curs evaluare risc nutritional master (1)
TRANSCRIPT
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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