Antoine Lavoiser is regarded as *father of nu: 🤍 *Eternal and Parental Nutrition 🔰* 🔰 Infant Formula - infant under 12 months of age . 🔰 _Six main_ types of tube feeding or enteral nutrition. 1: *NASOGASTRIC TUBE* starts in the nose and ends in the stomach. 2: *OROGASTRIC* starts in mouth and ends in the stomach. *3:NASOENTRIC TUBE* starts in nose and ends in the intestines subtypes includes nasojejunal and nasoduodenal tubes. *4:OROENTRIC* starts in the mouth and ends in the intestines. 5: *GASTROTOMY TUBE* placed through skin of the abdomen straight to the stomach su types includes PEG, PRG and button tubes . 6; *JEJUNOSTOMY TUBE* placed through the skin of the abdomen straight into the intestines subtypes are PEG and PRG . 🤍 _Enteral formula_ is classified into 06 types. 🔰 *Standard Formula* 👉contains intact nutrition. 👉Contain 1-1.2 kcal/ml and are used as over the counter Oral supplement and tube feeding formula. 👉Protein content 30-40 hm/ml. 🔰 *Calorie Dense* : 👉concentrated to provide 1.5-2 kcal/ml. 👉Used when fluid restriction is required in patient. 🔰 *Nestle Nutren 2.0* 👉500 calories 👉 Calorically dense liquid nutrition which contains taurine,carnitine and ultra trace elements for long term feeding 🔰 *Elemental and Semi Elemental.* 👉Contains partially or completely hydrolyzed nutrients i.e simpal sugars peptides and amino acids . 👉For the children having problems like malabsorption, short bawel syndrome and inflammatory bowel diseases. 🔰 *Disease Specific* . 👉 Designed for the patients with specific disease eg Diabetes and renal failure. 🔰 *Blenderized Feeding* . 👉For the patients who can't tolerate semi synthetic formula . 👉Made from real food ingredients such as chicken, Vegetables and fruits in the mixture. 👉 Aseptic technique is essential. 👉 Example complete Pediatric Reduced calorie. used for the children of age 1-13 years who need reduced calories , 1cup equivalent of fruits and vegetables/100 ml . 🔰 *Modular formula* 👉Provideds trimeverates i.e fats , carbohydrates and proteins as single nutrient. 👉 Macronutrients mixture. 🤍Parental Nutrition has two main types. 1: *Central parental nutrition or total parental nutrition* (TPN) : diliverd into central vain . 👉An extended period of intensive nutritional support for the patients who can't tolerate oral and enteral nutrition. 👉 Amino acids amount 85 gram , dextrose 250 ,lipids 100g , K 80 mEq, Mg 240 mg , P 310 mg ,Na 150 mEq, Ca 360 mg, Cl 143 mEq, Trace elements 5ml. 🤍2: *Partial Parental Nutrition.* 👉 Administrated through peripheral intravenous catheter. 👉Lipids emulsion and Amino - dextrose solutions are used. 🔰 *Infants formula* comes in three forms. 1: Powdered formula, 2 Concentrated liquid formula, 3 ready to use formula (most expensive). 💙 _Types of formula milk for infants 🍼._ ✨ *03* major types 🔰 *1:Cow milk protein based formula.* 👉most baby formula milk is made with cow's milk . 👉Gives right balance of nutrients. This formula has two types 1: First stage formula , whey amount is greater then casein i.e casein whey ratio is 40:60. 👉 Casein is lumpy and whey is watery. 👉For baby up to 0ne year. 2: Second stage . 👉 Casein is present in greater amount i.e casein whey ratio is 80:20. 🔰2: *Soy Based formula* . 👉Can be used if you want to exclude animal proteins from your child's diet.. 👉For babies who are allergic to cow's milk. 🔰3: *Hydrolyzed Protein formula.* 👉It has proteins in the p hydrolyzed form. eg completely hydrolyzed formula and partially hydrolyzed formula. [2/16, 12:12 PM] +92 311 5939250: *💫 Enteral and Parentral Nutrition points from Old slides ✍️*👇 [2/16, 12:12 PM] +92 311 5939250: *_Obesity* is believed to account for *80-85%* of the risk of developing *type 2 diabetes.*_ Means it is the *main cause* of type 2 diabetes. [2/16, 12:12 PM] +92 311 5939250: *Type I Diabetes...