CASE STUDY 1

DIABETES MELLITUS

INTRODUCTION TO DIABETES MELLITUS

The pancreas, in addition to its digestive functions, secretes two important hormones,
insulin and glucagon, that are crucial for normal regulation of glucose, lipid, and protein
metabolism. Although the pancreas secretes other hormones, such as amylin, somatostatin, and
pancreatic polypeptide, their functions are not as well established. Diabetes mellitus is a chronic
metabolic disorder that prevents the body to utilise glucose completely or partially.It is
characterised by raised glucose concentration in the blood and alterations in
carbohydrates,protein and fat metabolism.This can be due to failure in the formation of insulin
or liberation or action. Since insulin is produced by beta cells of islets of Langerhans,any
decrease in the number offunctioning cell will decrease the amount of insulin that can be
synthesised. Many diabetics can produce sufficient insulin but some stimulus to the islets
tissue is needed. During the early stages of the disease the Insulin Like Activity( ILA) of the
blood is often increased, but most this insulin appears to be bound to protein and is not available
for transport across the cell membrane and action of the cell

If left untreated, diabetes can cause many complications. Acute complications include diabetic
ketoacidosis and nonketotic hypersomolar coma. Serious long-term complications include
cardiovascular disease, stroke, chronic kidney failure, foot ulcer, and damage to the eyes.
Diabetes is due to either the pancreas not producing enough insulin or the (cells of the body not
responding properly to the insulin produced. There are three main types of diabetes mellitus:
•Type 1 DM

•Type 2 DM

•Gestational diabetes
SYMPTOMS

Weight loss, polyuria (increased urination), polydipsia (increased thirst), and

polyphagia(increased hunger) are the main symptoms. Symptoms may develop rapidly (weeks or
months) in type 1 DM, while they usually develop much more slowly and may be subtle or
absent in type 2 DM.
CAUSES
Type I diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islet of
langerhans in the pancreas, leading to insulin deficiency. Type 2 DM is characterized by insulin
resistance, which may be combined with relatively reduced insulin secretion.

PRINCIPLE OF THE DIET

-Low CHO Diet – It has been suggested that the removal of carbohydrates from the diet and
replacement with fatty foods such as nuts, seeds, meats, fish, oils, eggs, avocados, olives, and
vegetables may help reverse diabetes. Fats would become the primary calorie source for the
body, and complications due to insulin resistance would be minimized.

-High fiber diet – It has been shown that a high fiber diet works better than the diet
recommended by the American Diabetes Association in controlling diabetes, and may control
blood sugar levels with the same efficiency as oral diabetes drugs.

-Vegetarian diet – A low-fat vegan diet improves glycemic control similar to the ADA

-Natural Foods - the American Diabetes Association has endorsed a natural foods approach to
managing diabetes, advocating “fresh is best” and avoiding artificial sweeteners, instead
substituting measured amounts of fresh fruit or raw sugar.

GENERAL INFORMATION
Name : Mrs.Janaki M

Age : 68 years

Gender : Female

Hospital Number : 16033180

Ward Number : III A

Room Number : 309

Date of Admission : 06-12-2017

Date of Discharge : Still under treatment

Occupation :Nil

Activity : Moderate

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Hypertension, Cough

Present Complaints : DM

Personal History : Nil

Diagnosis : Type II Diabetes mellitus

NUTRITIONAL STATUS EVALUATION

 ANTHROPOMETRIC ASSESMENT

Height (cm) =154cm

Weight (Kg) =69kg

Body Mass Index (BMI) = Weight (Kg) / Height (m2) = 69/1.542 = 29.09

Ideal Body Weight (IBW) = Height (cm) - 100 = 154 – 100 = 54 kg

BIOCHEMICAL ASSESSMENT

TEST RESULT REFERENCE RANGE

Glucose random 247 mg/dl 70-140mg/dl
Creatinine(serum) 0.62 mg/dl 0.66-1.09mg/dl
Glucosylated Hb 12.0% 3.8-6.3%
Hemoglobin 12.6g/dl 12-15g/dl
RBS 138mg/dl 80-140 mg/dl
FBS 168 mg/dl 80-120 mg/dl

BIOPHYSICAL PARAMETERS

PARAMETERS VALUES REFERENCE VALUE

Blood pressure 146/90 120/80 mmHg
Body temperature 100⁰F 98.7⁰F
Pulse rate 100/min 72/min
Respiration rate 14/min 12-16/min

CLINICAL ASSESSMENT
 SYMPTOMS DIAGNOSIS

Hair Brittle hair

Nails Normal

Skin Normal

Eyes Normal

Mouth Normal

Neck Normal

DIETARY ASSESMENT

TYPE OF DIET: Non-vegetarian

FOOD FREQUENCY RECORD

Sl. No. Food item Daily Weekly Monthly Occasionally

1 Cereals 
2 Pulses 
3 Green leafy  
vegetables
4 Milk and milk 
products
5 Fish 
6 Meat 
7 Egg 
8 Fruits 
9 Nuts 
10 Fat and oil  
11 Sugar 
12 Chicken 
13 Vegetables
14 Roots and tubers 
15 Junk foods 
16 Baked foods 

C) ALLERGY TO FOOD: No allergy to food

PAST DIETARY INTAKE (24 HOUR RECALL METHOD)

TIME MENU QUANTITY

7.30am Tea 1 cup

8.30am Curd rice 2 cups

1.00pm Rice 2 cups

Rasam 1 cup

4.00pm Tea 1 cup

8.00pm Idly 2 No.

Sambar 1 cup
 APPROXIMATE NUTRIENT INTAKE

Energy 2731.96 kcal

Carbohydrate 489.64 g NUTRITIONAL STATUS OF THE

Protein 53.94g PATIENT According to the nutritional

assessement of the patient Mrs,Janaki.M
Fat 72.88g
68 years old female was suffering from
type 2 diabetes mellitus dise ase. The weight of the patient was 69kg and the height of the patient
was 154 cm. According to the body mass index, the patient was obese (29.09kg/m 2). The ideal
body weight was 54kg. In biochemical analysis, shows that the values were normal except blood
glucose level which was low. In clinical assessment, hair was brittle and all the other
characteristics was normal .

TREATEMENT
 The patient was taking prescribed in the hospital.

DRUGS

 INJ AMIKACIN

 INJ AMP CLOSE

 INJ.CIFRAN

 CAP:NEWFLOKA

NUTRITIONAL CARE PLAN

GOALS OF NUTRITIONAL CARE PLAN

 Low carbohydrate diet

 High fiber diet

 To maintain blood pressure level

DIET PRESCRIBED

DAY 1

TIME FOOD ITEM QUANTITY

Early morning Tea 100ml

Break fast Dosa 70g

Greenpeas curry 50g

Midmorning Apple 100g

Lunch Rice 80g

Sambar 50g

Fish curry 50g

Cabbage thoran 30g

Salad 100g

Tea time Milk 100ml

Whole wheat bread 40g

Evening Chicken soup 100ml

Dinner Oats porridge 50g

APPROXIMATE NUTRIENT INTAKE

INGREDINAT AMOUNT ENERGY CARBOHYDRATE PROTEIN FAT

SKIMMED MILK 200 58 9.2 5 0.2

RICE 60 207.6 47.4 3.84 0.24

BLACKGRAM 30 104.1 17.88 7.2 0.42

GREENPEAS 50 46.5 7.95 3.6 0.05

TOMATO 30 6.9 1.08 0.57 0.03

APPLE 100 59 13.4 0.2 0.5

REDGRAMDAL 20 67 11.2 4.46 0.34

ONION 30 15 3.33 0.36 0.03

CARROT 30 12.9 3.18 0.27 0.03

BRINJAL 30 7.2 1.2 0.42 0.009

LADIESFINGER 30 10.5 1.92 0.57 0.06

DRUMSTICK 20 5.2 0.74 0.5 0.02

FENUGREEK 5 16.6 2.2 1.3 0.2

CURRYLEAVES 10 10.8 1.87 0.61 0.1

SARDINE 100 101 - 21 1.9

CABBAGE 30 8.1 1.38 0.54 0.03

CURD 100 60 3 3.1 4

CUCUMBER 100 13 2.5 0.4 0.1

WHEAT 40 136.4 28.48 4.84 0.68

FOWL 100 109 - 25.9 0.6

OATS 50 187 31.4 6.8 3.8

OIL 10 90 - - 10

CAULIFLOWER 20 13.21 1.52 1.18 0.26

COCOUNTMILK 20 86 2.38 0.68 8.2

TOTAL 1431 193.21 93.34 31.79

DAY 2

TIME FOOD ITEM QUANTITY

Early morning Tea 100ml

Break fast Idly 70g

Sambar 50g

Tomato chutney 10g

Mid morning Oats porridge 50g

Lunch Rice 90g

Chicken curry 100g

Bittergourd thoran 50g

Salad 50g
Evening Apple 100g

Dinner Chappathi 40g

Vegitable Kurumma 50g

Salad 50g

Bed time - -

APPROXIMATE NUTRIENT INTAKE

INGREDIENT AMOUNT ENERGY CARBOHYDRATE PROTEIN FAT

SKIMMED MILLK 200 58 9.2 5 0.2

RICE 60 207.6 47.4 3.84 0.24

BLACKGRAM 30 104.1 17.88 7.2 0.42

REDGRAMDAL 20 67 11.2 4.46 0.34

ONION 30 15 3.33 0.36 0.03

CARROT 30 12.9 3.18 0.27 0.03

BRINJAL 30 7.2 1.2 0.42 0.03

LADIESFINGER 30 10.5 .82 0.57 0.06

DRUMSTICK 20 5.2 0.74 0.5 0.02

FENUGREEK 5 16.6 2.2 1.3 0.02

CURRYLEAVES 10 10.8 1.87 0.61 0.1

TOMATO 30 6.9 1.08 0.57 0.03

COCONUTMILK 20 86 2.38 0.68 8.2

OATS 50 187 31.4 6.8 3.8

FOWL 100 109 - 25.9 0.6

CUCUMBER 100 13 2.5 0.4 0.1

CURD 100 60 3 3.1 4

CABBAGE 30 8.1 1.38 0.54 0.03

APPLE 100 59 13.4 0.2 0.5

BITTERGOURD 100 25 4.2 1.6 0.2

WHEAT FLOUR 40 136.4 28.48 4.84 0.68

GREENPEAS 50 46.5 7.95 3.6 0.05

CAULIFLOWER 20 13.21 1.52 1.18 0.26

OIL 15 135 - - 15

TOTAL 1400 197.41 73.94 35.12

DAY 3

TIME FOOD ITEM QUANTITY

Early morning Tea 100ml

Break fast Chappatti 40g

Greenpeas curry 50g

Midmorning Apple 100g

Lunch Rice 60g

Fish curry 100g

Cabbage thoran 30g

Salad 100g

Evening Chicken soup 100g

 Dinner Oats porridge 60g

Bed time - -

APPROXIMATE NUTRIENT INTAKE

INGREDENT AMOUNT ENERGY CARBOHYDRATE PROTEIN FAT

SKIMMED MILK 200 58 9.2 5 0.2

WHEAT 40 136.4 28.48 4.84 0.68

FENUGREEK 50 16.6 2.2 1.3 0.2

GREENPEAS 50 46.5 7.95 3.6 0.05

TOMATO 30 6.9 1.08 0.57 0.03

APPLE 100 59 13.4 0.2 0.5

RICE 60 207.6 47.4 3.84 0.24

SARDINE 100 101 - 21 1.9

CABBAGE 30 8.1 1.38 0.54 0.03

CUCUMBER 100 13 2.5 0.4 0.1

CURD 100 60 3 3.1 4

ONION 30 15 3.33 0.36 0.03

CARROT 30 12.9 3.18 0.27 0.03

COCONUTMILK 20 86 2.38 0.68 8.2

FOWL 100 109 - 25.9 0.6

CAULIFLOWER 20 13.21 1.52 1.18 0.26

OATS 60 224.4 37.68 8.16 4.36

OIL 20 180 - - 20

TOTAL 1354 164.68 80.94 41.14

PROGRESS OF THE PATIENT

Problems oriented record: The patient come with hypertension and cough.

Dietary problems: No dietary problems.

Weight changes: No weight change during treatment.

Biochemical parameters: Patient have high blood sugar level.

