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 assessment
Nutritional requirement
 Micro &Macro micronutrients
 Fluid requirement
Access: oral, parenteral, or combinations
Nutrient formulation
Nutrient delivery
Monitoring 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 particul Body wt Energy Protein Fat Calcium Iron
ars Kcal/kg g/kg g/day Mg/day Mg/day
Infants 0-6 5.4 108 2 500
months

6-12 8.6 98 1.65 500

months

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 10-12yrs 35.4 62 1.5 22 600 34
nce
(boys)

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
Group particul Body wt Energy Protein Fat Calcium Iron
ars Kcal/kg g/kg g/day Mg/day Mg/day
Pregnant 50 +300 +15 30 1000 38
woman
Lactating 0-6 50 +550 +25 45 1000 30
Month

6-12 50 +400 +18 45 1000 30

month

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
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

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
 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
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
 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 nutrition
For children;
Child Calories Amino acid Lipids
g/kg g/kg

New born 110-125 kcal 2-5 1-3

/kg
Older child 100-110 1.5-3 1-3
kcal/kg

Adult Dextrose Amino acid Lipids Total

100ml/hr 25g 4g 110g

2400ml/hr 600g gives 96g gives 550( 2974
2040 kcal 384 500ml)
 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
 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)
 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)