NUTRITIONAL CARE PLAN
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Transcript of NUTRITIONAL CARE PLAN
Nutritional care
plan
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
Components of nutrition care plan
Nutritional assessmentNutritional requirement
Micro &Macro micronutrients Fluid requirement
Access: oral, parenteral, or combinationsNutrient formulationNutrient deliveryMonitoring strategies
Nutritional Assessment
Methods Used Are:
Anthropometric Assessment Biochemical Assessment Clinical Assessment Dietary Assessment
NUTRITIONAL REQUIREMENT
Food pyramid:
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.
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
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
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
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
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
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
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.
Access Oral Enteral nutrition
Nasogastric tube PEG / Gastrostomy Jejunostomy
PEG-J ( Jejunostomy feeding passed through the PEG)
Surgical jejunostomy Parenteral nutrition
Peripheral Central
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)
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
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.
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
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
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)
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)