nutritional care plan
TRANSCRIPT
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Nutritional care
plan
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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
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Components of nutrition care plan
Nutritional assessmentNutritional requirement
Micro &Macro micronutrients Fluid requirement
Access: oral, parenteral, or combinationsNutrient formulationNutrient deliveryMonitoring strategies
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Nutritional Assessment
Methods Used Are:
Anthropometric Assessment Biochemical Assessment Clinical Assessment Dietary Assessment
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NUTRITIONAL REQUIREMENT
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Food pyramid:
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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.
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Group particulars
Body wt EnergyKcal/kg
Protein g/kg
Fat g/day
CalciumMg/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
Adolescence (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
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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 particulars
Body wt EnergyKcal/kg
Protein g/kg
Fat g/day
CalciumMg/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
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PARTICULARS ENERGY
Obese 25kcal/kg body weight
Normal weight 30 kcal/kg body weight
Underweight 35kcal/kg body weight
Preterm baby 60-150kcal/kg/dayPrt – 3.4g/kg
PEM 150-200kcal/kg body weightPrt-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
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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 metabolismTrace 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
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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 quantityVitamin A - necessary for clear vision in dim lightVitamin D - required for bone growth and calcium
metabolismVitamin E -preventing the oxidation of vit-A & β
carotene in intestine
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Vitamin B complex;Thiamine - proper utilization of CHO in the bodyRiboflavin - 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
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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.
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Access Oral Enteral nutrition
Nasogastric tube PEG / Gastrostomy Jejunostomy
PEG-J ( Jejunostomy feeding passed through the PEG)
Surgical jejunostomy Parenteral nutrition
Peripheral Central
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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)
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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
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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.
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Total parental nutritionFor children;
Child Calories Amino acidg/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
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Nutrient FormulationRegular or special dietOral supplementsEnteral 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
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Nutrient DeliveryOral (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)
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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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