EXERCISE 6

MEDICAL NUTRITION THERAPY FOR FEVERS, BURNS AND INFECTIONS

Introduction

Objectives
At the end of this exercise, the students were able to:
1. Analyze case conditions of patients during dietary management;
2. Plan a diet modified in energy and carbohydrate under different conditions;
and
3. Prepare and evaluate modified diets.
Methodology
For this exercise, the students were tasked to prepare a diet for patients with
fever or infections, those who have gone on surgery and those who have to deal
with burns. Given the height and weight of the first 56 year-old male patient with
tuberculosis, DBW was determined using the Adopted Method while his TER was
computed using Method I (Cooper) and Harris Benedict formula. BMI classification
using Asian Cut off points was used to determine his nutritional status. One day
sample menu for the patient was prepared with consideration to the patients
current state and need based on medical diagnosis.
For the second case patient, a 30 year-old male patient weighing 60 kg with a
height of 5 feet and 3 inches and had undergone a post gastrectomy and intestinal
resection, NDAP formula was used to determine his DBW. His TER was computed
using Method II (Krause) and Harris Benedict formula. The nutritional status was
determined using WHO cut off points for BMI. Likewise, a one day sample menu was
made for the patients considering possible complications. The mode of feeding as
well as timing and transitions were specified for the patient.
Using the conventional and curreri formula, a diet plan for a 3 year old
Discussion
For the first case patient who is a 56 year old confined to bed with fever of
39.5 and tuberculosis, it is determined that he has a normal nutritional status based
on Asia Pacific cut off points. Given his condition, there is a 32.5% increase in his
BMR due to his 2.5 C increase in temperature from the normal temperature of 37.
With this, his total energy requirement for the day falls on 2000 kcal (using Method
I). A high calorie, high protein diet is advised for the dietary management of his
disease. Sample diet plans are provided below to give the patient 2000 kcal with
265 g of CHO, 125 g of protein and 50 g of fat. (Another diet plan with 1700 kcal
from computation from Harris Benedict Formula was also provided.) The high
protein is needed because of the accompanied increase in BMR. An adequate
carbohydrate is given as well as to spare protein for being used as energy source
instead of helping the body recover from disease. High amount of fluids should also
be given to patient due to the increased loss of body fluids and electrolytes caused
by the fever. Vitamin and mineral supplementation are given according to patients
needs especially that some of the drugs for treatment of tuberculosis are
antagonistic with some such as Vitamin B6.
For the second patient who had undergone post-gastrectomy and intestinal
resection, his nutritional status is determined to be normal according to WHO cut off
points. As a result of the surgery, the stomach is smaller with less room to be held,
and the intestines have decreased ability for digestion, this is why progressive diets
are given post-surgery to patients. Nutrition support via enteral feeding is not
mandatory to be given to patients as long as they can tolerate food. Apply nutrition
support only if oral intake cannot be applied, if the patient is undernourished on
time of surgery, and if oral intake would be inadequate (<60%) for 10 continuous
days. Jejunostomy or nasogastric enteral feeding are usually recommended for
patients who had undergone gastrointestinal surgery.
The progressive diet should start from clear liquids for 1-2 days to full liquid
to soft diet depending on the patients tolerance before one could go back to full
normal diet. Sample progressive diet from clear liquid to regular diet is provided
below. After the surgery, certain complications such as the dumping syndrome,
diarrhea, weight loss and decreased absorption of vitamins and minerals can occur.
To prevent this, in dumping syndrome, simple carbohydrates and alcoholic
beverages are usually avoided. Small frequent meals (around 6-8 meals per day)
are given as well instead of having large ones. It is also advised to not drink during
the meals as to avoid feeling full early due to the smaller capacity of the stomach.
Low fiber foods/soluble fibers are also given instead of insoluble ones because of
their easy digestibility.