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Evaluarea riscului nutritional

Dr Maria Nitescu
Sef de lucrari UMF Carol Davila Bucuresti

De ce screening nutritional?

Pentru a identifica pacientii/persoanele malnutrite

Pentru a identifica pacientii la risc de malnutritie

Definitie
Malnutritia reprezinta starea de nutritie caracterizata
prin deficit sau exces de energie, proteine si alti nutrienti,
ce produce efecte adverse masurabile asupra stucturii si
functionarii tesuturilor/corpului, precum si manifestari
clinice.

Desi termenul de malnutritie se foloseste atat pentru


exces, cat si pentru deficit ponderal, in acest context se
foloseste pentru subnutritie.

Consecintele malnutritiei(1)
Efecte

Consecinte

Afectarea raspunsului imun

-Scaderea rezistentei la infectii

Reducerea tonusului muscular


si oboseala musculara

- Inactivitate, scaderea
capacitatii de munca si autoingrijire
- risc de cadere
- reducerea expectoratiei si
intarzierea recuperarii dupa
infectii respiratorii

Pierderea capacitatii de
termoreglare

-hipotermie

Afectarea vindecarii plagilor

Infectii ale plagilor, fracturi


nesuturate

Tulburari hidro-electrolitice

Hiperhidratare sau deshidratare

Consecintele malnutritiei(1)
Efecte

Consecinte

Afectarea ciclului menstrual

Afectarea functiei de
reproducere

Afectarea fatului si copilului mic

Malnutritia in sarcina predispune


la boli cronice( boli cv, avc,
diabet)in viata de adult

Afectarea cresterii

Piticismul, intarzierea dezvoltarii


sexuale, reducerea masei si
tonusului muscular

Afectarea functiei psiho-sociale

Malnutritia determina apatie,


introversie, autoneglijare,
ipohondrie, pierderea libidoului
si deteriorarea interactiunilor
sociale, inclusiv a relatiei mamacopil

Riscul de malnutritie in UK

Riscul de malnutritie
In ambulator: 16-21% dintre pacienti sunt la risc
de malnutritie
In adaposturi: 10-14%
93% dintre pacientii cu risc de malnutritie traiesc
in comunitate, 5% se afla in camine si 2% in
spitale.

Grupuri vulnerabile dpdv al riscului nutritional

Bolnavi cronici
Varstnici
Persoane recent externate din spital
Saraci
Persoane izolate social

Impactul social
In comunitate:
- batranii malnutriti pot fi internati mai des si fac mai multe
vizite la medic
- persoanele cu BMI<20: merg mai des la medic, au mai
multe prescriptii de medicamente, se interneaza mai des
decat cei cu BMI intre 20-25.

In spital:
- pacientii cu risc de malnutritie au o durata de spitalizare
mai lunga
- De regula, sunt transferati in alte unitati sanitare si nu
externati, datorita complicatiilor ce apar

Nutrition Assessment
Components
Gather data, considering
Dietary intake
Nutrition related consequences of health and disease
condition
Psycho-social, functional, and behavioral factors
Knowledge, readiness, and potential for change

Compare to relevant standards


Identify possible problem areas

Example of Nutrition
Assessment Content
Nutrition
assessment
what data
are most
effective for
identifying
clients
nutrition
related
problem
of interest

Type of assessment
Content component
What type
of
assessment
data?

Nutritional adequacy
Fat and cholesterol intake
Trans fatty acid intake
Health status
Lipid profile
BMI
Waist circumference

What are the reliable


standards (ideal goals)?
how well, how much,
how long

Nutrition Diagnosis
Purpose
Identify and label the nutrition problem
Nutrition diagnosis
NOT medical diagnosis
EXPLICIT statement of nutrition diagnosis
Note: Documentation is an on-going process
that supports all the steps in the Nutrition Care
Process

Nutrition Intervention
Purpose
Plan and implement purposeful actions to
address the identified nutrition problem

bring about change


set goals and expected outcomes
client-driven
based on scientific principles and best available
evidence

Note: Documentation is an on-going process that


supports all the steps in the Nutrition Care Process

Nutrition Monitoring &


Evaluation
Purpose

Determine the progress that is being made toward th


clients goals or desired outcomes

Monitoring: review and measurement of status


at scheduled times
Evaluation: systematic comparison with previous
status, intervention goals, reference standard
Note: Documentation is an on-going process that
supports all the steps in the Nutrition Care Process

Nutrition Screening
Purpose: To quickly identify individuals
who are malnourished or at nutritional risk
and to determine if a more detailed
assessment is warranted
Usually completed by DTR, nurse,
physician, or other qualified health care
professional
At-risk patients referred to RD

Characteristics of Nutrition
Screening

Simple and easy to complete


Routine data
Cost effective
Effective in identifying nutritional
problems
Reliable and valid

Nutrition Screening Tools

Acute-care hospital or residential setting


Perinatal service
Pediatric practice
Malnutrition Universal Screening Tool
(MUST)
Nutrition Screening Initiative (NSI)

MUST-malnutrition universal screening tool


( instrument universal pentru screeningul malnutritiei )

1.
2.
3.
4.
5.

Dezvoltat de Asociatia Britanica de Nutritie Enterala si


Parenterala in 2003.
Etape:
Masurarea BMI(IMC)
Masurarea scaderii involuntare in greutate
Efectul bolii acute
Calcularea scorului total al riscului de malnutritie
Planul de ingrijire

Food and Nutrient Intake Risk


Factors
Calorie or protein, vitamin and mineral intake greater
or less than required
Swallowing difficulties
Gastrointestinal disturbances, bowel irregularity
Impaired cognitive function or depression
Unusual food habits (pica)
Misuse of supplements
Restricted diet
Inability or unwillingness to consume food
Increase or decrease in activities of daily living

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

Psychological/Social Risk
Factors

Language barriers
Low literacy
Cultural or religious factors
Emotional disturbances associated with feeding
difficulties (e.g., depression)
Limited resources for food preparation or obtaining food
or supplies
Alcohol or drug addiction
Limited or low income
Lack of ability to communicate needs
Limited use or understanding of community resources
Hammond KA. Assessment: Dietary and Clinical Data. In Krause, 12th edition, p. 386

Physical Risk Factors


Extreme age (adults >80 years, premature
infants, very young children)
Pregnancy: adolescent, closely spaced, or
three or more pregnancies
Alterations in anthropometric measurements,
marked overweight/ underweight for age,
height, both; depressed somatic fat and
muscle stores
NOTE: recent unintentional weight loss is
more predictive of morbidity/mortality than
wt/ht status
Hammond KA. Assessment: Dietary and Clinical Data. In Krause, 12th edition, p. 386

Physical Risk Factors (cont)


Chronic renal/cardiac disease, diabetes,
pressure ulcers, cancer, AIDS, GI
complications, hypermetabolic stress,
immobility, osteoporosis, neurological
impairments, visual impairments

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