Assessment The Nutritional Status Among Critical Patient With Enteral Feeding In Respiratory Care Unit In Baghdad Teaching Hospitals

Background and Objectives : Nutritional status has a significant impact on both health and disease. The study aims to identify the nutritional status of critical patient with enteral feeding in RCU in Bagdad Teaching Hospitals . Methods and materials : A descriptive study was carried out. The sample consisted of 50 adult patients with enteral feeding on mechanical ventilation in RCU , for the period from 1 of November 2010 to the 1 of April 2011 . The questionnaire tool was consisted of two parts, first one the demographical data and the second part was related to the nutritional assessment scale physical and chemical . Questionnaire tool was tested for its validity and reliability by a panel of experts with nursing specialty in college of nursing . Descriptive and inferential procedures were used to analyze the data . Results : The results of the study showed that the most of sample majority were male at age group of (20-30) years old , free earning ( not employed ) with enteral feeding since 3-4 month , waist circumference and mid circumference below normal standard. Conclusion: Disoriented with wasted muscle anemic and low S. protein also the study showed significant relation between period of patient on enteral tubation and occupation which revealed that there situation was highly affected by there low income . Keyword: (Nutritional Status, Enteral Feeding, critical patient. INTRODUCTION Nutritional status has a significant impact on both health and disease. For well and patients , good nutritional status can help to maintain health , promote normal growth and development protect against disease , during illness good nutritional status can reduce the risk for complications and speed recovery time . The nutritional assessment is a systematic approach used to identify the patients actual needs and formulate a plan to met these needs (Lillis et al., 2011). Also Perry and Potter(2002) mentioned that nutritional assessment is a procedure conducted to determine appropriate nutritional therapy by collection of objective and subjective data related to nutritional status , which may include , An thropometrics , Biochemical test , clinical observation and dietary evaluation . No single biochemical test , such as serum albumin , can accurately indicate poor nutrition , but collectively biochemical test , measurements of height , weight , upper arm circumference and waist circumference car accurately reflect the clients nutritional status . Besides , significance of nutritional assessment as the first step in the detection of malnutrition optimal scheme of nutritional assessment enable the clinician to quickly detect the presence of malnutrition and provide guide for nutritional therapy (Audis, 2003). Biochemical assessment reflects both the tissue level of a given nutrient and any abnormality of metabolism in the utilization of nutrients , these determined from studies of serum ( albumin , transferrin , electrolytes , hemoglobin , vitamin A. C , and total lymphocyte count , and studies of urine (creatinine, thiamine, niacin) (patricia et al., 2005) . Anthropometry measurements aid in identifying nutritional problems include the ratio of high to waist circumference , mid-upper arm circumference ( MAC) to (TSF) triceps skin fold , values for MAC ,TSF are compared to standards (Cheatham, 2007). During the 1990s there was a major shift from parenteral . nutrition to enteral nutrition (EN) , which remains the preferred method of providing nutritional support to the critically ill given its improved patient outcome , EN can help prevent mucosal a trophy and increased permeability with resultant decreases in bacterial translocation (Alexander and Susle, 2004). * PhD. in Nursing / Assistant Professor / College of Nursing / University of Baghdad ** PhD. in Nursing/ Assistant Professor / College of Nursing /University of Baghdad Biologist / College of Dental/ University of Baghdad. Mosul Journal of Nursing, Vol.1, No.2, 2014 88 Malnutrition in patients receiving mechanical ventilation has an adverse effect on all physiological process , it increase the risk for infection and pulmonary edema , decrease phosphorus levels needed for cellular energy production , impairs production of surfactant and make weaning from mechanical ventilation difficult due to muscle fatigue and diaphragmatic skeletal muscle weakness , so nutritional status is a multidimensional phenomenon requires several methods of assessment , including nutrition related health indicators and nutritional intake (Magool, 2007). MATERIALS AND METHOD A descriptive design was carried out from the period from 1 of November 2010 to the 1 of April 2011. A purposive sample of 50 mechanical ventilation with enteral feeding since at least one month at respiratory care unit (RCU) were included . The study was carried out in (Gazy Al-Haririe, Baghdad, AL-Kadhemia, IbnAlnaffis, Al-Yarmok Teaching Hospitals). A structured questionnaire format was filled by the investigator it was consist of the sociodemographic data sheet consists of 5 items age, gender, occupation, level of education, and of period of enteral intubation and specific questionnaire of nutritional assessment consists of two parts which are the physical assessment, which consist of 8 items and 13 sub items; and the chemical nutritional assessment consists of 5 main items. All items of part two were measeared with by nominal scale of normal which was given a score of (2) to normal and abnormal( 1). Validity of the instrument was determined through a panel of 10 experts from different fields and setting. The reliability of the questionnaire was determined (r = 0.85) which was adequately reliable. A statistical analysis was applied using a statistical analysis which included the frequency, percentage, mean of score (MS) and chi-squire test.