CONCLUSION

Mrs.Janaki.M 68 years old women admitted in the hospital due to diabetes mellitus. She is a
known case of Type2 Diabetes mellitus. She already had the past history of hypertension and
cough. It was found from her anthropometric profile that her BMI was 29.09kg/m². Which shows
that she is obese. On assessing the dietary habit it was noticed that the calorie intake was low on
the basis of diagnosis and nutritional assessment, the diet counseling was given. The diet
prescribed for the patient is low calorie, normal protein, low fiber diet with liberal vitamins and
minerals. At the time of discharge she will be given counseling regarding to the importance of
the diet and exercise in maintaining the blood glucose level.
 CASE STUDY 2

HEART DISEASE

INTRODUCTION TO HEART DISEASE

Cardiovascular disease (CVD) is a general term describing diseases of the heart and blood
vessels. Coronary Heart Disease is the most common form of CVD and is caused by
atherosclerosis in the large and medium sized arteries that supply the heart muscle with oxygen
and nutrients.

Causes:

 Cigarette smoking
 LDL cholesterol
 High cholesterol diet
 Hypertension
 Left ventricular hypertrophy
 Thrombogenic factors
 Obesity
 Postmenopausal status
 Age
 Male gender
 Hereditary factors

Clinical effects:

The clinical effects of atherosclerosis are manifested principally in medium sized arteries
including the coronary, carotid, cerebral arteries supplying the lower limbs particularly the iliac
femoral arteries. The principal clinical results of atherosclerotic lesions are due to partial or
total occlusion of the arterial lumen.

PRINCIPLE OF THE DIET

 -Diet therapy remains the first line of treatment for patient with high blood cholesterol
levels.
 -Low fat particularly low saturated fat, low cholesterol high in PUFA with w-6 to w-3
ratio 4:10:1 lo carbohydrate and normal protein minerals, vitamins are suggested.
 -High fiber diet with increased amount of antioxidants is also recommended.
GENERAL INFORMATION

Name : Mrs. Madhavi

Age : 85 years

Gender : Female

Hospital Number : 16007834

Ward Number : III A

Room Number : 308

Date of Admission : 11-12-2017

Date of Discharge : Still under treatment

Occupation : Nil

Activity : Moderate

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Hypertension, Diabetes mellitus

Present Complaints : Chest pain

Personal History : Nil

Diagnosis : Choronary Artery Disease.

NUTRITIONAL STATUS EVALUATION

ANTHROPOMETRIC MEASURMENT

 Height (cm) = 152cm

 Weight (Kg) = 50 kg
 Body Mass Index (BMI) = 50/1.522= 21.64
 Ideal Body Weight (IBW) =152-100=52kg

BIOCHEMICAL PARAMETER

PARAMETERS VALUE REFERENCE VALUE

Hemoglobin 12.9g/dl 13.5-17.0g/dl

Fasting blood glucose 241mgldl 90-110mg/dl

Serum creatinine 0.9mg/dl 0.6-1.2mg/dl

Serum sodium 134mEq/l 136-145mEq/L

Serum potassium 4.0mEq/l 3.8-5.0 mEq/L

SGPT 50IU/L 5-40IU/L

SGOT 0.95IU/L 5-40IU/L

BIOPHYSICAL PARAMETERS

PARAMETERS VALUES REFERENCE

VALUE

Blood pressure 146/90 120/80 mmHg

Body temperature 100⁰F 98.7⁰F

Pulse rate 70/mnt 72/mnt

Respiration rate 13/mnt 12-16/mnt

CLINICAL ASSESSMENT
 ORGANS OBSERVATION

Hair Soft, Brittle

Eyes Normal

Mouth Normal

Tongue Normal

Nails Normal

Skin Normal

Neck Normal

Teeth Normal

DIETARY ASSESMENT

A. TYPE OF DIET: Non-vegetarian

C)ALLERGY TO FOOD: No allergy to food

FOOD FREQUENCY RECORD

Sl.No FOOD GROUPS DAILY WEEKLY MONTHLY OCCASIONALLY

1 Cereals 
2 Pulses 
3 Greenleafy 
4 vegetables
Milk and milkproducts 
5 Fish  
6 Meat  
7 Egg 
8 Fruits 
9 Nuts  
10 Fat and oil 
11 Sugar 
12 Chicken  
13 Vegetable 
14 Roots and tubers 

C)ALLERGY TO FOOD: No allergy to food

PAST DIETARY INTAKE

MEAL TIME MENU INGREDIENTS AMOUNT

Early morning Tea Milk 75ml

Sugar 15g

Break fast Idiyappam Rice flour 60g

Green peas curry Green peas 25g

Onion 10g

Tomato 10g

Tea Milk 75ml

Lunch Rice Rice 100g

Sambar Red gram dhal 25g

Tomato 10g

Carrot 10g

Ladies finger 20g

Pumpkin 10g

Onion 10g

Ash guard thoran Ash guard 20g

Dinner Chappathi Wheat flour 50g

Tomato chutney Tomato 20g

Onion 10g
APPOROXIMATE NUTRIENT INTAKE

INGREDIENTS AMOUNT ENERGY PROTEIN FAT

(g) (Kcal) (g) (g)

Rice 100 346 6.4 0.4

Rice flour 60 207 4.08 0.3

Wheat flour 50 170 6.05 0.85

Red gram dhal 25 63.5 1.85 0.025

Green peas 25 23.25 1.8 0.025

Tomato 30 6.9 0.57 0.03

Carrot 10 4.8 0.095 0.11

Ladies finger 20 3.5 0.19 0.02

Pumpkin 10 2.5 0.14 0.01

Onion 30 17.7 0.54 0.03

Ash guard 20 2 0.08 0.02

Sugar 30 119.4 0.03 _

Milk 150 100.5 4.8 6.15

Oil 10 90 _ 10

Total 1157.3 26.886 18.035

NUTRITIONAL STATUS OF THE PATIENT

According to the nutritional assessement of the patient Mrs.Madhavi,85 years

old female was suffering from Choronary Artery disease. The weight of the patient was 50kg
and the height of the patient was 152 cm. According to the body mass index, the patient was
normal (21.6kg/m2). The ideal body weight was 52kg. In biochemical analysis, shows that the
values were normal except SGPT which was high. In clinical assessment, hair was soft brittle
and all the other characteristics was normal .
TREATMENT

Under medication

DRUGS

 T- LOSAR
 T-ALDACTONE
 T-LANOXIN
 T-GLIMY
 INJ-LASIX
 INJ-PANTOCIP

NUTRITIONAL CARE PLAN

GOALS OF NUTRITIONAL CARE PLAN

 To reduce blood sugar level

 To provide high fiber diet
 To maintain blood pressure level

DIET ORDER/ DIET PRESCRIPTION

NUMBER OF DIET TYPE OF DIET

Day 1 Soft diet

Day 2 Normal diet

Day 3 Normal diet

DIET PRESCRIBED BY THE HOSPITAL

DAY 1

TIME MENU SERVINGS

 EARLY MORNING Milk 100ml

BREAKFAST Appam 20g

Vegetable curry 60g

MID MORNING Pomegranate 70g

LUNCH Rice 40g

Sambar 70g

Salad 50g

Bittergurd thoran 30g

EVENING Vegetable soup 40g

DINNER Wheat dosa 20g

Egg curry 40g

Salad 50g

BED TIME Oats 180g

APPROXIMATE NUTRIENT INTAKE

INGREDIENTS QUANTITY ENERGY CARBOHYDRATE PROTEIN FAT

(g) (kcal) (g) (g) (g)

Skimmed milk 100ml 43.5 6.9 3.75 0.15

Rice flour 20g 69.2 15.8 1.28 0.08

Cauliflower 10g 3 0.4 0.26 0.04

Brinjal 10g 2.4 0.4 0.14 0.03

Onion stalk 10g 4.1 0.89 0.09 0.02

Tomato 10g 2 0.36 0.09 0.02

Soya bean 20g 86.4 4.18 8.64 3.9

Pomegranate 70g 45.5 10.15 1.17 0.07

Rice 40g 138.4 30.68 3 0.4

Ladies finger 10g 3.5 0.64 0.19 0.02

Drumstick 10g 2.6 0.37 0.25 0.01

Onion 10g 5 1.11 0.12 0.01

Green tomato 10g 2.3 0.36 0.19 0.01

Red gram dhal 10g 33.5 5.76 2.23 0.17

Cucumber 10g 1.3 0.25 0.04 0.01

Onion 10g 5 1.11 0.12 0.01

Tomato 10g 2 0.36 0.09 0.02

Sprouted green10g 34.8 5.99 2.45 0.12

Carrot
10g 4.8 1.06 0.09 0.02
Bitter guard
30g 3.6 0.75 0.06 0.03

Tomato 10g 2 0.36 0.09 0.02

Potato 10g 9.7 2.26 0.16 0.01

Carrot 10g 4.8 1.06 0.09 0.02

Onion 10g 5 1.11 0.12 0.01

Wheat flour 20g 69.6 14.78 2.2 0.08

2 Egg white 30g 51.9 - 3.99 0.2

Onion 10g 5 1.11 0.12 0.01

Cucumber 10g 1.3 0.25 0.04 0.01

Onion 10g 5 1.11 0.12 0.01

Tomato 10g 2 0.36 0.09 0.02

Carrot 10g 4.8 1.06 0.09 0.02

Sprouted green10g 34.8 5.99 2.24 0.12

Oats 20g 74.8 6.56 2.72 1.52

Skimmed milk 150ml 43.5 6.9 3.75 0.15

Almond 25g 163 2.62 5.2 14.72

Sugar 25g 99.5 24.85 0.025 -

TOTAL 1069 157.9 45.455 22.22.14

DAY 2

TIME MENU SERVINGS

EARLY MORNING Skimmed Milk 100ml

BREAKFAST Ragi dosa 50g

Cauliflower gravy 110g

MID MORNING Sliced watermelon 70g

LUNCH Boiled rice 30g

Sardine curry 80g

Amaranth poriyal 40g

Salad 40g

EVENING Tea 100ml

Kesari 20g

DINNER Wheat porridge 75g

Green gram thoran 15g

Sugar 25g

Almond 20g
APROXIMATE NUTRIENT INTAKE

INGREDIENTS QUANTITY ENERGY CARBOHYDRATE PROTEIN FAT

(g) (kcal) (g) (g)

Milk 100ml 67 4.2 1.63 0.1

Ragi 50g 104 3.6 3.6 0.65

Cauliflower 50g 15 2 1.3 0.2
Beans 20g 31.6 5.96 1.48 0.2
Green tomato 10g 2.3 0.36 0.19 0.01
Onion 10g 5 1.11 0.105 0.01
Brinjal 20g 4.8 0.8 0.28 0.07

Watermelon 70g 11.2 2.31 0.14 0.14

Boiled rice 30g 103.2 23.7 1.92 0.12

Sardine 50g 50.5 - 10.5 0.95
Green mango 10g 4.4 1.01 0.07 0.01
Tomato 20g 4 0.72 0.18 0.04
Amaranth 20g 66.6 5.96 1.26 0.02
Carrot 10g 6.8 1.06 0.09 0.02
Tomato 10g 2 0.36 0.09 0.02
Cucumber 10g 1.3 0.25 0.04 0.01
 Onion 10g 5 1.11 0.105 0.01

Milk 100ml 29 4.6 2.5 0.1

Kesari dhal 15g 51.75 8.49 4.23 0.09

Wheat flour 75g 255.75 52.05 9.075 1.275

Green gram 15g 50.1 8.505 3.345 0.255

Almond 25g 163.75 2.625 5.2 14.745

Sugar 20g 79.6 19.88 0.5 -

TOTAL 1104.25 155.66 50.75 19.12

DAY 3

TIME MENU SERVINGS

EARLY Tea 100ml

MORNING

BREAKFAST Chappathi 75g

Masala curry 90g

MID MORNING Sliced water melon 70g

LUNCH Rice 30g

Cat fish curry 80g
Drumstick leaf poriyal 20g
Salad 40g

EVENING Milk 100ml

White bread 15g

DINNER Ragi porridge 50g

Green gram thoran 15g

BED TIME Milk 100ml

 Almond 25g
Sugar 20g

APPROXIMATE NUTRIENT INTAKE

INGREDIENTS QUANTITY ENERGY CARBOHYDRATE PROTEIN FAT

(g) (kcal) (g) (g) (g)

Skimmed Milk 100ml 29 4.6 2.5 0.1

Wheat flour 75g 255.75 52.05 9.075 1.275

Soya 25g 108 5.225 10.8 4.875

Beans 25g 39.5 7.45 1.85 0.05

Green tomato 10g 2.3 0.36 0.19 0.01

Onion

Brinjal 10g 5 1.11 0.105 0.01

20g 4.8 0.8 0.28 0.07

Watermelon 70g 11.2 2.31 0.14 0.14

Boiled rice 30g 103.8 23.7 1.92 0.12

Catfish 50g 43 - 10.7 -

Green mango 10g 4.4 1.01 0.07 0.01

Tomato 20g

Drumstick leaves 20g 4 0.72 0.18 0.04

 Carrot 10g 18.4 2.5 1.34 0.34

Tomato

Cucumber 10g 4.8 1.06 0.09 0.02

Onion 10g 2 0.36 0.09 0.02

10g 1.3 0.25 0.04 0.01

10g 5 1.11 0.105 0.01

Milk 100ml 29 4.6 2.5 0.1

Bread 15g 36.75 7.785 1.17 0.105

Ragi 75g 104 3.6 3.6 0.65

Green gram 15g 50.1 8.505 3.345 0.255

Almond 25g 163.75 2.625 5.2 14.745

Sugar 20g 79.6 19.88 0.05 -

TOTAL 1144.7 150.9 53.9 23.2

PROGRESS OF THE PATIENT

Problems oriented record: The patients come with hypertension and chest pain

Dietary problems: No dietary problems

Weight changes: No weight change during treatment

Biochemical parameters: Patient have high blood sugar level.