* Insufficient or no production of Insulin . *Type 2 diabetes* ... Cells don't response to insulin 🫥 [2/16, 12:13 PM] +92 311 5939250: ✍️ *Prevalence of Type 2 diabetes is more in females than males in KPk*. [2/16, 12:13 PM] +92 311 5939250: ✍️ *Weight control and Exercise* are best ways to manage Diabetes. [2/16, 12:14 PM] +92 311 5939250: ✍️ *Frequent Urination (polyuria) , increased thirst (polydipsia) and increased appetite (polyphagia)are common symptoms of DM (Diabetes Mellitus)* [2/16, 12:14 PM] +92 311 5939250: ✍️ *Management Of Renal diseases* 💫 [2/16, 12:14 PM] +92 311 5939250: ✍🏻 *Unit 07 Important Points Applied Nutrition* 🥀 ⭐ *Nephrolithiasis* (گردوں کی پتھری)::: Risk factors. 1::: *Family or personal history.* 2: *Dehydration* 3::: *Diet high in proteins , sodium and sugar, high oxalate.* 4::: certain *supplements* (دوائیاں جن کو مخصوص غذائی اجزاء کی کمی کیلئے استعمال کیے جاتے ہیں جیسے کیلشیم اور وٹامنز سپلیمنٹس) and *medications* . 5::: *Gastric Bypass surgery.* 👉 *Diseases* that may increase the risk of kidney stones. *Tubular acidosis ,Cystinuria, hyperthyroidism and some UTIs.* 👉A balanced diet adequate in both *energy and protein* is recommended in managing Renal failure. 👉A low protein diet of *0.6-0.8 g/kg/day* is often recommended for the management of chronic kidney disease. 👉A dialysis diet is one which is low in sodium, phosphorus and protein. 👉Some dialysis diet me also called for limited *potassium and calcium.* 👉 Dialysis diet stresses the Importance of *high quality protein and limiting fluids.* 💫 *Nephrotic Syndrome* ::: Demage to the clusters of small blood vessels (Glomerulus) in kidneys due to high dietary protein intake. 👉 Characterized by Proteinuria, hypoproteinemia (low protein in blood) and generalized edema. 👉 *Low sodium* helps with swelling in the hands and legs during nephrotic syndrome. 👉The amount of fluid and protein intake by a patient depends upon *patient's condition, age and weight.* 👉Low fat *(1%)* dairy products should be used. 👉 Rarely should *potassium and phosphorus* be restricted oy if kidneys are failing and as determined by a nephrologist during nephrotic syndrome. [2/16, 12:14 PM] +92 311 5939250: 💫Remember..... Dialysis Diet is low in *Sodium, phosphorus and protein* . [2/16, 12:15 PM] +92 311 5939250: ✍️ *Liver Diseases Management* 💫 [2/16, 12:15 PM] +92 311 5939250: ✍️ Most common cause of Gall stones is high level of *cholesterol* . ✍️ *Pigmented Gall stones* are due to excess *Bilirubin* . ✍️ Healthy Foods recommended for Gall bladder. 💫 Fresh fruits and vegetables. 💫Whole grains 💫Lean meat, poultry, fish. 💫Low fat dairy products. 💫 Eating at regular basis. ✍️Foods to prevent Gall stones . 💫 Caffeinated coffee ☕😋. 💫For woman at least one serving of peanut 🥜 decrease *20* % chance of having their gall bladder to be removed😨. ✍️Salt in Chirosiss typically less than *1500 miligrams/day .* ✍️ *1 gram of protein/Kg .* ✍️ *Vit A* is contraindicated in liver failure . [2/16, 12:15 PM] +92 311 5939250: ✍️ *Unit 05 Nutritional consideration in Cardiovascular diseases Management.* ✍️Normal BP *120/80* ✍️ *Hypertension* is considered as silent 🔕 killer . ✍️ *Non modifiable ( that can't be changed 🤷‍♂️) risk factors for Hypertension are.* 💫 Family history 💫Age 💫Gender 💫Race 💫Age over *65* years with co-existing disease such as diabetes and kidney diseases.. 💫 *Coronary arteries* provide blood to Heart. 💫For hypertension moderate salt restriction of *10-05 gram per day* . ✍️ Healthy level of total _cholesterol_ is *125 to 200mg/dL .* ✍️ Healthy level of _non HDL_ isLess than *130mg/dL.* ✍️ Healthy level of _LDL_ is Less than *100mg/dL.