Nutrition Care Plan Dr.

Dominguez November 14, 2013

Condition Protein Requirement
Nutrition Care Plan  Non- critically ill 0.8-2 gm/kg/day
 How much and what type of nutrient to give (nutrient formulation)  Critically ill, normal
 Nutrient delivery process and monitoring determine the outcome or problem
success of the management process.  Critically ill, with CKD
or dialysis
Components of Nutrition Care Plan  Critically ill with CKD, 0.6-0.8 gm/kg/day
 Nutritional assessment no dialysis
 Nutritional requirements  Burns 2.5 gm/kg/day
** Convert the TPR to kcal by multiplying TPR by 4 kcal/gm.
Nutritional Requirement **in the computation- use upper reference value (2, 0.8, 2.5)
 Total Caloric Requirement
 Total Protein Requirement Non- Protein Calories (NPC)
 Non- Protein Calories  NPC= TCR-TPR in calories
 Electrolytes, vitamins, and trace elements
Condition CHO Fat
Total Caloric Requirement (TCR)
 Usual 60-70% (70%) 30-40% (30%)
Condition Energy Factor
Critically ill (initial phase) 15-20 kcal/ kg/ day  Critically ill 50% 50%
**in the computation- use 70% for CHO, and 30% for fat (usual condition), 50%
Critically ill (follow up phase) 20-25 kcal/ kg/ day CHO and 50% fat for critically ill

Non critically ill 25-30 kcal/ kg/ day

**in the computation- use upper reference value (20, 25, 30)

Body Composition Weight Reference to Use

Non- obese including ACTUAL/IDEAL/ESTIMATED
underweight body weight
Obese (BMI >/=30) IDEAL body weight

*IBW Formula
 IBW for a woman may be estimated as 100 pounds for the first 5 feet plus
an additional 5 pounds for every inch over 5 feet. The IBW for a man is 106
pounds for the 5 feet plus an additional 6 pounds for every inch over 5
feet.

Total Protein Requirement (TPR)

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Nutrition Care Plan Dr. Dominguez November 14, 2013
1. CHO Formulation= NPCx % requirement divided by 4 kcal/ gm Nutrient Delivery
2. Fat Formulation= NPC x % requirement divided by 9 kcal/ gm  Oral
 Gastric feeding
Fluid Requirements: o Bolus (manual or gravity tube)
 Usual complication: 30 ml/kg body wt o Intermittent or continuous using enteral pumps
 Mostly dependent on fluid balance records  Small intestine feeding
 Critical care set up: include insensible water loss in the fluid balance o Intermittent or continuous using gravity drip
which is about 800- 1000ml/day o Enteral pumps

Access Monitoring Strategies

 Oral  Calorie count
 Enteral  Regular weight determinations (once a week)
o NGT  Fluid balance
o PEG/ gastrostomy  Complete blood count
o Jejunostomy  Total lymphocyte count
 Parenteral Nutrition  Serum albumin
o Peripheral
o Central Case:
 68- year old female
Nutrient Formulation  Admission weight: 30kgs
 Regular or special diet  BMI: 12 kg/ m2
 Oral supplements
 Enteral Nutrition  Dx: esophageal tumor
o Standard formulations: Pre- mixed solutions  High risk/ severe malnutrition
o Modular formulations: Custom built- for the patients
o Special (elemental or semi- elemental) Nutrition Care Plan
 Parenteral Nutrition
o Individual (amino acids, fat, dextrose) or 3 in 1 combinations TCR= 30 kgs x 20 kcal 600 kcal/ day
o Formulations for peripheral or central route
TPR= 30 kgs x 2 gm 60 gm/ day x 4 kcal/
g= 240 kcal/ day
NPC= 600 kcal- 240 kcal 360 kcal/ day
CHO= 360 kcal x 0.5/ 4 gm 45 gm/ day
Fat= 360 kcal x 0.5/ 9 gm 20 gm/ day
Fluid requirement= 30 ml x 30kg 900 ml/ day

Access
 *PEG/ gastrostomy, jejunostomy, or Parenteral nutrition (Central)

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