Nutritional care must be detailed carefully and accurately in every case study. You need to include details of what type of food was offered, and why that food was appropriate for the patient. You also need to include how the food was offered (bowl, syringe fed etc and why), RER calculations, and intake recording showing if RER was met each day. If RER wasn’t met (for hospitalisation over 24 hrs) you should discuss how you are going to address the deficit and steps you can take to help the patient eat. This is particularly important in the Diploma, and the Cert IV only subjects.
It may be useful to include supporting documentation as an appendix.
Don’t forget to cover the supply and monitoring of water intake too.
OHS and hygiene considerations should also be discussed, as well as techniques to address any inappetance.
Examples:
Grade: Fail
Nutrition is important for healing patients. The patient was fed 1 can of Hills a/d twice per day.
Grade: Pass
Nutrition is vital in recovering surgical patients. Tissue synthesis and wound healing depend on local and whole body nutrition. The patient’s nutritional requirements were calculated by working out the Resting Energy Requirement (RER). The RER of a non-fasted patient in a cage in a thermo neutral environment can be calculated using the following formula.
| RER = 70 x (BWkg)0.75 | |
| For this patient: | RER = 70 x (4.5)0.75 |
| RER = 216 kcal per day. |
Since surgical patients often will not eat as much as normal, the food offered should be calorie dense. Fat can provide 2.5 times the energy of protein or carbohydrate and is often used as a good energy source, however contraindications such as pancreatic disease can limit how much fat should be fed to a patient.
The patient was prescribed Hills Prescription Diet A/D. This food contains high levels of protein and fats in an energy dense formula and is ideal for post surgical patients.
Each can of A/D has 115kcal per 100grams. To calculate how much must be fed, the RER is divided by 115 kcal then times by the 100gms.
216 kcal ÷ 115kcal = 1.9 then 1.9 x 100 = 190 gms per day
Each can has 156gms, so the 190gms is divided by 156gms to give the total amount in cans per day, which is 1.2 cans. This was split into 6 meals per day (one every 4 hours) of 30gms and syringe fed as the patient was reluctant to eat. To make syringe feeding easier, the A/D was blended with water to make a slurry.
Grade: Credit+
Nutrition is vital in recovering surgical patients. Tissue synthesis and wound healing depend on local and whole body nutrition. Amino acids and carbohydrates are needed for collagen and ground substance synthesis while fibroblasts require energy to synthesize RNA, DNA and ATP necessary for proteins. The liver and bone marrow require energy and protein for glucose, platelet, leukocyte and monocyte production.
The immune system is particularly susceptible to the effects of poor nutrition and post surgical patients depend on a healthy immune system to ward off infection. There are other factors that make adequate nutrition following surgery even more critical and these are in response to the injury itself. Following trauma, metabolic and physiologic changes occur in response to the release of catecholamines, adrenocorticoids, glucagon, and a number of other hormones associated with the "fight or flight" response.
The patient’s nutritional requirements were calculated by working out the Resting Energy Requirement (RER). The RER of a non-fasted patient in a cage in a thermo neutral environment can be calculated using the following formula.
| RER = 70 x (BWkg)0.75 | |
| For this patient: | RER = 70 x (4.5)0.75 |
| RER = 216 kcal per day. |
Since surgical patients often will not eat as much as normal, the food offered should be calorie dense. Fat can provide 2.5 times the energy of protein or carbohydrate and is often used as a good energy source, however contraindications such as pancreatic disease can limit how much fat should be fed to a patient.
The patient was prescribed Hills Prescription Diet A/D. This food contains high levels of protein and fats in an energy dense formula and is ideal for post surgical patients.
Each can of A/D has 115kcal per 100grams. To calculate how much must be fed, the RER is divided by 115 kcal then times by the 100gms.
216 kcal ÷ 115kcal = 1.9 then 1.9 x 100 = 190 gms per day
Each can has 156gms, so the 190gms is divided by 156gms to give the total amount in cans per day, which is 1.2 cans. This was split into 6 meals per day (one every 4 hours) of 30gms and syringe fed as the patient was reluctant to eat. To make syringe feeding easier, the A/D was blended with water to make a slurry.