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Nutritional Assessment thr.docx

  1. Master Saurabh s/o Mast Ram is got admitted in Paediatric ward on 31/5/22 and diagnosed to be as Failure to thrive I assessed the child as part of my routine case study and along with I assessed the nutritional status of the child and prepared a nutritional plan and given health education regarding nutrition and importance of maintaining diet Demographic data Name: Master Saurabh Age/sex 12 yrs./ Male C.R. no: 9599 Ward no Paediatric ward Address: S/o Mast Ram, vill- Wasan P.O –Wasan Teh –Mandi Distt-Mandi(h.p) Diagnosis Failure to thrive DOA: 31/5/22 Consultant in charge: Dr. Naag Raj Present Health history: Patient was occur vomiting after eating from 2 days and take less intake diet and sometimes sleep excessive.All time get lethargic . Past health history: Patient was admitted in hospital when he was 3 year old then he suffered from upper respiratory infection. Birth history: Antenatal period was uneventful. No eclampsia or any other complications. Normal vaginal delivery (institutional) Birth weight- 2.5 kg. Cried soon after birth. Neonatal period was uneventful. No NICU stay. Immunization: Immunisation is up to date, done according to national immunisation schedule
  2. Nutrition and dietary history: Child were exclusively breast fed for 6 months. Continued breast feeding along with complimentary feeds up to 2 year. Child follows normal vegetarian diet. Ht- 158 cm Wt- 26 kg Family health history: Chid belongs to joint family father, mother, and paternal grandmother. No. of family members - 12. No family history of diabetes mellitus/ hypertension/ tuberculosis/ stroke/MI PHYSICAL EXAMINATION: General appearance : The child is moderately built. Behavior : Less active and feels very lethargic Emotional stability :Cool and respond well. Level of consciousness :Conscious and well oriented. Vital signs: Temperature 37 0 C Normal Pulse 80/ min Normal Respiratory rate 20/min Normal Blood pressure 100/74 mm of Hg Normal Anthropometry
  3. Parameters Patient value Normal Value Remarks Weight 26KG 50-60 Subnormal height 158 cm 164-180 normal BMI 10.7 kg/m2 15-17 Subnormal Head circumference 53 cm 50 - 55 cm Normal Chest circumference 55 cm 55-60 cm Normal
  4. Normal Average Growth velocity in children Age Growth velocity 0-4 months 1.0 kg/month (30gm/day) 5-8 month 0.75 kg/month (20gm/day) 9-12 month 0.50 kg/month (15gm/day) 1-3 years 2.25 kg/year 4-9 years 2.75 kg/year 10-18 years 5-6 kg/year AGE MULTIPLICATION At birth 2.5 kg- 3.5 kg. Normal Birth weight At 5 months 2 x birth weight 1 year 3 x birth weight 2 years 4 x birth weight 3 years 5x birth weight 7 years 7 x birth weight
  5. HEAD TO TOE ASSESSMENT Head- size is normal, no scalp lesions dandruff or pediculosis. Hair color normal and normal distribution. Hair luster: absent Thinning: absent Sparse: absent Discolored: absent Easily plucked: absent Flag sign: absent Eyes conjunctiva – whitish. No sign of anaemia present, no icterus, no discharge from eyes, normal visual acuity. Conjunctiva: pink Xerosis: absent Bitot’s spot: absent Corneal opacity: absent Night blindness: absent Ears-Normal, are in alignment with the eyes, no lesion or discharge, hearing is normal. Nose -Normal nostrils and nasal ridges, no running nose, no nasal septal deviation Lips and tongue—Lips are normal pink in colour, no pallor. No angular or aphthous stomatitis, no cheilosis or other lesions. Tongue red (Not beefy red) Pallia atrophic: absent Dental caries: absent Mottled enamel: absent
  6. Neck- Normal range of movement performing. Goiter enlargement: absent lymph adenopathy: absent Throat -Normal. No lesions or pharyngitis, no sore throat or congestion. Genital area-Neatness and cleanliness maintained. Voiding self. Bones and skeletal system Normal muscle mass. No bone deformities Cranial bossing: absent Craniotabes:absent Beading of the ribs:absent Knock knees:absent Bow legs:absent Talipes: absent Skin Colour: Pallor Follicular hyperkeratosis: absent Mosaic dermatosis: absent Pellagrous dermatosis: absent Pavement dermatosis: absent Mental status-child is conscious and well oriented to time person and place. Looks lethargic and less active . NUTRITIONAL HEALTH EDUCATION Nutritional counselling is important responsibility of the nurse to promote the nutritional status of the children and to prevent nutritional deficiency diseases.
