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NUTRITIONAL CARE PLAN

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NUTRITIONAL CARE PLAN

  1. 1. Nutritional care plan
  2. 2. It is the substance, procedure , and setting involved in ensuring the proper intake & assimilation of nutrients , especially for hospitalized patient. Objectives • To present the components of the nutrition care plan • To discuss the different approaches in determining the contents of the nutrition care plan
  3. 3. Components of nutrition care plan Nutritional assessment Nutritional requirement  Micro &Macro micronutrients  Fluid requirement Access: oral, parenteral, or combinations Nutrient formulation Nutrient delivery Monitoring strategies
  4. 4. Nutritional Assessment Methods Used Are: Anthropometric Assessment Biochemical Assessment Clinical Assessment Dietary Assessment
  5. 5. NUTRITIONAL REQUIREMENT
  6. 6. Food pyramid:
  7. 7. Food pyramid: Education tool that shows the dietary guidelines in easily understood graphic format. Balanced diet : Contains the various food groups of food stuff in the correct proportions. Recommended dietary allowances/intakes: The intake of nutrient derived from diet which keeps nearly all people in good health.
  8. 8. Group particul ars Body wt Energy Kcal/kg Protein g/kg Fat g/day Calcium Mg/day Iron Mg/day Infants 0-6 months 5.4 108 2 500 6-12 months 8.6 98 1.65 500 Children 1-3yrs 12 102 1.8 25 400 12 4-6 19 89 1.6 25 400 18 7-9 27 73 1.5 25 400 26 Adolesce nce (boys) 10-12yrs 35.4 62 1.5 22 600 34 girls 10-12yrs 31.5 62 1.8 22 600 19 Boys 13-15yrs 47.8 50 1.5 22 600 41 Girls 13-15yrs 46.7 44 1.4 22 600 28 Boys 16-18yrs 57.1 46 1.4 22 500 50 Girls 16-18yrs 49.9 41 1.2 22 500 30
  9. 9. To avoid iron deficiency a woman should consume iron rich food. Iron rich food: roasted bengal gram , rice flakes , cow pea , sirukeerai , mullakeerai , araikerai , manathakkali , sundakai , watermelon ,raisins(dry grapes) , savalai (fish) , beef , liver sheep Group particul ars Body wt Energy Kcal/kg Protein g/kg Fat g/day Calcium Mg/day Iron Mg/day Pregnant woman 50 +300 +15 30 1000 38 Lactating 0-6 Month 50 +550 +25 45 1000 30 6-12 month 50 +400 +18 45 1000 30
  10. 10. PARTICULARS ENERGY Obese 25kcal/kg body weight Normal weight 30 kcal/kg body weight Underweight 35kcal/kg body weight Preterm baby 60-150kcal/kg/day Prt – 3.4g/kg PEM 150-200kcal/kg body weight Prt-5g/kg Diabetes mellitus IBW*0.9/25-35kcal Acute renal failure 25-30kcal/kg , Prt -0.6-0.8g/kg Chronic real failure 35-50kcal/kg , Prt-0.5g/kg Hemodialysis 35kcal/kg , Prt-1-1.2g/kg Peritoneal dialysis 35kcal/kg , Prt-1.2-1.5g/kg
  11. 11. Micronutrients Electrolytes and Minerals (Na,K,Mg,): Na & k -essential to maintain osmotic balance and keep the cells in proper shape Mg- required for cellular metabolism Trace elements : Needed in very minute quantity for proper growth , development and physiology of the organism I- required for the normal function of thyroid gland Zn- co-factor for a no of enzymes Cu-play an important role in iron absorption
  12. 12. Cr - lead to impaired glucose tolerance Mn - participate in lipid & CHO metabolism Mo -essential constituent of xanthine and aldehyde oxidases and involved in uric acid metabolism Vitamins: water and fat soluble: Essential for normal growth and nutrition & required in small quantity Vitamin A - necessary for clear vision in dim light Vitamin D - required for bone growth and calcium metabolism Vitamin E -preventing the oxidation of vit-A & β carotene in intestine
