The document discusses the components and approaches for developing a nutrition care plan. It outlines that a nutrition care plan includes nutritional assessment, determining nutritional requirements, deciding on oral or tube feeding access, selecting appropriate nutrient formulations, developing a delivery method, and establishing monitoring strategies. The key components are assessing the patient's nutritional needs, calculating macro and micronutrient requirements based on age and medical condition, and choosing an access route, formula, and delivery approach along with monitoring to ensure the plan meets the patient's nutritional goals.

1. Nutritional care
plan

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. 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. Nutritional Assessment
Methods Used Are:
Anthropometric Assessment
Biochemical Assessment
Clinical Assessment
Dietary Assessment

5. NUTRITIONAL
REQUIREMENT

6. Food pyramid:

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. 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. 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. 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. 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. 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. 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. 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. Access
 Oral
 Enteral nutrition
 Nasogastric tube
 PEG / Gastrostomy
 Jejunostomy
 PEG-J ( Jejunostomy feeding passed
through the PEG)
 Surgical jejunostomy
 Parenteral nutrition
 Peripheral
 Central

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. 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. 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. 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. 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. 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. 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)