  7. Functions of food: They are mainly body building, energy giving and protection by maintenance and regulation of tissue functions. Classification of Nutrients:Nutrients are classified as a) Proteins b) Fats c) Carbohydrates d) Vitamins e) Minerals Proteins: The sources of proteins are milk, cheese, liver, fish, meat, eggs, pulses, beans, soya beans Fats: the sources of fats are butter, ghee, cheese, fish oil, mustard oil, groundnut, coconut oil Carbohydrates: The sources of carbohydrates are wheat, rice, millet, suji, maize, glucose, fructose, banana, potato, sweet potato. Vitamins: Fat soluble vitamins - A,D,E and K. Water soluble vitamins - B and C The sources of vitamins and minerals are green leafy vegetables, eggs, yellow fruits, exposure to sunlight, cereals, nuts, amla, roots and tubers, citrus fruits like orange, lemon, guava, papaya, liver, fish, milk, meat, legumes, jaggery Special Considerations  Teach child healthy food habits like green vegetables and fresh fruits. Give him at least 3 servings of fruit everyday  Milk provides complete nutrition for your child. Under 5-year-old children should not use skimmed milk to restrict on fat and cholesterol as they need the extra calories, but grilled and baked foods are always preferable to fried and fatty ones.  Include 3 meals and two nutritious snacks every day.  Try to avoid low nutritious food items for your child likes sweet dessert, candies, soft drinks and chips.  A proper nutritious diet can reduce large number of medical problems. It also increases the stamina of your child. Protein has a very important role in the diet of the growing child because there is considerable increase in muscular development during these years. The requirements for essential amino acids are higher for children than adults.  Don’t restrict your child to a single food item. Encourage him to eat variety of food.  Vitamins and minerals must be supplemented adequately. Calcium and iron requirements are relatively greater during early childhood. Deficiency of calcium can affect the bones of growing children. Foods rich in calcium such as milk and milk products, green leafy vegetable and fish should be included in the diet of children. Balanced diet should include food item rich in calcium.  Nutritious diet includes leafy green vegetables and fresh fruits. Choose a diet moderates in sugars and low in fat.
  8. DIET PLAN FOR SAMEER FOR ONE DAY Food Item Ingredients: Quantity/ Amount Carbohydrate Protein Fat Total Energy Milk Milk - 150 ml 12 gm 8 gm 8 gm 152 Kcal Breakfast Boiled Egg 0 10gm 9gm 121 Kcal 1Apple 25 1gm 0gm 95 kcal Lunch Chappathi 2 no’s 140Kcal Rice1/3 cup 80 Kcal Daal 17gm 3gm 308 Kcal Dahi150 ml 5gm 5gm 90 kcal Greenbean Sabji 7 gm 1.8gm .2gm 31kcal
  9. Tea and Biscuit Milk 150 ml 12 gm 8 gm 8 gm 100 Kcal Sugar 20gm 27 0gm 0gm gm 110kccal Dinner Chappathi2 no’s 140Kcal Mung Daal 100 gm 25gm 1.2 gm 350kcal Milk Milk 150 ml 12 gm 8 gm 8 gm 100 Kcal