CONCLUSION

Mrs. Madhavi 85 years old female was admitted in the hospital due to chest pain. She is a
known case of choronary artery disease. She already had the past history of hypertension and
diabetes mellitus. It was found from her anthropometric profile that her BMI was
21.64kg/m².Which shows that she is normal weight. On assessing the dietary habit it was
noticed that the calorie intake was normal. On the basis of diagnosis and nutritional assessment.
The diet counseling was given. The diet prescribed for the patient is normal calorie, high protein
with liberal vitamins and minerals. At the time of discharge she will be given counseling
regarding to the importance of diet.
 CASE STUDY 3

GASTRO INTESTINAL DISEASE

INTRODUCTION TO GASTRO INTESTINAL DISEASE

Gastric disease

Stomach diseases refer to diseases affecting the stomach. Inflammation of the stomach by
infection from any cause is called gastritis, and when including other parts of the
gastrointestinal tract called gastroenteritis. When gastritis is persists in a chronic state, it is
associated with several diseases, including atrophic gastritis, pyloric stenosis, and gastric
cancer. Another common condition is gastric ulceration, peptic ulcers. Ulceration erodes the
gastric mucosa, which protects the tissue of the stomach from the stomach acids. Peptic ulcers
are most commonly caused by a bacterial Helicobacter pylori infection.

Intestinal disease

The small and large intestines may be affected by infectious, autoimmune, and
physiological states. Inflammation of the intestines is called enterocolitis, which may lead to
diarrhea.
Acute conditions affecting the bowels include infectious diarrhea and mesenteric
ischemia. Causes of constipation may include faecal impaction and bowel obstruction, which may
in turn be caused by ileus, intussusceptions, volvulus. Inflammatory bowel disease is a condition of
unknown etiology, classified as either Crohn's disease or ulcerative colitis, that can affect the
intestines and other parts of the gastrointestinal tract. Other causes of illness include intestinal
pseudo obstruction, and necrotizing enterocolitis.

PRINCIPLE OF THE DIET

 Adequate amount of calorie, protein, fat, vitamins and minerals along with high amount
of fiber and fluid is recommended

GENERAL INFORMATION

Name : Mrs. Radhamani

Age : 58 years

Gender : Female

Hospital Number : 16026139

Ward Number : II B

Room Number : 204

Date of Admission : 12-12-2017

Date of Discharge : Still under treatemnt

Occupation : Nil

Activity : Moderate

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Hysterectomy -20 years back

Present Complaints : Peptic ulcer

Personal History : Nil

Diagnosis : Peptic ulcer

NUTRITIONAL STATUS EVALUATION

ANTHROPOMERIC ASSESMENT

 Height(cm) = 165cm
 Weight (Kg) = 67 kg
 Body Mass Index (BMI)= Weight (Kg) / Height (m2) = 67/1.652 = 24.609
 Ideal Body Weight (IBW) = Height (cm) - 100= 165 – 100= 65kg

BIOCHEMICAL ASSSESSMENT

TEST RESULT REFERENCE VALUE

Total RBC count 4×106/UL 4.5-5.6×106/UL

Haemoglobin 10.2g/dl 13-17g/dl

Haematocrit(PCV) 32.5% 35%

Total WBC count 8.8×103/UL 4-10×103/UL

Neutrophil 61.4% 40-80%

Lymphocyte 29.7% 20-80%

Monocyte 7.3% 2-10%

Eosinophil 1.17% 1.6%

Basophil 6.5% 0.2%

Platelet 243×103/UL 150-400×103/UL

Serum sodium 130mEq/L 136-145mEq/L

BIOPHYSICALPARAMETERS
 PARAMETERS VALUES REFERENCE VALUE

Blood pressure 126/90mmHg 120/80 mmHg

Body temperature 98.6°F 98.7⁰F

Pulse rate 66/min 72/min

Respiration rate 16/min 12-16/min

CLINICAL ASSESSMENT

ORGANS OBSERVATION
Hair Soft, Brittle
Eyes Normal
Mouth Normal
Nails Normal
Skin Normal
Neck Normal

DIETARY ASSESMENT

B. TYPE OF DIET: Non-vegetarian

C)ALLERGY TO FOOD: No allergy to food

FOOD FREQUENCY RECORD

Sl.No FOOD GROUPS DAILY WEEKLY MONTHLY OCCASIONALLY

1 Cereals 
 2 Pulses 
3 Greenleafy 
4 vegetables
Milk and milkproducts 
5 Fish  
6 Meat  
7 Egg 
8 Fruits 
9 Nuts  
10 Fat and oil 
11 Sugar 

C) ALLERGY FOODS: No allergy to food items

PAST DIETARY INTAKE PATTERN (24 HOUR RECALL):

TIME MENU QUANTITY

7.30am Tea 1 cup

8.30am Curd rice 2 cups

1.00pm Rice 2 cups

Rasam 1 cup

4.00pm Tea 1 cup

8.00pm Idly 2 No.

Sambar 1 cup
APPOROXIMATE NUTRIENT INTAKE

NUTRIENT VALUE

Energy 3731.96 kcal

Carbohydrate 489.64 g

Protein 53.94g

Fat 72.88g
NUTRITIONAL STATUS OF THE PATIENT

According to the nutritional assessement of the patient Mrs.Radhamani 58 years

old female was suffering from Peptic ulcer disease. The weight of the patient was 67kg and the
height of the patient was 165 cm. According to the body mass index, the patient was normal
(24.6kg/m2). The ideal body weight was 65kg. In biochemical analysis, shows that the values
were normal except RBC level ,serum sodium and Packed cell volume which was low. In clinical
assessment, hair was soft brittle and all the other characteristics was normal .

TREATEMENT

The patient was taking prescribed in the hospital.

DRUGS

 Tab. Nexpro 40mg

 Tab. Amlodipine 5mg
 Inj. Tazact 4.5gm
 Inj. Neksium 40gm
 Inj. Perinorm 1Lamp

NUTRITIONAL CARE PLAN

GOALS OF NUTRITIONAL CARE PLAN

 To provide high fiber diet.

 To maintain blood pressure level.
 To provide adequate amount of calorie.

DIET ORDER/ DIET PRESCRIPTION

 NUMBER OF DIET TYPE OF DIET

Day 1 Soft diet

Day 2 Normal diet

Day 3 Normal diet

DAY-1

TIME FOOD ITEM QUANTITY

Early morning Tea 100ml

Break fast Idly 120g

Mint chutneyS 40g

Mid morning Ragi porridge 100ml

Lunch Rice 110g

Sambar 80g

Steamed sardine 50g

Beetroot thoran 30g

Tea time Milk 100ml

Egg 70g

Dinner Oats porridge 120ml

Bed time - -

APPROXIMATE NUTRIENT INTAKE

INGREDIENT AMOUNT ENERGY CARBOHYDRATEPROTEIN FAT

MILK 300 201 13.2 9.6 12.3
SUGAR 10 39.8 9.94 0.01 -
RICE 200 692 158 12.8 0.8
BLACKGRAM 30 104.1 17.88 7.2 0.42
MINT 30 14.4 1.74 1.44 0.18
CHILLY 10 2.9 0.3 0.29 0.06
RAGI 60 196.8 43.2 4.38 0.78
RED GRAM 35 117.25 20.16 7.805 0.595
DAL
CARROT 10 4.8 1.06 0.09 0.02
LADIES 10 3.5 0.64 0.19 0.02
FINGER
DRUMSTICK 100 26 3.7 2.5 0.1
CURRYLEAVES10 10.8 1.87 0.36 0.1
TOMATO 10 2.3 0.36 0.19 0.01
BRINJAL 10 2.4 0.4 0.14 0.03
ONION 10 5 0.222 0.12 0.01
SARDINE 50 50.5 - 10.5 0.95
BEETROOT 30 12.9 2.64 0.51 0.03
EGG 70 121.1 - 9.31 9.31
OATS 60 224.4 37.68 8.16 4.36
OIL 30 270 - - 30
TOTAL 2101.95 312.99 75.59 60

DAY-2

TIME FOOD ITEM QUANTITY

Early morning Tea 100ml

Break fast Dosa 90g

Sambar 50g

Midmorning Oats porridge 60g

 Lunch Rice porridge 110g

Curd 100ml

Steamed sardine 50ml

Carrot thoran 30g

Tea time Sandwitch 90g

Milk 100ml

Dinner Ragi dosa 60g

Vegetable curry 50g

Bed time - -

APPROXIMATE NUTRIENT INTAKE

INGREDIENT AMOUNT ENERGY CARBOHYDRATE PROTEIN FAT

MILK 200 134 8.8 6.4 8.2
SUGAR 10 39.8 9.94 0.01 -
RICE 200 692 158 12.8 0.8
BLACKGRAM 30 104.1 17.88 7.2 0.42
REDGRAM 35 117.25 20.16 7.805 0.595
CARROT 30 4.4 3.18 0.27 0.06
LADIESFINGE 10 3.5 0.64 0.19 0.02
R
DRUMSTICK 100 26 3.7 2.5 0.1
CURRYLEAVE 10 10.8 1.87 0.36 0.1
S
TOMATO 10 2.3 0.36 0.19 0.01
BRINJAL 10 2.4 0.4 0.14 0.03
ONION 10 5 0.222 0.12 0.01
OATS 60 224.4 37.68 8.16 4.56
MINT 15 9.6 1.16 0.72 0.09
CURD 100 60 3 3.1 4
SARDINE 50 50.5 - 10.5 0.95
BEETROOT 10 4.3 0.88 0.17 0.01
WHEAT 20 68.2 14.24 2.42 0.34
EGG 70 121.1 - 9.31 9.31
RAGI 60 196.8 43.2 4.38 0.78
OIL 30 270 - - 30
CHILLY 10 2.9 0.3 0.29 0.06
TOTAL 2159 325.6 77.03 60.45

DAY-3

TIME FOOD ITEM QUANTITY

Early morning Tea 100ml

Break fast Idly 110g

Sambar 70g

Midmorning Oats porridge 60g

Lunch Rice 110g

Fish curry 50g

Beetroot chutney 30g

Brinjal thoran 20g

 Tea time Egg omlet 70g

Milk 100ml

Dinner Ragi porridge 60g

Bed time - -

APPROXIMATE NUTRIENT INTAKE

INGREDIENT AMOUNT ENERGY CARBOHYDRATE PROTEIN FAT

MILK 300 201 13.2 9.6 12.3
SUGAR 10 39.8 9.94 0.01 -
RICE 200 692 158 12.8 0.8
BLACKGRAM 30 104.1 17.88 7.2 0.42
REDGRAMDAL35 117.25 20.16 7.805 0.595
CARROT 10 4.8 1.06 0.09 0.02
LADIESFINGER10 3.5 0.64 0.19 0.02
DRUMSTICK 100 26 3.7 2.5 0.1
CURRYLEAVES10 10.8 1.87 0.36 0.1
TOMATO 10 2.3 0.36 0.19 0.01
BRINJAL 10 2.4 0.4 0.14 0.03
ONION 10 5 0.222 0.12 0.01
OATS 60 224.4 37.68 8.16 4.56
SARDINE 50 50.5 - 10.5 0.95
MINT 30 14.4 1.74 1.44 0.18
BEETROOT 30 12.9 2.64 0.51 0.03
CHILLY 10 2.9 0.3 0.29 0.06
EGG 121.1 - 9.31 9.31
RAGI 196.8 43.2 4.38 0.78
OIL 270 - - 30
TOTAL 2102 313 75.6 60

PROGRESS OF THE PATIENT

Problems oriented record: The patients come with abdominal pain

Dietary problems: No dietary problems

Weight changes: No weight change during treatment

Biochemical parameters: Patient have low haemoglobin level

CONCLUSION

Mrs.Radhamani 58 years old women admitted in the hospital due to peptic ulcer. She is a
known case of peptic ulcer. She already had the past history of hysterectomy. It was found from
her anthropometric profile that her BMI was 24.6 kg/m². Which shows that she is normal
weight. On assessing the dietary habit it was noticed that the calorie intake was normal on the
basis of diagnosis and nutritional assessment. The diet counseling was given. The diet priscribed
for the patient is normal calorie, normal protein and high fiber diet with liberal vitamins and
minerals. At the time of discharge she will be given counseling regarding to the importance of
diet.
 CASE STUDY 4

LIVER DISEASE

INTRODUCTION TO LIVER DISEASE

There is little evidence that the liver ages and it can function well into old age if disease free. It
is also able to naturally regenerate lost tissue. Chronic liver disease is characterised by scarring
and destruction of the liver tissue. Early changes, such as 'fatty liver' (a build up of fat in the
liver cells) can progress via inflammation (hepatitis) and scarring (fibrosis) to irreversible
damage (cirrhosis). At this point, the liver will not be able to regenerate itself though further
 damage can be averted. Most chronic liver disease is symptomless ('silent') and when symptoms
do develop, they are often vague such as tiredness, weakness, loss of appetite and nausea.

