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 Analyze case conditi conditions ons of patients patients during during dietary dietary anageen anageent! t! ". #lan a diet odi$ed odi$ed in energy and carbohyd carbohydrate rate under under di%erent di%erent condition conditions! s! and &. #repar #repare e and evaluate evaluate odi$e odi$ed d diets. diets. 'ethodology (or this exercise, exercise, the students were tas)ed to prepare prepare a diet for patients with fever or infections, those who have gone on surgery and those who have to deal with burns. *iven the height and weight of the $rst + year-old ale patient with tuberculosis, /0 was deterined using the Adopted 'ethod while his 23 was coputed using 'ethod I 45ooper6 and 7arris /enedict forula. /'I classi$cation using using Asian 5ut o% points was used to deterine deterine his nutritio nutritional nal status. status. One day sapl saple e enu enu for the patien patientt was prepa prepare red d with with consi consider derati ation on to the patie patient8 nt8s s current state and need based on edical diagnosis. (or the second case patient, a &9 year-old ale patient weighing 9 )g with a height of + feet and & inches and had undergone a post gastrectoy and intestinal resection, A# forula was used to deterine his /0. 7is 23 was coputed using 'ethod II 4;rause6 and 7arris /enedict forula. he nutritional status was deterined using 07O cut o% points for /'I. .+ and tuberculosis, it is deterined that he has a noral nutritional nutritional status based on Asia #aci$c cut o% points. *iven his condition, there is a &".+? increase in his /'3 due to his ".+ 5 increase in teperature fro the noral teperature of &@. 0ith this, his total energy reuireent for the day falls on "999 )cal 4using 'ethod I6. A high calorie, high protein diet is advised for the dietary anageent of his disease. Baple diet plans are provided below to give the patient "999 )cal with "+ g of 57O, 1"+ g of protein and +9 g of fat. 4Another diet plan with 1@99 )cal fro fro coput coputati ation on fro fro 7arris 7arris /ened /enedict ict (or (orula ula was also also provi provided ded.6 .6 he he high high prote protein in is needed needed becaus because e of the accop accopani anied ed incre increas ase e in /'3. /'3. An adeu adeuate ate carbohydrate is given as well as to spare protein for being used as energy source instead of helping the body recover fro disease. 7igh aount of Cuids should also
be given to patient due to the increased loss of body Cuids and electrolytes caused by the fever. Ditain and ineral suppleentation are given according to patient8s needs especially that soe of the drugs for treatent of tuberculosis are antagonistic with soe such as Ditain /. (or the second patient who had undergone post-gastrectoy and intestinal resection, his nutritional status is deterined to be noral according to 07O cut o% points. As a result of the surgery, the stoach is saller with less roo to be held, and the intestines have decreased ability for digestion, this is why progressive diets are given post-surgery to patients. utrition support via enteral feeding is not andatory to be given to patients as long as they can tolerate food. Apply nutrition support only if oral inta)e cannot be applied, if the patient is undernourished on tie of surgery, and if oral inta)e would be inadeuate 4E9?6 for 19 continuous days. Fejunostoy or nasogastric enteral feeding are usually recoended for patients who had undergone gastrointestinal surgery. he progressive diet should start fro clear liuids for 1-" days to full liuid to soft diet depending on the patient8s tolerance before one could go bac) to full noral diet. Baple progressive diet fro clear liuid to regular diet is provided below. After the surgery, certain coplications such as the duping syndroe, diarrhea, weight loss and decreased absorption of vitains and inerals can occur. o prevent this, in duping syndroe, siple carbohydrates and alcoholic beverages are usually avoided. Ball freuent eals 4around -G eals per day6 are given as well instead of having large ones. It is also advised to not drin) during the eals as to avoid feeling full early due to the saller capacity of the stoach.