  13. 13. Vitamin B complex; Thiamine - proper utilization of CHO in the body Riboflavin - essential for several oxidation process inside the cell and concerned with energy and protein metabolism. Nicotinic acid - component of coenzyme in oxidative reactions and concerned with metabolism of CHO,fat,and proteins. Pyridoxine - metabolism of amino acid and conversion of tryptophan to nicotinic acid Folic acid - required for the multiplication and maturation of red calls Vitamin B12- required for proper functioning of the CNS & metabolism of folic acid. Vitamin-C -required for iron absorption
  14. 14. FLUID REQUIREMENT Water need for the function of:  Cell life, Chemical and metabolic reactions  Regulate body temperature  Transport of nutrients, Elimination of waste Formulas Used: For 0 - 10 kg: weight (kg) x 100 mL/kg/day For 10-20 kg: 1000 mL + [weight (kg) x 50 ml/kg/day] For > 20 kg: 1500 mL + [weight (kg) x 20 ml/kg/day] Infusion rate = total fluid volume per day ÷ 24 hours Fluid Requirement for renal patient: Urine output + 500ml.
  15. 15. Access  Oral  Enteral nutrition  Nasogastric tube  PEG / Gastrostomy  Jejunostomy  PEG-J ( Jejunostomy feeding passed through the PEG)  Surgical jejunostomy  Parenteral nutrition  Peripheral  Central
  16. 16. Oral feeding: ⍟ Clear fluid diet (eg.barley water,dhal water,clear stained fruit juice, tea/coffee (without milk),coconut water.) ⍟ Full fluid diet ( porridge ,dhal soup , dhal payasam , strained juices , cooked& pureed fruits ,milk , milk shakes , lassi , tea , coffee , strained soups , ice cream) ⍟ Soft diet (maida,all dhals ,juices, vegetables (cooked) , milk & milk product, egg(not fried),minced non veg, kheer , puddings. ⍟ Regular diet ( normal diet)
  17. 17. ENTERAL NUTRITION/TUBE FEEDING During acute initial phase of illness exogenous energy 20-25 Kcal/Kg/day During recovery phase -30-40 Kcal/Kg/day Protein intake should be 1.2-1.5 g/Kg/day never exceeding 1.8 g/Kg/day Except extreme losses: burns, digestive losses
  18. 18. Type of tube feeding:  Blended ( blended regular food,)  Elemental(low residue diet , lactose free, ready to absorb)  Non elemental( low residue with fiber, may contain lactose)  Specific nutrient modular( supply single nutrients , good for diet manipulation  Disease specific formular ( those have problem in metabolism or oral esophagus.
  19. 19. Total parental nutrition For children; Child Calories Amino acid g/kg Lipids g/kg New born 110-125 kcal /kg 2-5 1-3 Older child 100-110 kcal/kg 1.5-3 1-3 Adult Dextrose Amino acid Lipids Total 100ml/hr 25g 4g 110g 2400ml/hr 600g gives 2040 kcal 96g gives 384 550( 500ml) 2974
  20. 20. Nutrient Formulation Regular or special diet Oral supplements Enteral nutrition: ⍟ Standard formulation, Modular formulations ⍟ Special (elemental or semi-elemental) Parenteral nutrition: ⍟ Individual (amino acids, fat, dextrose) or 3 in 1 combinations Formulations for peripheral or central route
  21. 21. Nutrient Delivery Oral (as in regular intake or as oral supplement)  Gastric feeding:  Bolus (either manual or with a gravity tube) –– for adequate gastric capacity and function  Intermittent or continuous using pumps ––for volume restricted or gastric dysfunction  Small intestine feeding: Intermittent or continuous using gravity drip, but with smaller volumes (30smaller 30-80 ml/hour)
  22. 22. Monitoring Strategies • Fluid balance • Complete Blood Count Total Lymphocyte Count mild depletion-1500-1800 moderate -900-1500 severe -less than 900 • Serum albumin (value as initial assessment tool, but not as protein build up; frequent determination for issues only, pressure not nutritional)

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