CAUSES

A variety of illnesses can affect the liver, for example,certain drugs like excessive amounts of
acetaminophen,and acetaminophen combination medications like Vicodin, Norco, and stains.

•cirrhosis

• alcohol abuse

• hepatitisA, B, C, D, and E,

• Epstein Barr virus (infectious mononucleosis),

• non-alcoholic fatty liver disease.

• Iron overload (hemochromatosis)

SYMPTOMS

• weakness and fatigue.

• weight loss

•nausea

•vomiting and yellow discoloration of the skin(jaundice)

PRINCIPLE OF THE DIET

-A high calorie , high protein , high carbohydrate, moderate or restricted fat high vitamin diet
helps in regeneration of liver and helps to prevent the formation of ascites .
GENERAL INFORMATION

Name :Mr.Raghavan

Age : 58 Years

Gender : Male

Hospital Number : 16033245

Ward Number : III A

Room Number : 310

Date of Admission : 6-12-2017

Date of Discharge : 13-12-2017

Occupation : coolie

Activity : Moderate

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Nil

Present Complaints : Liver cirrhosis, Hypertension

Personal History : Nil

Diagnosis : Chronic liver disease.

NUTRITIONAL STATUS EVALUATION

ANTHROPOMETRIC ASSESSMENT

Weight(cm) = 76 kg

Height (kg) = 180cm

Body Mass Index (BMI) = Weight (kg)/ Height (m2) = 76/1.82 = 23

Ideal Body Weight (IBM)= Height -100 = 180-100 = 80kg

BIOCHEMICAL ASSSESSMENT
 PARAMETERS 6/12/17 REFERENCE VALUE

Hemoglobin 8.6 g/dl 13.5-17.0g/dl

PCV 36.9% 40-50%

Red cell count 3.29 m/cu mm 4.6-6.0m/cu mm

Platelets 1.31 L/µl 1.5-4L/µl

Neutrophils 64.6% 40-65%

Lymphocytes 20% 30-50%

E.S.R 75mm 5-15mm

Urea 50m g/dl 15-40mg/dl

Sercreatinine 1.5 g/dl 0.6-1.2mg/dl

SGOT 36 IU/L 5-40IU/L

SGPT 21 IU/L 5-40IU/L

Albumin 2.7 g/dl 3.5-5g/dl

Globulin 3.0 g/dl 2-3.5g/dl

Uric acid 0.6 mg/dl 0.5-7.0mg/dl

Ser potassium 5.2 mEq/L 3.8-5.0 mEq/L

Ser sodium 138 mEq/L 136-145mEq/L

Blood pressure 100/60 mmHg 120/80mmHg

BIOPHYSICALPARAMETERS

PARAMETERS VALUES REFERENCE VALUE

Blood pressure 126/90 120/80 mmHg

Body temperature 102 °F 98.7⁰F

Pulse rate 67/mnt 72/mnt

Respiration rate 23/mnt 12-16/mnt

 CLINICAL ASSESSMENT

ORGANS OBSERVATION

Hair Dry

Nails Normal

Skin Normal

Eyes Normal

Mouth Normal

Neck Normal

DIETARY ASSESSMENT

TYPE OF DIET : Non vegetarian

FOOD FREQUENCY RECORD :

Sl. FOOD ITEM DAILY WEEKLY MONTHLY OCCASIONALLY

NO

1 Cereals 

2 Pulses 

3 Green leafy 
vegetables

4 Milk and milk 

products

5 Fish 

6 Meat 

7 Egg 
 8 Fruits 

9 Nuts 

10 Fat and oil 

11 Sugar 

PAST DIETARY INTAKE PATTERN

TIMING FOOD ITEM QUANTITY

Early morning Tea 100 ml

Breakfast Uppuma 200 g

Coconut chatni 1/2cup

Mid-morning Apple juic 1 glass

Lunch Rice 300g

Bitter guard 1/2 cup

Amaranth 1/2 cup

Evening Tea 300 ml

Bread 2 no

Dinner Dosa 3 no

Coconut chatni 1/2 cup

APPOROXIMATE NUTRIENT INTAKE

Energy 188.2(kcal)
Protein 44.49 (g)

Carbohydrate 332.65(g)

Fat 33.96(g)

NUTRITIONAL STATUS OF THE PATIENT

According to the nutritional assessement of the patient Mr.Raghavan,56 years

old male was suffering from Chronic liver disease. The weight of the patient was 76kg and the
height of the patient was 180 cm. According to the body mass index, the patient was normal
(23kg/m2). The ideal body weight was 80kg. In biochemical analysis, shows that the values were
normal excep ESR,urea, serum creatinine,serum protein which was high. In clinical assessment,
hair was dry and all the other characteristics was normal .

TREATMENT

The patient was taking prescribed in the hospital

DRUGS

 Inj. Kephazon 1gm

 Inj. Deriphyllin 1 lamp

 Inj. Pantocid 40mg

 Inj. Lasix 40mg

 Tab. Udiliv 300mg

 Tab. Becozuls 2mg

 Levolinnebu 30mg
 NUTRITIONAL CARE PLAN

GOALS OF NUTRITIONAL CARE PLAN

 To increase the blood heamoglobin level through diet

 To maintain body weight

 To maintain biophysical biochemical parameters

 To maintain blood pressure level

 DIET ORDER/ DIET PRESCRIPTION

NUMBER OF DIET TYPE OF DIET

Day 1 Normal diet

Day 2 Normal diet

Day 3 Normal diet

DIET PRESCRIBED BY THE HOSPITAL

DAY 1
MEAL TIME MENU QUANTITY

6.00am6.00am Tea 200ml

8.00am Dosa 180g

Onion chutney 60g

10.00am Oats 50g

12.30pm Rice 100g

Sambar 190g

Cabbage thoran 30g

 Boiled sardine 100g

3.00pm Boiled Tapioca 70g

Pears 100g

8.00pm Chappathi 40g

Vegetable curry 180g

Sugar 25g

APROXIMATE NUTRIENT INTAKE

TIME FOOD INGREDIENT QUANTITY ENERGY CARBOHYDRATE PROTEIN FAT

ITEM
Early Tea Skimmed milk 200 58 9.2 5 0.2
morning Sugar 25 99.5 24.85 0.025 ---
Breakfast Dosa Rice 150 519 118.5 9.6 0.6
Black gram dal 30 104.1 7.2 17.88 0.4

Onion Onion 60 30 6.66 0.72 0.06

chatney
Mid Oats Oats 50 187 31.4 6.8 3.8
morning
Lunch Rice Rice 150 519 118.5 9.6 0.6

Sambar Red gram dal 35 117.25 20.6 7.805 0.595

Chilly 5 2.9 0.3 0.29 0.06
Brinjal 30 7.2 1.2 0.42 0.009
Ladiesfinger 60 21 3.84 1.14 1.2
Drumstick 30 7.8 1.11 0.75 0.03
Yam 30 33.3 7.8 0.4 0.05

Cabbage Cabbage 30 13.5 2.3 0.9 0.05

thoran

Boiled Sardine 100 101 -- 21 1.9

Sardine
Evening Boiled Tapioca 40 109.9 26.67 0.450 0.14
Tapioca
 Pears Pears 100 52 11.9 0.6 0.2

Dinner Chappathi Wheat 40 136.4 28.48 4.84 0.68

Veg curry
Green garm dal 50 174 0.9 12.25 0.6
Mint 20 9.6 1.16 0.96 0.12
Curry leaves 20 21.6 3.74 1.2 0.2
Carrot 60 25.8 6.36 0.54 0.06
Coconut 20 88.8 2.6 0.9 8.32
Oil 10 90 ---- ----- 10

TOTAL 2009.65 325.7 94.5 29.274

DAY 2

MEAL TIME MENU QUANTITY

6.00am Tea 200ml
8.00am Chapathi 40g

10.00am Tapioca 70g

1.00pm Rice 150g
3.00pm Ragi porridge 50g
8.00pm Dosa 50g
Sugar 25g

APROXIMATE NUTRIENT INTAKE

TIME FOOD ITEM INGREDIENT QUANTITY ENERGY CARBOHYDRATE PROTEIN FAT

Early Tea Skimmed milk 200 58 9.2 5 0.2

morning Sugar 25 99.5 24.85 0.025 ---
Breakfast Idli Rice 150 519 118.5 9.6 0.6
 Sambar Black gram dal 30 104.1 7.2 17.88 0.4
Red gram dal
Chilli 35 117.25 20.6 7.805 0.595
Brinjal 5 2.9 0.3 0.29 0.06
Drumstick 30 7.2 1.2 0.42 0.09
Lady’s finger 30 7.8 1.11 0.7 0.03
Carrot 30 21 2.84 1.14 1.2S
Yam 30 12.9 3.18 0.27 0.03
20 33.3 7.8 0.4 0.05
Mid Boiled Tapioca Tapioca 70 109.9 26.67 0.49 0.14
morning
Lun Rice 150 519 118.5 9.6 0.6
ch
Green gram dhal 50 17.4 9.9 12.25 0.6
Onion
Curry leaves 20 10 2.22 0.24 0.02
Coccount 20 21.6 3.74 1.2 0.2
Mint 30 133.2 3.9 1.35 12.48
20 9.6 1.16 0.96 0.12
Oil
Cabbage 10 90 ---- 10
30 13.5 2.3 0.9 0.05
Butter milk
100 15 0.5 0.8 1.1
Evening Oats Oats 50 187 31.4 6.8 3.8

Dinner Chappathi Wheat 40 136.4 28.48 4.84 0.68

Egg Curry Egg 60 31.2 0.42 6.6 0.12

Onion 30 15 3.33 0.36 0.03

Tomato 30 6.9 1.08 0.57 0.3

TOTAL 2043 489.4 79.53 52.274

 MENU QUANTITY
6.00am Tea 200ml
8.00am Idly 80g
10.00am Boiled tapioca 70g
1.00pm Rice 100g
3.00pm Oats 50g
8.00pm Chappathi 50g
Sugar 25g

APPROXIMATE NUTRIENT INTAKE

TIME FOOD ITEM INGREDIENT QUANTITY ENERGY CARBOHPROTEIN FAT

YDRATE
Early Tea Skimmed milk 200 58 9.2 5 0.2
morning Sugar 25 99.5 24.85 0.025 ---
Breakfast Chappathi Wheat 40 136.4 28.48 4.84 0.68

Egg Curry Egg 60 31.2 0.42 6.6 0.12

Onion 30 15 3.33 0.36 0.03

Tomato 30 6.9 1.08 0.57 0.3

Mid morning Boiled Thapioca Thapioca 70 109.9 26.67 0.49 0.14

Pears Pears 100 5.2 11.9 0.6 0.2

Lunch Rice Rice 150 519 118.5 9.6 0.6

Veg curry Green garm dal 50 17.4 9.9 12.25 0.6

Onion 20 10 2.22 0.24 0.02
Curry leaves 20 21.6 3.74 1.2 0.2
Coconut 30 133.2 3.9 1.35 12.48
Mint 20 9.6 1.16 0.96 0.12
Oil 10 90 ---- ---- 10

Cabbage thoran Cabbage 30 13.5 2.3 0.9 0.05

Chutney Onion 60 30 6.66 0.72 0.06

Boiled Sardine Sardine 100 101 ---- 21 1.9

Evingin Ragi porridge Ragi 50 164 36 3.65 0.65

Dinner Idli Rice 150 519 118.5 9.6 0.6

Sambar Black gram dal 30 104.1 7.2 17.88 0.4

Red gram dal 35 117.25 20.6 7.805 0.595

Chilli 5 2.9 0.3 0.29 0.06
Brinjal 30 7.2 1.2 0.42 0.09
Drumstick 30 7.8 1.11 0.7 0.03
Lady’s finger 30 21 2.84 1.14 1.2
Carrot 30 12.9 3.18 0.27 0.03
Yam 30 33.3 7.8 0.4 0.05

TOTAL 2124 368 97 18

PROGRESS OF THE PATIENT

Problems oriented record: The patients come with bronchial effusion

Dietary problems: No dietary problems

Weight changes: No weight change

Biochemical parameters: Patient have low haemoglobin level and low PCV
CONCLUSION

Mr. Raghavan 58 year old man admitted in the hospital due to liver cirrhosis, hypertension .Heis
a known case of choronary liver disease. It was found from his anthropometric profile that his
BMI was 23 kg/m². Which shows that he is normal weight. On accessing the dietary habit it was
noticed that the calorie in take was high on the basis of diagnosis and nutritional assessment.
The diet counseling was given. The diet prescribed for the patient is high calorie , high protein,
high carbohydrate diet with liberal vitamins and minerals. At the time of discharge he will be
given conseling regarding to the importance of diet.
 CASE STUDY 5

KIDNEY DISEASE

INTRODUCTION TO KIDNEY DISEASE

According to the world health organization (WHO) global Burden of Disease project,
Kidney disease contributes to nearly 850000 deaths per year, along with other urinary tract
problems. In order to understand the increasing global burden of kidney disease there is a need
to understand the increasing causes, risk factors, diagnosis, treatment and prevention. Chronic
kidney disease (CKD) is an age related progressive loss of kidney function.

