Transcript CHAPTER 6 : NUTRITION

Feeding methods
Enteral & parenteral nutrition
-enteral nutrition is needed for persons with
underlying chronic disease or traumatic injury
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-also elderly person ,these patients expose to
burn ,or malignant cancer need enteral
nutrition to restore some of their health .
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** mode of enteral nutrition support :
oral supplements .
-add energy –nutrient food as Ensure with or between
Meals .
2-tube feeding :
-insufficient food intake either as supplement or as the complete
meal .
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** nutrient component :
carbohydrate
protein
amino acid
fat
vitamins & minerals .
** ways of formula feeding :
nasogastric tube :
indicated in short term theorpy .
2- esophagostomy { cancer neck } or traumatic injury
3-gastrostomy : tube placed in the stomach .
4- jejunostomy :
Tube placed in the duodenum or jejunum of small intestine .
Indicated in case of cancer stomach
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** nursing care :
check for gastric residuals .
note any signs of abdominal distension .
monitor vital signs as temperature ,pulse ,respiration .
monitor the flow rate & record intake & output .
report patient response to the formula .
monitor state of hydration .
follow up of lab investigation as needed .
**N.B: - vomiting ,abdominal distension , frequency of bowel
movement after formula feeding ,if developed better to give
intermittent bolus feeding until tolerance to formula occur
 ** parenteral feeding :
 total parentral nutrition .
 any feeding methods other than by the normal gastro-intestinal route
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 given through central or peripheral veins .
 when the GIT cant be used .
 ** indication for TPN:
 problems in the gastro-intestinal tract .
 sever mal nutrition .
 patient expose to sepsis ,chemotherapy .
 malabsorption & inadequate oral intake .
 massive burn .
 comatose patient .
 hepatic insufficiency .
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Nutrition during pregnancy & lactation
** factors determining nutritional needs :
@ age & parity :
teenage mother
number of pregnancy & interval between pregnancies ,reflect on outcome of pregnancy
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@preconception nutrition :
Diet ,food habits
General health & fitness.
State of nutrition at time of conception .
@fetus ,mother ,placenta interaction .
** energy need during pregnancy ,calories increased to nourish baby ,with appropriate
weight gain .
** protein need60gm \ day help in rapid growth of the fetus ,enlargement of uterus .
** calcium 1200 gm\day ,essential for skeletal tissue growth .
drink cup of milk daily is essential .
** iron 30gm \day .
supplementary iron given because of insufficient maternal stores .
vitamins A,B,C,D,with adequate exposure to sunlight .
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** general dietary problems :
nausea & vomiting .
hyper emesis gravid rum .
constipation .
hemorrhoids .
heart burn or gastric pressure .
** weight gain during pregnancy : 10-12 Kg
-fetus : 3.400 gm
-placenta : 450 gm
-amniotic fluid : 900 gm
-uterus : 1100 gm
Breast 1400gm
-blood volume : 1800 gm
- maternal body : 1800 gm
** nutritional risk factors in pregnancy :
age : less than 15 yrs ,more than 35 yrs .
frequent pregnancy 3 or more during two years period .
poor obstetrical history .
poverty .
abuse of nicotine ,alcohol ,or drugs
inadequate weight ,less than 85 % of standard weight ,more than 120% of
standard weight .
 ** complications of pregnancy :
 anemia : common problem during pregnancy { iron deficiency ,folate
deficiency ,hemorrhagic anemia }
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pregnancy induced hypertension { PIH }:
-low to free salt diet .
-low cholesterol .
-high protein ,vitamins ,& minerals .
-normal CHO .
- monitor of body weight .
- restriction of fluid .
3- gestational diabetes mellitus :
- low CHO diet especially glucose .
-low cholesterol diet .
-normal protein diet .
Exercise
stress reduction .
insulin therapy .
maternal phenylekentonuria .
** nutrition during lactation :
-because mother breast feeding , she need good nutrition in form of protein ,milk ,milk
product ,minerals ,& vitamins .
-finally mother need period of rest & relaxation to take care of her self ,her baby & her
family
Thank you