For this project, you will complete the calculations for the patient described below:
John Q. Patient is a 65-year-old Caucasian man with a single-leg amputation. His activity level is typically low. But when he has surgery or if he has burns (Q11 & 12), he will be confined to the bed. Here is some information about JQP:
- Knee Height (KH) 50 cm
- Weight: 200 lb
- Mid-Arm Circumference (MAC): 35 cm
- Calf-Circumference (CC): 38 cm
Conversions:
1 pound/2.2 = kg or kg x 2.2 = pounds
Example 140 pounds/2.2 = 63.6 kg or round to 64 kg.
1 Foot = 12”
1 inch x 2.54 = cm or cm/2.54 = inches.
1 cm/100 = meters or meters x 100 = cm
Example 6 feet = 6 x 12 = 72 inches
72 inches x 2.54 = 182.33 cm or round to 182
72 inches x 2.54 = 182.33 cm or round to 182
BMI = weight in pounds/height inches/height inches x 703
Example 140/72 = 1.944/72=.027 x 703 = 18.95
BMI classification (Table 6.6 pg 177) = Normal weight
IMPORTANT TIPS:
- This project can be time consuming with all of the calculations – please start early!
- This project does not require double spacing, nor does it require a reference page.
- Be sure to include your math equations in your paper (show all your work) see p. 236, box 7.4, for an example of how to show your equations.
- These equations build upon each other, so you want to double check all of your answers
- Be sure to add units (calories, grams protein, etc.) for your final answer.
- The energy equations are all based on the person’s actual weight (200 pounds) – this will need to be converted to kg for the equations.
- Questions requiring activity factors – use a confined to bed activity factor because they are for surgery.
- All other questions, use a low activity factor.
- For equations with decimal points; keep up to two decimal places in your equations, and round when you get the final answer.
Calculations:
Equation:
1. Stature in cm from KH (Table 7.1, pp. 219). Convert answer to inches. 10 points
Show Work:
2. Calculate adjusted body weight 10 points
3. BMI based on adjusted body weight. 10 points
BMI based on adjusted body weight. 10 points
Identify BMI classification (normal weight, overweight, obesity)
4. Desirable body weight. 15 points
Choose a method: HAMWI (p. 170-171 in text on weight standards), 1983 Metropolitan Life Insurance HT/WT table (p. 171-172, table 6.1) for medium build – select the midpoint of the range given, or select the midpoint of a normal BMI.
Identify the method you chose. Show your work.
5.Estimated body weight in kg from anthropometric measures. Convert answer to pounds (p. 224, table 7.3). 10 points
Equation:
Show work:
6. Estimated body weight in kg from KH and MAC. Convert answer to pounds (p. 225, table 7.4). 15 points
Equation:
Show work:
Note: Mifflin St Jeor has been determined to have better accuracy for estimated energy needs for healthy overweight and obese individuals and in real practice is used most frequently.
7. REE: compare Mifflin St Jeor REE equation and one equation you choose from the text. REE represents resting energy expenditure in kilocalories/day. 20 points – 10 points each equation
REE Harris Benedict p. 232, table 7.7*
REE National Academy of Science p. 233, table 7.8**
REE WHO p. 232, table 7.7*
The Mifflin-St Jeor equations are*:
Male: REE = 10×weight + 6.25×height – 5×age + 5
Female: REE = 10×weight + 6.25×height – 5×age – 161
*These equations require weight = kilograms, height = centimeters, age = years.
** This equation requires wt = kg, ht = meter, age = years
Label your equations and list all of your work.
PA factors are specific to each equation. Use the factors identified for each equation you select.
8. EER (Estimated energy requirement) in Kcals/day. (p. 233-234, table 7.9) 15 points
Use a low activity factor and complete the equation as identified below, showing all of your steps.
EER Males 19 years and older, p. 234
EER = 662 – (9.53 x age) + PA x [(15.91 x wt) + (539.6 x ht)]
9. TEE (Total Energy Expenditure) in kilocalories/day (p. 235). Use a low activity factor as identified in table 7.10 on p. 235. 15 points
TEE for individuals who are overweight p. 235 (7.10)
Complete the equation as identified below, showing all of your steps.
TEE = 1086 – (10.1 x age) + PA x [(13.7 x wt) + (416 x ht)]
10. 24-hour energy expenditure with minor and major surgery.
Evidenced based research indicates that for overweight individuals in critical condition, the best equation to use is Ireton-Jones. Harris Benedict is not currently recommended for this situation, but has been the gold standard in the past. Calculate REE using the Ireton Jones equation below.
Kcals = IJEE x AF x IF.
Activity factors (AF) – Box 7.3, p. 233, and injury factors (IF) -Table 7.11, p. 237.
15 points
Ireton-Jones, 1992 Equation (used for overweight, critically ill patients):
Spontaneously breathing IJEE (s) = 629 – 11 (A) + 25 (W) – 609 (O)
A = age in years, W = weight in kg, 0= obesity BMI >27 if obesity present = 1, if obesity absent = 0
IJEE = (show work)
Equation for 24-hr EE:
5 points IJEE = ____________ Kcals
AF confined to bed =
IF for minor surgery =
IF for major surgery =
5 points 24-hour EE for minor surgery =
5 points 24-hour EE for major surgery =
11. Protein requirements 15 points
Use table 7.13, p. 239. Patient weight in pounds divided by 2.2 to convert to kg.
Equation: actual body weight in kg x ___g protein = ____g protein/day
Show your work and add units to your answer.
- When healthy
- With mild infection
- With major surgery
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