CAUSES & SYMPTOMS

Causes of kidney disease are many and varied. Leading causes are diabetes, high blood
pressure, inherited disease, and infection. Acute kidney disease is often marked by alack of
urination and increased fluid buildup in the body. Chronic kidney disease is oftencalled a“silent"
killer, because no obvious symptoms develop until the kidneys are permanently damaged.
Chronic kidney disease-most often results from other diseases such as diabetes or Hypertension.

•A change in the frequency and quantity of urine passed , especially at night ( usually an
increased at first)
•Puffiness as around the eyes blood in the urine (hematuria)
•Pain in the back (under the lower ribs , where the kidneys are located )
•Tiredness, inability to concentrate
•Generally feeling unwell
•Loss of appetite
•Nausea and vomiting
PRINCIPLE OF THE DIET
High calorie, low protein, adequate fat, low sodium and potassium. Restricted fluid .high
purine and high nitrogen, avoid strong spices such as pepper, mustard, coffee.

GENERAL INFORMATIONS

Name :Mr. Ramachandran

Age : 69years

Gender : Male

Hospital Number : 16034169

Ward Number : III A

Room Number : 317

Date of Admission :15-12-2017

Date of Discharge : Still under treatment

Occupation : Driver

Activity : Moderate

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Chronic Kidney Disease

Present Complaints : Breathlessness

 Personal History : Nil

Diagnosis : Chronic Kidney Disease

NUTRITIONAL STATUS EVALUATION

ANTHROPOMETRIC ASSESSMENT

Weight(cm) = 69kg

Height (kg) =167cm

Body Mass Index= Weight (kg)/ Height (m2) = 69/1.67×1.67 = 24.74

Ideal Body Weight = 167-100 = 67kg

BIOCHEMICAL ASSSESSMENT

PARAMETERS 16/12/17 RERERENCE VALUE

Hemoglobin 8.3 g/dl 12.0-15.5g/dl
PCV 24.9% 38-45%
Red cell count 3.02 m/cu mm 4.6-6.0m/cu mm
Platelets 4.41 L/µl 1.5-4L/µl
Neutrophills 84.2% 40-65%
Lymphocytes 11% 30-50%
Urea 40 mg/dl 15-40mg/dl
Serum creatinine 3.8 mg/dl 0.6-1.2mg/dl
Serum sodium 129 mEq/L 136-145mEq/L
Serum potassium 6.9 mEq/L 3.8-5.0 mEq/L

BIOPHYSICAL PARAMETERS
PARAMETERS VALUES REFERENCE
VALUE

Blood pressure 100/70mmHg 120/80 mmHg

Body temperature 92ºF 98.7⁰F

Respiration rate 20/mnt 72/mnt

Pulse rate 14/mnt 12-16/mnt

CLINICAL ASSESSMENT

ORGANS OBSERVATION

Hair Easily pluckable

Nails Transverse lines

Skin Normal

Eyes Normal

Mouth Normal

Neck Normal

DIETARY ASSESSMENT

TYPE OF DIET : Non vegetarian

 FOOD FREQUENCY RECORD :

Sl. No. FOOD ITEM DAILY WEEKLY MONTHLY OCCASIONALY

1 Cereals 

2 Pulses 

3 Green leafy vegetables 

4 Milk and milk products 

5 Fish 

6 Meat 

7 Egg 

8 Fruits 

9 Nuts 

10 Fat and oil 

11 Sugar 

PAST DIETARY INTAKE

MEAL TIME MENU INGREDIENTS AMOUNT

Early morning Tea Milk 75ml
Breakfast Idiyappam Rice flour 60g
Lunch Rice Rice 100g
 Evening Payasam Milk 75ml
Dinner Rice porridge Rice 100g

APPROXIMATE NUTRIENT VALUE

INGREDIENT AMOUNT(g) ENERGY(Kcal) PROTEIN(g) FAT(g)

Rice flour 60 207 4.08 0.3
Rice 200 692 12.8 0.8
Coconut 20 88.8 0.90 8.32
Green chilly 10 2.9 0.29 0.06
Ladies finger 20 3.5 0.19 0.02
Tomato 10 2 0.09 0.02
Onion 20 10 0.24 0,02
Red gram dhal 25 63.75 1.85 0,025
Buttermilk 100 15 0.8 2.2
Dhal 20 67 4.46 0.34
Brinjal 20 4.8 0.28 0.06
Milk 225 65.25 5.65 0,225
Sugar 15 59.7 0.015 -
Oil 10 90 - 10
TOTAL 1371.7 31.59 24.415

NUTRITIONAL CARE PLAN

GOALS OF NUTRITIONAL CARE PLAN

 To increase the blood heamoglobin level through diet

 To provide low protein diet

  To provide high calorie foods

 To maintain blood pressure level

NUTRITIONAL STATUS OF THE PATIENT

According to the nutritional assessment of the patient Mr.Ramachandran,69

years old male was suffering from Chronic kidney disease. The weight of the patient was 69kg
and the height of the patient was 167 cm. According to the body mass index, the patient was
normal (24.7kg/m2). The ideal body weight was 67kg. In biochemical analysis, shows that the
values were normal except neutrophil,serum creatinine,serum pottassium which was high. In
clinical assessment, hair was easily pluckable, nail was transverse lines and all the other
characteristics was normal .

TREATMENT

Medication was given to the patient

DRUG

 InjHastix 100mg

 T Cetanil 10mg

 T Ecospirin 75/10
  T Nefrotrers 150mg

DIET ORDER/ DIET PRESCRIPTION

NUMBER OF DIET TYPE OF DIET

Day 1 Normal diet

Day 2 Soft diet

Day 3 Soft diet

DIET PRESCRIBED BY THE HOSPITAL

DAY 1

MEAL TIME MENU QUANTITY

6.30am Tea 75ml
8.30am Noolappam 50g
10.00am Apple date juice 200ml
1.00pm Rice 100g
3.00pm Tea 75ml
8.00pm Tapioca 70g

APPROXIMATE NUTRIENT INTAKE

FOOD ITEM QUANTITY(g) ENERGY(kcl) CARBOHYDRATE(g) PROTEIN(g) FAT(g)

Milled rice 50 172.5 39.1 3.4 0.25
Parboiled rice 100 346 79 6.4 0.4
Onion 140 60 13.2 1.48 0.42
Apple 100 59 13.4 0.2 0.5
Dates 100 317 75.8 2.5 0.4
Tapioca 70 109 26.27 0.49 0.14
Amaranth 100 19 3.5 0.9 0.1
Beatroot 50 21.5 4.4 0.85 0.05
Carrot 10 4.8 1.06 0.01 0.02
Beans 10 15.8 2.98 0.74 0.02
Fat(Oil) 25 225 - - 25
Milk 150 100.5 6.6 4.8 6.15
Sugar 20 99.5 24.85 0.025 -
Egg white 2 34 - 6.8 -
Cucumber 50 48.15 1.25 0.2 0.05
Bread 100 245 51.9 7.8 0.7
Arrowroot 100 334 83 0.2 0.1
TOTAL 2211.65 426.31 36.795 34.3

DAY-2

MEAL TIME MENU QUANTITY

6.30am Milk 75ml
8.30am Appam 50g
10.00am Boiled banana 100g
 1.00pm Rice 50g
3.00pm Tea 75ml
8.00pm Rice porridge 50g
Sugar 20g

APPROXIMATE NUTRIENT INTAKE

FOOD ITEM QUANTITY(g) ENERGY(kcl) CARBOHYDRATE(g) PROTEIN(g) FAT(g)

Parboiled rice 100 346 79 6.4 0.4
Onion 140 60 13.2 1.48 0.42
Banana 100 116 27.2 1.2 0.3
Dates 100 317 75.8 2.5 0.4
Oats 100 317 75.8 2.5 0.4
Bottle guard 100 12 2.5 0.2 0.1
Carrot 10 4.8 1.06 0.01 0.02
Beans 10 15.8 2.98 0.74 0.02
Fat(Oil) 25 225 - - 25
Milk 150 100.5 6.6 4.8 6.15
Sugar 20 99.5 24.85 0.025 -
Egg white 2 34 - 6.8 -
Cucumber 50 48.15 1.25 0.2 0.05
Bread 100 245 51.9 7.8 0.7
Arrowroot 100 334 83 0.2 0.1
TOTAL 2156.55 413.9 36.16 33.98
DAY-3

MEAL TIME MENU QUANTITY

6.00am Tea 75ml
8.30am Tapioca 70g
10.00am Apple dates smoothi 200ml
 1.00pm Rice 100g
3.00pm Tea 75ml
8.00pm Appam 50g
Sugar 20g
Fat 25g

APPROXIMATE NUTRIENT INTAKE

FOOD ITEM QUANTITY(g) ENERGY(kcal) CARBOHYDRATE(g) PROTEIN(g) FAT(g)

Parboiled rice 100 346 79 6.4 0.4
Onion 140 60 13.2 1.48 0.42
Apple 100 59 13.4 0.2 0.5
Dates 100 317 75.8 2.5 0.4
Tapioca 70 109 26.27 0.49 0.14
Amaranth 100 19 3.5 0.9 0.1
Carrot 10 4.8 1.06 0.01 0.02
Beans 10 15.8 2.98 0.74 0.02
Fat(Oil) 25 225 - - 25
Milk 150 100.5 6.6 4.8 6.15
Sugar 20 99.5 24.85 0.025 -
Egg white 2 34 - 6.8 -
Bread 100 245 51.9 7.8 0.7
Arrowroot 100 334 83 0.2 0.1
TOTAL 2163.5 425.06 36.59 34.25
PROGRESS OF THE PATIENT

Problems oriented record: The patients come with Chronic kidney disesase

Dietary problems: No dietary problems

Weight changes: No weight change during treatment

Biochemical parameters: Patient have low haemoglobin level

CONCLUSION

The patient Mr. Ramachandran 69 years old man admitted in the hospital due to
breathlessness. He is a known case of chronic kidney Disease. It was found from his
anthropometric profile that his BMI was 24.74kg/M². Which shows that he is normal weight. On
assessing the dietary habits it was noticed that the calorie intake was high on basis of diagnosis
and nutritional assessment, the diet counseling was given. The diet prescribed for the patient is
high calorie. low protein with liberal vitamins and minerals. At the time of discharge he will be
given counseling regarding to the importance of diet.

CASE STUDY 6

CANCER
INTRODUCTION TO CANCER
 Cancer is a term used to refer malignant neoplasms or tumours. Neoplasia means cells in a
tissue proliferate without the normal controls on growth. In malignant neoplasms the cells spread to
adjacent tissues and interfere with the function and often have undesirable systemic effects. .

CASES

Cancer is caused by mutation or abnormal activation of cellular genes that control cell growth and
cell mitosis. The abnormal genes are called oncogenes.

