris patients referred to *D


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C-aracteristics of Nutrition

Screening

Simple and eas> to complete

*outine data Cost effective

Effective in identif>ing nutritional

pro#lems

*elia#le and valid


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Nutrition Screening .ools

(cute)care -ospital or residential setting

Perinatal service

Pediatric practice Malnutrition Universal Screening .ool

%MUS.'

Nutrition Screening +nitiative %NS+'


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MUS.)malnutrition universal screening tool

% instrument universal pentru screeningul malnutritiei '

Devoltat de (sociatia Britanica de Nutritie Enterala si

Parenterala in 3558$

Etape1

&$ Masurarea BM+%+MC'

3$ Masurarea scaderii involuntare in greutate8$ Efectul #olii acute

6$ Calcularea scorului total al riscului de malnutritie

9$ Planul de ingri,ire


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Food and Nutrient +ntae *is

Factors

Calorie or protein" vitamin and mineral intae greateror less t-an re@uired

SAalloAing difficulties

:astrointestinal distur#ances" #oAel irregularit> +mpaired cognitive function or depression Unusual food -a#its %pica' Misuse of supplements *estricted diet

+na#ilit> or unAillingness to consume food +ncrease or decrease in activities of dail> living

Hammond KA. Assessment: Dietary and Clinical Data. In Krause, 12thedition, p. 386


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Ps>c-ological/Social *is

Factors anguage #arriers

oA literac>

Cultural or religious factors

Emotional distur#ances associated Ait- feedingdifficulties %e$g$" depression'

imited resources for food preparation or o#taining foodor supplies

(lco-ol or drug addiction

imited or loA income

ac of a#ilit> to communicate needs

imited use or understanding of communit> resources

Hammond KA. Assessment: Dietary and Clinical Data. In Krause, 12thedition, p. 386


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P->sical *is Factors

E!treme age %adults 5 >ears" premature

infants" ver> >oung c-ildren'

Pregnanc>1 adolescent" closel> spaced" or

t-ree or more pregnancies (lterations in ant-ropometric measurements"

mared overAeig-t/ underAeig-t for age"

-eig-t" #ot- depressed somatic fat and

muscle stores

N.E1 recent unintentional Aeig-t loss is

more predictive of mor#idit>/mortalit> t-an

At/-t statusHammond KA. Assessment: Dietary and Clinical Data. In Krause, 12th edition, p. 386


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P->sical *is Factors %cont'

C-ronic renal/cardiac disease" dia#etes"

pressure ulcers" cancer" (+DS" :+

complications" ->permeta#olic stress"

immo#ilit>" osteoporosis" neurologicalimpairments" visual impairments

Hammond KA. Assessment: Dietary and Clinical Data. In Krause, 12th edition, p. 386

Curs Evaluare Risc Nutritional Master (1)

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