SYMPTOMS

•Oral cancer

•Lung/throat cancer

•Stomach cancer

•Colon cancer

•Breast cancer

•Cervical/uterine cancer

•Kidney cancer

•Bladder cancer

•Prostate cancer

•Melanoma (Skin cancer)

PRINCIPLE OF THE DIET

 The body requires additional protein for tissue regeneration and healing.
 Spicy food is best avoided as it can cause nausea and stomach discomfort.
  Small meals, eaten frequently (every 2 -3 hours) are advised, rather than large meals.
 Instead of frying; you can grill, roast, bake, stir-fry or blanch the food. Limit fat intake
to less than 20 per cent of total calories.
 To preserve nutrients, eat freshly cooked food, rather than frozen or packaged foods.

GENERAL INFORMATION

Name : Mrs. Ayisha

Age : 45years

Gender : Female

Hospital Number : 16032934

Ward Number : III A

Room Number :301

Date of Admission : 02-12-2017

Date of Discharge : Still under treatment

Occupation : Nil

Activity : Nil

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Done chemotherapy

Present Complaints : Pain in right breast

Personal History : Nil

Diagnosis : Breast cancer

NUTRITIONAL STATUS EVALUATION

ANTHROPOMETRIC ASSESMENT

Height (cm) = 168cm

Weight (Kg) = 62 kg

Body Mass Index (BMI) = Weight (Kg) / Height (m2) = 62/1.682 = 21.9

Ideal Body Weight (IBW ) = Height (cm) – 100 = 168 – 100= 68kg

BIOCHEMICAL PARAMETERS

TEST RESULT REFERENCE VALUE

Hemoglobin 8.6g/dl 12-15.5g/dl
Glucose Random (Plasma) 40 mg/dl 70- 140 mg/dl
Urea (Serum) 21 mg/ dl 14-40 mg/ dl
Serum Urea Nitrogen 9.81 mg/dl 6.5-18 mg/dl
(calculated)(Serum)
Creatinine 0.63 mg/dl 0.8-12.5 mg/dl
Bilirubin (Serum) 0.2 mg/dl 0-.2 mg/dl
Direct 0.2 mg/ dl 0- .2 mg/dl
Indirect 0.2 mg/dl 0.2-0.8 mg/dl
Total 0.4 mg/dl 0.2-1.0 mg/dl

BIOPHYSICAL PARAMETERS
PARAMETERS VALUES REFERENCE VALUE

Blood pressure 150/90 mmHg 120/80 mmHg

Body temperature 99 °F 98.7⁰F

Pulse rate 92/mnt 72/mnt

Respiration rate 14/mnt 12-16/mnt

CLINICAL ASSESSMENT

ORGANS OBSERVATION
Hair Easily pluckable
Nails Normal
Skin Normal
Eyes Normal
Mouth Normal
Neck Normal

DIETARY ASSESMENT
TYPE OF DIET: Non vegetarian

FOOD FREQUENCY RECORD

Sl. No. FOOD ITEMS DAILY WEEKLY MONTHLY OCCASIONALLY

1 Cereals
2 Pulses  

3 Green leafy 

4 vegetables
Milk and milk 

5 products
Fish 

6 Meat 

7 Egg 

8 Fruits 

9 Nuts 

10 Fat and oil 

11 Sugar 

C .ALLERGY TO FOOD: No allergy to food

PAST DIETARY INTAKE

TIME MENU QUANTITY

7.30am Milk 100ml
8.30am Idly 2 No
6.30pm Tea 100ml
Oil 15 ml

APPOROXIMATE NUTRIENT INTAKE

Energy 860 kcal

Carbohydrate 137 g

Protein 19.29g

Fat 45.62g
-

NUTRITIONAL STATUS OF THE PATIENT

According to the nutritional assessement of the patient Mrs.Ayisha,45 years

old female was suffering from breast cancer disease. The weight of the patient was 62kg and the
height of the patient was 168 cm. According to the body mass index, the patient was normal
(21.9kg/m2). The ideal body weight was 65kg. In biochemical analysis, shows that the values
were normal except haemoglobin which was low. In clinical assessment, hair was easily plukable
and all other characteristics was normal .

TREATMENT

The patient was taking prescribed in the hospital

DRUGS

• C-PAN-D
• Injection Emeset

• Bolus

• T .Pantacoid.

• T .Domstal

• Injection Fluroacil

• Injection Methotresiate

• Injection Endoxan

NUTRITIONAL CARE PLAN

GOALS OF NUTRITIONAL CARE PLAN

 High protein diet

 High calorie diet

 The diet should be blank

DIET ORDER/ DIET PRESCRIPTION

NUMBER OF DIET TYPE OF DIET

Day 1 Normal diet
TIME MENU QUANTITY
Day 2 Soft diet
6.00am Badam 10g
Day 3 Soft diet
7.30am Wheat porridge 100 g
DIET
10.30am Strawberry shake 150ml
PRESCRIBED
12.30pm Rice 100g
Carrot 60g DAY 1

4.30pm Oats 60g

7.30pm Wheat dosa 100g
10.00am Protein drink 100ml
APROXIMATE NUTRIENT INTAKE
TIME FOOD ITEM INGREDIENTS QUANTITY ENERGY CARBO PROTEIN FAT
HYDRATE
Morning Badam milk Badam 10g 65.5 1.05 2.08 5.8

Milk 100g 67 4.4 3.2 4.1

Break fast Wheat porridge Wheat flour 100g 346 71.2 11.8 1.5

Soyachunks gravy

Soya 20g 86.4 4.1 8.6 3.9

Midmorning Strawberry shake Strawberry 50g 22 4.9 0.3 0.1

Lunch Boiled Rice 100g 346 79 6.4 0.4

rice Egg 60g 103.8 - 7.9 0.4

Egg omlette Onion 30g 17.7 3.7 0.5 0.03

Tea Time Oats porridge Oats 60g 224 37.6 8.1 4.5

Cashewnut 10g 59.6 2.23 2.12 4.6

Milk 100g 67 4.4 3.2 4.1

Dinner Wheat Dosa Wheat flour 100g 348 73.9 11 0.9

Green peas curry Green peas 20g 18.6 3.1 1.4 0.02

Onion 30g 17.7 3.7 0.5 0.03

Bed Time Protein powder 100ml 147.04 19.3 5.9 4.6

Protein Drink Oil 10g 90 - - 10

Sugar 10g 39.8 9.9 0.01 -

TOTAL 2366 372.74 85.6 49.81

DAY 2
 TIME TEA TIME QUANTITY
6am Protein drink 100ml
7.30am Rice porridge 100g
10.30am Oats+ 60g
12.30pm Rice 100g
4.30pm Milk 100ml
7.30pm Chappathi 100g
10.00pm Banana 50g

APPOROXIMATE NUTRIENT INTAKE

TIME FOOD ITEM INGREDIENTS QUANTITY ENERGY CARBO PROTEIN FAT

HYDRATE

Tea time Protein Drink Protein powder 100ml 147.04 19.3 5.9 4.6

Break fast Rice porridge Rice flour 100g 346 79 6.4 0.4

Soyabean fry Soyabean 20g 86.4 4.1 8.6 3.9

Midmorning Oats+fruit mix Oats 60g 224 37.6 8.1 4.5

Strawberry 50g 52 4.9 0.3 0.1

Cashewnut 10g 59.6 2.2 2.1 4.6

Milk 100g 67 4.4 3.2 4.1

Badam 10g 65.5 1.05 2.08 5.8

Lunch Boiled rice Rice 100g 346 79 6.4 0.4

Greenpeas curry Greenpeas 20g 18.6 3.1 1.4 0.02

Onion 30g 17.7 3.7 0.5 0.03

0.03
 Egg omlette Potato 30g 29.1 6.7 0.4 0.4

Beans thoran Egg 60g 103.8 - 7.9 0.03

Curd Onion 30g 17.7 3.7 0.5 0.3

Beans 30g 47.4 8.9 2.2 0.06

Carrot 30g 14.4 3.1 0.2 4

Curd 100g 60 3 3.1

Tea Time Milk Milk 100g 67 4.4 3.2 4.1

Paripuvada Red gram dhal

20g 100.4 17.2 6.6 0.4

Dinner Chappathi Wheat flour 100g 346 71.2 11.8 1.5

Vegitable Tomato 60g 12 2.1 0.5 0.1

curuma
Onion 60g 35.4 7.5 1.08 0.06

Potato 30g 29.1 6.7 0.4 0.03

Bed Time Banana Banana 50g 58 13.6 0.6 0.1

TOTAL 2350 386.4 83.4 39.5

DAY 3
Time Menu Quantity
6.am Oats+ 60g
7.30am Wheat dosa 100g
Onion curry 170g
10.30am Banana shake 110g
12.30pm Rice 100g
Carrot thoran 60g
Soyabean curry 80g
Butter milk 40g
4.30pm Protein drink 100ml
7.30pm Wheat porridge 100g
Egg omlet 90g
10.00pm Milk+ 100ml
APPOROXIMATE NUTRIENT INTAKE

TIME FOOD ITEM INGREDIENTS QUANTITY ENERGY CARBO PROTEIN FAT

HYDRATE

Tea time Oats+Badam Oats 60g 224 37.6 8.1 4.5

Badam 10g 65.5 1.05 2.08 5.8

Break fast Wheat dosa Wheat flour 100g 346 71.2 11.8 1.5

Soyabean curry Soyabean 20g 86.4 4.1 8.6 3.9

Onoin 30g 17.7 3.7 0.5 0.03

Potato 30g 29.1 6.7 0.4 0.03

Midmorning Banana shake Banana 50g 58 13.6 0.6 0.1

Milk 60g 13.6 40.2 2.5

Lunch Rice Rice 100g 346 79 6.4 0.4

Sambar Redgram dhal 20g 100.4 17.2 6.6 0.4

Tomto 60g 12 2.1 0.5 0.1

Onion 60g 35.4 7.5 1.08 0.06

Potato 30g 29.1 6 0.4 0.03

.
Carrot 30g 14.1 7 0.2 3.9

Carrot thoran Beans 30g 47.4 2.2 0.06

3.1
Butter milk Butter Milk 40ml 6 0.3 0.4
8.9

0.2

Tea Time Protein Drink Protein powder 100ml 147.04 19.3 5.9 4.6

Dinner Wheat porridge Wheat flour 100g 346 71.2 11.8 1.5

Egg omlette

Egg 60g 103.8 - 7.9 0.4

 Onion 30g 17.7 3.7 0.5 0.03

Bed Time Fruit mix Milk 100g 67 4.4 3.2 4.1

Strawberry 50g 52 4.9 0.3 0.1

Cashewnut 10g 59.6 2.2 2.1 4.6

TOTAL 2308 384.59 83.98 35.5

PROGRESS OF THE PATIENT

Problems oriented record: The patients come with pain in left breast

Dietary problems: No dietary problems

Weight changes: There was a weight loose during the treatment

Biochemical parameters: Patient have low blood sugar level.

CONCLUSION

Mrs.Ayisha is an 45 years old female who was admitted in hospital due to pain in right breast.she is a
known case of breast cancer.she already done the chemotherapy. It was found from her antropometric
profile that her BMI waswas21.9 kglm2 which shows that she is normal weight on assessing the
dietary habits it was noticed that the calorie intake was high on the basis of diagnosis and nuttitional
assessment, the diet counseling was given. The diet prescribed for the patient is high calorie,high
protein with liberal vitamins and minerals. At the time of discharge. she will be given counseling
regarding to the importance of diet.
 CASE STUDY 7

SURGERY

INTRODUCTION TO SURGERY

An act of performing surgery may be called a surgical procedure, operation, or simply surgery.
The patient or subject on which the surgery is performed can be a person or an animal. A
surgeon is a person who practices surgery and a surgeon's assistant is a person who practices
surgical assistance. A surgical team is made up of surgeon, surgeon's assistant, anesthesia
provider, circulating nurse and surgical technologist. Surgery usually spans minutes to hours,
but it is typically not an ongoing or periodic type of treatment. The term surgery can also refer
to the place where surgery is performed, or simply the office of a physician, dentist, or
veterinarian.

Surgery is a technology consisting of a physical intervention on tissues, and muscle. As a

general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or
closure of a previously sustained wound. Other procedures that do not necessarily fall under this
rubric, such as angioplasty or endoscopy, may be considered surgery if they involve "common"
surgical procedure or settings, such as use of a sterile environment, anesthesic conditions,
typical surgical instruments, and suturing. All forms of surgery are considered invasive
procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate
the structure being excised (e.g. laser ablation of the cornea) or to a radiosurgical procedure
(e.g. irradiation of a tumor).

PRINCIPLE OF DIET

Bland diet-A bland diet is a (diet consisting of foods that are generally soft, low in dietary fiber,
cooked rather than raw, and not spicy.

Soft diet-A Mechanical soft diet is recommended in many situations, including some types of
dysphagia (difficulty swallowing), surgery involving the jaw, mouth or gastrointestinal tract,
and pain from newly adjusted dental braces.

Low residue diet-It is similar to a (low-fiber diet, but typically includes restrictions on foods
that increase bowel activity, such as milk, milk products, and prune juice.
GENERAL INFORMATIONS

Name :Mrs. Gracy varkey

Age : 43years

Gender : Female

Hospital Number : 16004568

Ward Number : III A

Room Number : 314

Date of Admission : 1-12-2017

Date of Discharge : Still under treatement

Occupation : Housewife

Activity : Moderate

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Abdominal pain, vomiting

Present Complaints : fever, jaundice and constipation

Personal History : Nil

Diagnosis : Inguinal hernia

NUTRITIONAL STATUS EVALUATION

ANTHROPOMETRIC ASSESSMENT

Weight (cm) =50kg

Height (kg) =161cm

Body Mass Index (BMI) = Weight (kg)/ Height (m2) = 60/1.61² = 23.14

Ideal Body Weight (IBM) = 161-100 = 61kg

BIOCHEMICAL ASSSESSMENT

BIOCHEMICAL PARAMETERS

PARAMETERS 1/12/17 REFERENCE VALUE

Haemoglobin 12 g/dl 13.5-17.0g/dl

Serum creatinine 0.9 mg/dl 0.6-1.2mg/dl

Serum sodium 138 mEq/L 136-145mEq/L

Serum potassium 3.8 mEq/L 3.8_5.0mEq/L

BIOPHYSICAL PARAMETERS

PARAMETERS VALUES REFERENCE VALUE

Blood pressure 110/70mmHg 120/80 mmHg

Body temperature 98.6⁰F 98.7⁰F

Pulse rate 88/min 72/mnt

Respiration rate 20/min 12-16/mnt

 CLINICAL ASSESSMENT

ORGANS OBSERVATION
Hair Brittle hair
Nails Normal
Skin Pale colour
Eyes Normal
Mouth Normal
Neck Normal

DIETARY ASSESMENT

C. TYPE OF DIET: Non-vegetarian

C)ALLERGY TO FOOD: No allergy to food

FOOD FREQUENCY RECORD

Sl.No FOOD GROUPS DAILY WEEKLY MONTHLY OCCASIONALLY

1 Cereals 
2 Pulses 
3 Greenleafy 
4 vegetables
Milk and milkproducts 
5 Fish  
6 Meat  
 7 Egg 
8 Fruits 
9 Nuts  
10 Fat and oil 
11 Sugar 
12 Chicken  
13 Vegetable 
14 Roots and tubers 

PAST DIETARY INTAKE PATTERN

TIME MENU QUANTITY

7.30am Tea 1cup
8.30am Uppuma 2cup
1.00pm Rice 2cup
Vegetable curry 1cup
4.00pm Tea 1cup
8.00pm Rice 1/2cup
Sambar 1/2cup

APPOROXIMATE NUTRIENT INTAKE

ENERGY 2100.95Kcal

CARBOHYDRATE 435.21g

PROTEIN 60.94g

FAT 33.34g

NUTRITIONAL STATUS OF THE PATIENT

According to the nutritional assessement of the patient Mrs.Gracy Varkey,43

years old female was suffering from Inguinal hernia disease. The weight of the patient was 50kg
and the height of the patient was 161 cm. According to the body mass index, the patient was
normal (23.14kg/m2). The ideal body weight was 61kg. In biochemical analysis, shows that the
values were normal except haemoglobin which was low. In clinical assessment, hair was
brittle,pale skin and all the other characteristics was normal .

TREATMENT

The patient was taking prescribed in the hospital

DRUGS

 InjZostum 1.5mg

 InjMetxogyl 500mg

 Inj Tramadol 100mg

 T Paracetamol 650mg

NUTRITIONAL CARE PLAN

 GOALS OF NUTRITIONAL CARE PLAN

 Low fibre diet

 To maintain biophysical biochemical parameter

DIET ORDER/ DIET PRESCRIPTION

NUMBER OF DIET TYPE OF DIET

Day 1 Soft diet

Day 2 Soft diet

Day 3 Low residue diet

DIET PRESCRIBED

DAY 1

MEAL TIME MENU QUANTITY

Early morning Tea 100ml

Breakfast Idly 60g

Chutney 40g

Mid morning Ragi porridge 30g

Lunch Rice porridge 60g

Ammaranth leaves thoran 100g

Cucumber gravy 70g

Tea time Oats porridge 100ml

Dinner Wheat porridge 60g

Bed time Milk 100ml

 APROXIMATE NUTRIENT INTAKE

TIME FOOD ITEM INGREDIENTS QUANTITY ENERGY CARBOHY PROTEIN FAT

DRATE

Tea time Tea Milk 100g 67 4.4 3.2 4.1

Break fast Iddily Rice 60g 207.6 47.4 3.8 0.2

Blackgram 30g 104.1 17.88 7.2 0.42

Chuttney Onion 40g 23.6 5.04 0.7 0.04

Tomato 50g 10 1.8 0.4 0.1

Coconut 20g 88.8 2.6 0.8 8.2

Midmornin Ragi porridge Ragi 30g 98.4 21.6 2.19 0.39

g

Lunch Rice Rice 60g 207.6 47.4 3.8 0.2

Amaranth leaf Amaranth leaf

porriyal
100g 26 2 3 0.7
Cucumber
Cucumber
gravy
Tomato 40g 5.2 1 0.16 0.04
 Onion 20g 4 0.75 0.18 0.04

Carrot thoran 20g 10 2.22 0.24 0.02

Carrot

40g 19.2 4.24 0.36 0.08

Tea Time Tea Milk 100g 67 4.4 3.2 4.1

Oats Oats 20g 74.8 6.56 2.72 1.52

Dates 20g 63.4 15.16 0.5 0.08

Nuts 20g 137.4 2.2 3.12 0.36

Fats 20g 180 - - 20

Suger 20g 79.6 19.8 0.02 -

Bed Time Milk Milk 100g 67 4.4 3.2 4.1

TOTAL 1914 283.27 56.59 46.13

DAY-2

MEAL TIME MENU QUANTITY

Early morning Milk 100ml
Breakfast Dosa 60g
Mid morning Oats 100g
Evening Milk 100g
Dinner Rice 100g
 APPROXIMATE NUTRIENT INTAKE

TIME FOOD ITEM INGREDIENTS QUANTITY ENERGY CARBOHYDRATE PROTEIN FAT

Tea time Tea Milk 100g 67 4.4 3.2 4.1
break fast Dosa Rice 60g 207.6 47.4 3.8 0.2

Coconut Coconut 10g 44.4 1.3 0.4 4.1

chuttney
Onion 40g 23.6 5.04 0.7 0.04

Midmornin Oats Oats 50g 187 31.4 6.8 3.8

g
Milk 80g 53.6 3.5 2.5 3.2
Lunch Rice Rice 60g 207.6 47.4 3.8 0.2

Sambar Onion 25g 14.75 3.15 0.45 0.025

Tomato 25g 5 0.9 0.2 0.05

Potato 25g 24.25 5.65 0.4 0.025

Redgramdhal 15g 50.25 8.6 3.3 0.25

Egg omlette Egg 60g 103.8 - 7.9 0.4

 Onion 50g 29.5 6.3 0.9 0.05

Beans thoran Beans 40g 63.2 11.8 2.8 0.4

Onion 25g 14.75 3.15 0.45 0.025

Tea Time Tea Milk 100g 67 4.4 3.2 4.1

Biscutt Wheat flour 40g 139.2 29.5 4.4 0.3

Dinner Rice porridge Rice 60g 207.6 47.4 3.8 0.2

Curd

Carrot thoran Curd 50g 30 1.5 1.5 2.0

Sambar Carrot 40g 19.2 4.24 0.36 0.08

Onion 25g 14.75 3.15 0.45 0.025

Onion 25g 14.75 3.15 0.45 0.025

Tomato 25g 5 0.9 0.2 0.05

Potato 25g 24.25 5.65 0.4 0.025

Redgramdhal 15g 50.25 8.6 3.3 0.25

TOTAL 1928 308.28 55.68 43.92

DAY-3

MEAL TIME MENU QUANTITY

Early morning Tea 100ml
Breakfast Idiyyappam 60g
Mid morning Fowl soup 100ml
Evening Milk 100ml
Dinner Wheat dosa 60g
 APPROXIMATE NUTRIENT INTAKE

TIME FOOD INGREDIEN QUANTIT ENERG CARBOHYDRA PROTEI FAT

ITEM TS Y Y TE N
Tea time Tea Milk 100g 67 4.4 3.2 4.1
Break fast Idiyappa Rice flour 60g 207.6 47.4 3.8 0.2
m
Egg 60g 103.8 - 7.9 0.4
Egg curry
Potato 50g 48.5 11.3 0.8 0.05

Onion 50g 29.5 6.3 0.9 0.05

Tomato 30g 60 1.08 0.27 0.06

Midmorni Fowl Fowl 100ml 109 - 25.9 0.6
ng soup
Lunch Rice Rice 60g 207.6 47.4 3.8 0.2

Masala Onion 50g 29.5 6.3 0.9 0.05

Curry
Tomato 30g 60 1.08 0.27 0.06

Beans 50g 79 14.9 3.7 0.5

Soyabean 25g 108 5.225 10.8 4.87

Beetroot 50g 215 4.4 0.85 0.05

Carrot 50g 24 5.3 0.45 0.1

 Amaranth Pumpkin 50g 12.5 2.3 0.7 0.05
Leafporiy
al Amaranth leaf 100g 26 2 3 0.7

Curd Curd

50g 30 1.5 1.5 2

Tea Time Tea Milk 100g 67 4.4 3.2 4.1

Rusk Wheat flour 40g 139.2 29.5 4.4 0.3

Dinner Wheat Wheat flour 60g 204.6 41.64 7.26 1.02
dosha

Coconut 10g 44.4 1.3 0.4 4.1

Coconut
Onion 40g 23.6 5.04 0.7 0.04
chuttney

Oil 20g 180 - - 20

Sugar 20g 79.6 19.8 0.02 -

TOTAL 2155 262.565 53.85 43.60

5

PROGRESS OF THE PATIENT

Problems oriented record: The patients come with abdominal pain and vomiting

Dietary problems: No dietary problems

Weight changes: No weight change during treatment

Biochemical parameters: Patient have normal biochemical parameters

CONCLUSION
The patient Mrs Gracy Vorkey 43 years old female was admitted in the hospital on 1/12/2016
with presenting complaints of abdominal pain, vomiting, fever and jaundice. She was diagnosed
for inguinal hernia. It was found from his anthropometric profile that her BMI was 23.14kg/m².
which shows that she is normal weight. On assessing the dietary habits it was noticed that the
calorie intake was high on the basis of diagnosis and nutritional assessment, the diet counseling
was given. The diet prescribed for the patient is high calorie , high protein, low fibre diet with
liberal vitamins and minerals. At the time of discharge she will be given counseling regarding to
the importance of diet.

CASE STUDY 8

TUBE FEEDING

INTRODUCTION TO TUBE FEEDING

A tube feeding is a medical device used to provide nutrition to patients who cannot obtain
nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The state
of being fed by a feeding tube is called gavage, enteral feeding or tube feedings. A variety of
feeding tubes are used in medical practice. They are usually made of polyurethane or silicone.
The diameter of a feeding tube is measured in French units (each French unit equals 0.33
millimeters). They are classified by site of insertion and intended use.

TYPES

 Nasogastric tube feeding

 Nasojejunal tube feeding
 Gastro stomy or gastric tube feeding
 Gastricdrinage tube
 Gastrojejunal tube feeding

PRINCPLE OF DIET
In this diet, a feeding tube is inserted through the nose of an individual down their esophagus. At
the other end of the tube is an electric pump.

The only nourishment the patient receives is KE diet powder – an infusion of proteins, fats
andmicronutrients with no carbohydrates – mixed with water through the feeding tube.

GENERALGENERAL INFORMATIONS

Name : Mr.Balakrishnan

Age : 84years

Gender : Male

Hospital Number : 16032942

Ward Number : III A

Room Number : 302

Date of Admission : 05-12-2017

Date of Discharge : 13-12 -2017

Occupation : Nil

Activity : Sedentery

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Chronic Kidney Disease

Present Complaints : Seizure disorder, Hypertension, vomiting

Personal History : Nil

Diagnosis : Seizure Disorder, Coronary Artery Disease

NUTRITIONAL STATUS EVALUATION

ANTHROPOMETRIC ASSESSMENT

Weight (cm) = 50kg

Height (kg) =156cm

Body Mass Index

BMI = Weight (kg)/ Height (m2) = 50/1.56*1.56 = 20.5

Ideal Body Weight

IBW = 156-100 = 56kg

BIOCHEMICAL ASSSESSMENT

PARAMETERS 05/12/17 REFERENE

Hemoglobin 11.6g/dl VALUE
12.0-15.5g/dl
PCV 30.2% 38-45%
Red cell count 3.62 m/cu mm 4.6-6.0m/cu mm
Platelets 2.86 L/µl 1.5-4L/µl
Neutrophils 55.7% 40-65%
Lymphocytes 24.4% 30-50%
E.S.R 4.4mm 5-15mm
Sercreatinine 0.6mg/dl 0.6-1.2mg/dl
Urea 18mg/dl 15-40mg/dl
SGOT 21IU/L 5-40IU/L
SGPT 23IU/L 5-40IU/L
Ser sodium 120 mEq/L 136-145mEq/L
Ser potassium 4.5 mEq/L 3.8-5.0 mEq/L

BIOPHYSICAL PARAMETERS

PARAMETERS 5/12/17 REFERENCE

VALUE
Blood pressure 130/80mmHg 120/80 mmHg
Body temperature 98.6◦F 98.7⁰F
Pulse rate 64/min 72/mnt
Respiration rate 22/min 12-16/mnt

CLINICAL ASSESSMENT

ORGANS OBSERVATION

Hair Dry

Nails Normal

Skin Normal

Eyes Normal

Mouth Normal
Neck Normal

DIETARY ASSESMENT

D. TYPE OF DIET: Non-vegetarian

C) ALLERGY TO FOOD: No allergy to food

FOOD FREQUENCY RECORD

Sl.No FOOD GROUPS DAILY WEEKLY MONTHLY OCCASIONALLY

1 Cereals 
2 Pulses 
3 Greenleafy 
4 vegetables
Milk and milkproducts 
5 Fish  
6 Meat  
7 Egg 
8 Fruits 
9 Nuts  
10 Fat and oil 
11 Sugar 
12 Chicken  
13 Vegetable 
14 Roots and tubers 

C ALLERGY TO FOOD: No allergy to food

PAST DIETARY INTAKE PATTERN

Time Menu Serving

6.00am Ensure/ Glusarina 200ml

8.00am Oats grind 200ml

10.00am Arrow root, porridge 200ml

12.00pm Rice(2 spoon)+ dhal(2 spoon)+ 200ml

oil(10ml)+grinded vegetables
(2 spoon)

2.00pm Oats grinded 200ml

4.00pm Egg white grinded with Milk 200ml

(1 No)

6.00pm Oats grinded 200ml

8.00pm Chapatti grinded with curd 200ml

(1 No)

10.00pm Glusarena/ Ensure 200ml

NUTRITIONAL STATUS OF THE PATIENT

According to the nutritional assessment of the patient Mr.Balakrishnan,84 years old

male was suffering from Seizure disease and hypertension. The weight of the patient was 50kg
and the height of the patient was 156 cm. According to the body mass index, the patient was
normal (20.5kg/m2). The ideal body weight was 56kg. In biochemical analysis, shows that the
values were normal except PCV, Red cell count and potassium which was low. In clinical
assessment, hair was dry and all the other characteristics was normal .

TREATMENT

The patient was taking prescribed in hospital

DRUGS

 T.EpilexChrono 500mg

 T.Eptoin 100mg

 T.Levasan 500mg

 T Folic Acid 5mg

NUTRITIONAL CARE PLAN

GOALS OF NUTRITIONAL CARE PLAN

 Low carbohydrates diet

 To maintain the blood pressure

 To maintain biophysical biochemical parameter

DIET ORDER/ DIET PRESCRIPTION

NUMBER OF DIET TYPE OF DIET

Day 1 Fluid diet
Day 2 Fluid diet
Day 3 Semifluid diet

DIET PRESCRIBED

TIME MENU AMOUNT

6:00 am NeproLP 250ml

8:00 am Oats 200ml

10:00 am Arrowroot 200ml

12:00 am NeproLP 200ml

2:00 pm Kanji 250ml

4:00 pm Arrowroot 200ml

6:00 pm NeproLP 200ml

8:00 pm Oats 200ml

10:00 pm Kanji 300ml

APPROXIMATE NUTRIENT INTAKE

DAY 1

FOOD AMOUNT ENERGY CARBOHYDRATE PROTEIN FAT

ITEM

NeproLP 30g 151.2 15.6 3.6 7.8

Oats 30g 116.7 19.8 5.1 2.1

Sugar 5g 19.9 4.95 - -

Arrowroot 50 g 167 41.55 0.1 0.05

Sugar 5g 19.9 4.95 - -

NeproLP 30 g 151.2 15.6 3.6 7.8

Rice blend 50 g 173 39.5 3.4 0.2

Arrowroot 50 g 167 41.55 0.1 0.05

Sugar 5g 19.9 4.95 - -

NeproLP 30 g 151.2 15.6 3.6 7.8

Oats 30 g 116.7 19.8 5.1 2.1

Sugar 5g 19.9 4.95 - -

Rice blend 50 g 173 39.5 3.4 0.2

TOTAL 1446kcal 268.3g 28g 28.1g

APPROXIMATE NUTRIENT INTAKE

DAY 2

FOOD AMOUNT ENERGY CARBOHYDRATE PROTEIN FAT

ITEMS
NeproLP 30g 151.2 15.6 3.6 7.8
Oats 30g 116.7 19.8 5.1 2.1
Sugar 5g 19.9 4.95 - -
Arrowroot 50 g 167 41.55 0.1 0.05
Sugar 5g 19.9 4.95 - -
NeproLP 30 g 151.2 15.6 3.6 7.8
Rice blend 50 g 173 39.5 3.4 0.2
Arrowroot 50 g 167 41.55 0.1 0.05
Sugar 5g 19.9 4.95 - -
NeproLP 30 g 151.2 15.6 3.6 7.8
Oats 116.7g 116.7 19.8 5.1 2.1
Sugar 19.9g 19.9 4.95 - -
Rice blend 173g 173 39.5 3.4 0.2
Oil 5ml 45 - - -
TOTAL 1491kcal 268.3g 28g 28.1g

APPROXIMATE NUTRIENT INTAKE

DAY 3

FOOD ITEM AMOUNT ENERGY CARBOHYDRATE PROTEIN FAT

NeproLP 30g 151.2 15.6 3.6 7.8

Oats 30g 116.7 19.8 5.1 2.1

Sugar 5g 19.9 4.95 - -

Arrowroot 75 g 250.5 62.2 0.1 0.1

Sugar 5g 19.9 4.95 - -

NeproLP 30 g 151.2 15.6 3.6 7.8

Rice blend 50 g 173 39.5 3.4 0.2

Arrowroot 75g 250.5 62.2 0.1 0.1

Sugar 5g 19.9 4.95 - -

NeproLP 30 g 151.2 15.6 3.6 7.8

Oats 30 g 116.7 19.8 5.1 2.1

Sugar 5g 19.9 4.95 - -

Rice blend 50 g 173 39.5 3.4 0.2

TOTAL 1613kcal 309.6g 28g 28.2g

PROGRESS OF THE PATIENT

Problems oriented record: The patients come with hypertension, vomiting, fever

Dietary problems: No dietary problems

Weight changes: There is a weight loss during treatment

Biochemical parameters: Patient have low haemoglobin and high blood pressure level

CONCLUSION

Mr.Balakrishnan 84 years old male was admitted in the hospital on 05/12/2017 due to
Seizure disorder, hypertension, Coronary Artery Disease and vomiting.. He already had the past
history of chronic kidney disease. It was from his anthropometric profile that his BMI was
21.36 kg/m². which shows that he is normal weight on assessing the dietary habits it was noticed
that the calorie intake was low on the basis of diagnosis and nutritional assessment ,the diet
counseling was given. The diet prescribed for the patient is tube feeding with low calorie,
normal protein, liberal vitamins and minerals. At the time of discharge he will be given
counseling regarding to the importance of diet.
SUMMARY AND CONCLUSION

CASE STUDY 1

Mrs.Janaki.M 68 years old women admitted in the hospital due to diabetes mellitus. She is a
known case of Type2 Diabetes mellitus. She already had the past history of hypertension and
cough. It was found from her anthropometric profile that her BMI was 29.09kg/m². Which shows
that she is obese. On assessing the dietary habit it was noticed that the calorie intake was low on
the basis of diagnosis and nutritional assessment, the diet counseling was given. The diet
prescribed for the patient is low calorie, normal protein, low fiber diet with liberal vitamins and
minerals. At the time of discharge she will be given counseling regarding to the importance of
the diet and exercise in maintaining the blood glucose level.

CASE STUDY 2

Mrs. Madhavi 85 years old female was admitted in the hospital due to chest pain. She is a
known case of choronary artery disease. She already had the past history of hypertension and
diabetes mellitus. It was found from her anthropometric profile that her BMI was
21.64kg/m².Which shows that she is normal weight. On assessing the dietary habit it was
noticed that the calorie intake was normal. On the basis of diagnosis and nutritional assessment.
The diet counseling was given. The diet prescribed for the patient is normal calorie, high protein
with liberal vitamins and minerals. At the time of discharge she will be given counseling
regarding to the importance of diet.
 CASE STUDY 3

Mrs.Radhamani 58 years old women admitted in the hospital due to peptic ulcer. She is a
known case of peptic ulcer. She already had the past history of hysterectomy. It was found from
her anthropometric profile that her BMI was 24.6 kg/m². Which shows that she is normal
weight. On assessing the dietary habit it was noticed that the calorie intake was normal on the
basis of diagnosis and nutritional assessment. The diet counseling was given. The diet priscribed
for the patient is normal calorie, normal protein and high fiber diet with liberal vitamins and
minerals. At the time of discharge she will be given counseling regarding to the importance of
diet.

CASE STUDY 4

Mr. Raghavan 58 year old man admitted in the hospital due to liver cirrhosis,
hypertension .Heis a known case of choronary liver disease. It was found from his
anthropometric profile that his BMI was 23 kg/m². Which shows that he is normal weight. On
accessing the dietary habit it was noticed that the calorie in take was high on the basis of
diagnosis and nutritional assessment. The diet counseling was given. The diet prescribed for the
patient is high calorie , high protein, high carbohydrate diet with liberal vitamins and minerals.
At the time of discharge he will be given conseling regarding to the importance of diet.

CASE STUDY 5

The patient Mr. Ramachandran 69 years old man admitted in the hospital due to
breathlessness. He is a known case of chronic kidney Disease. It was found from his
anthropometric profile that his BMI was 24.74kg/M². Which shows that he is normal weight. On
assessing the dietary habits it was noticed that the calorie intake was high on basis of diagnosis
and nutritional assessment, the diet counseling was given. The diet prescribed for the patient is
high calorie. low protein with liberal vitamins and minerals. At the time of discharge he will be
given counseling regarding to the importance of diet.
CASE STUDY 6

Mrs.Ayisha is an 45 years old female who was admitted in hospital due to pain in right breast.she is a
known case of breast cancer.she already done the chemotherapy. It was found from her antropometric
profile that her BMI waswas21.9 kglm2 which shows that she is normal weight on assessing the
dietary habits it was noticed that the calorie intake was high on the basis of diagnosis and nuttitional
assessment, the diet counseling was given. The diet prescribed for the patient is high calorie,high
protein with liberal vitamins and minerals. At the time of discharge. she will be given counseling
regarding to the importance of diet.

CASE STUDY 7

The patient Mrs Gracy Vorkey 43 years old female was admitted in the hospital on 1/12/2016
with presenting complaints of abdominal pain, vomiting, fever and jaundice. She was diagnosed
for inguinal hernia. It was found from his anthropometric profile that her BMI was 23.14kg/m².
which shows that she is normal weight. On assessing the dietary habits it was noticed that the
calorie intake was high on the basis of diagnosis and nutritional assessment, the diet counseling
was given. The diet prescribed for the patient is high calorie , high protein, low fibre diet with
liberal vitamins and minerals. At the time of discharge she will be given counseling regarding to
the importance of diet.

CASE STUDY 8

Mr.Balakrishnan 84 years old male was admitted in the hospital on 05/12/2017 due to
Seizure disorder, hypertension, Coronary Artery Disease and vomiting.. He already had the past
history of chronic kidney disease. It was from his anthropometric profile that his BMI was 21.36
kg/m². which shows that he is normal weight on assessing the dietary habits it was noticed that
the calorie intake was low on the basis of diagnosis and nutritional assessment ,the diet
counseling was given. The diet prescribed for the patient is tube feeding with low calorie, normal
protein, liberal vitamins and minerals. At the time of discharge he will be given counseling
regarding to the importance of diet.