* ✍️ Healthy level of _HDL_ is *40mg/dL* or highe. ✍️ *Trans fats* are _most12:11 PM worst_ type of fats that raises *LDL* levels in body. ✍️ *HDL* _better for body_ and *LDL* are _harmful for body_ ✍️ *Fried foods , margarine and Margarine* should be avoided in *hyperlipidemia* (high level of lipids in body) which is the risk factor of coronary heart diseases [2/16, 12:17 PM] +92 311 5939250: ⭐ *Weight Management Unit 03 Important Points* ⭐ 🍏 ~Applied Nutrition~ 🍚 👉 *BMI* = Weight (Kg) ÷( height in meters)² Or 703 × weight (lb) ÷ (height in inches)² 👉 Very severely underweight BMI less than *15 Kg* 👉From *15-16 Kg* severely underweight. 👉From *17-18 Kg* underweight. 👉 *18.5-25 Kg* Normal or healthy BMI. 👉From *25-30 Kg* Overweight. 👉 *30-35 Kg* Obese class I or moderately obese. 👉From *35-40 Kg* Obese class II or severely obese. 👉Above *40 Kg* Obese class III or very severely obese. 👉A balanced diet provide *50-60* % calories from carbohydrates. 👉 *10-15%* from proteins. 👉 *20-30%* from both visible and invisible fats. 👉 *Life style and work habits partially* determine how many calories we need to eat each day. 👉 *Fat* is a very dense source of energy, it provides more than twice calories per gram than protein or carbohydrates. 👉 Cutting back on *fat* is the best way to reduce the total number of calories in your diet. 👉Sweets , soda and fruit drinks give few nutrients and no fiber. 👉Chose complex carbohydrates as it give *lots of nutrients and fibers without as many calories.* 👉A high protein diet can lead to *bed breath* . 👉Less amount of protein is given to *kidneys' patients* . 👉It takes *20 minutes* for your stomach to send a message to your brain that it is full🌝. 👉A *5%* weight loss reduces type 2 diabetes risk by *60%.* 👉The overall goal in weight loss is counseling is to help patients consume fewer calories and eat more healthy. 👉There are *5 steps* in nursing care for Obesity management (05As). 1: Ask 2:Asses, 3: Advise, 4: Agree , 5: Assist. 👉Balanced diet is easily achieved through *05* basic food groups. [2/16, 12:18 PM] +92 311 5939250: *Fetal growth* and development increases the *BMR* by *5 %* during 1st trimester and *12 % during 2nd & 3rd* trimester [2/16, 12:18 PM] +92 311 5939250: In the later trimester the absorption of *vit B12, iron and calcium* increases in order to meet the increased needs of mother and fetus [2/16, 12:19 PM] +92 311 5939250: Good health of fetus and newborn depends upon the nutritional status of the mother *during and prior to conception.* [2/16, 12:19 PM] +92 311 5939250: Additional energy is required during pregnancy. • Additional *300 Kcal* is required [2/16, 12:19 PM] +92 311 5939250: Group Energy Requirement (Kcal) 🫠Sedentary worker 1875 + 300 = 2175 🫠 *Moderate worker* 2225 + 300 = 2525 🫠 *Heavy worker* *2925 + 300 = 3225* [2/16, 12:19 PM] +92 311 5939250: Mothers need more Kcal for *two* reasons: ✍️• To supply the increased fuel demanded by the increased BMR ✍️• To spare protein for the newly added tissues [2/16, 12:19 PM] +92 311 5939250: *Protein* is a *primary need* during pregnancy Additional *15 g* protein is required for: [2/16, 12:20 PM] +92 311 5939250: *Calcium Requirement During Pregnancy* • Fetal bone, teeth development and growth. • Decreases the risk of *low birth weight* and *maternal hypertension and pre-eclampsia.* • Helps in muscle contraction. • Helps in *blood clotting.* RDA during pregnancy is *1g* . [2/16, 12:20 PM] +92 311 5939250: *Iron during Pregnancy* • Fetal growth • Increases RBC production in mothers • Building iron stores in fetal liver • RDA: *3 g/day* [2/16, 12:20 PM] +92 311 5939250: *Folic Acid* • Folic acid *400 mcg/d (RDA)* • Needed for maternal blood formation • Prevents *fetal neural tube defects* and improves birth weight. ✍️• *Pregnant women:* 600 mcg (RDA) ✍️• *Breastfeeding* women: 500 mcg (RDA) [2/16, 12:20 PM] +92 311 5939250: *Other Considerations During Pregnancy* • Avoid *caffeine* as it crosses placenta and enters fetal blood circulation and increases *the risk of premature delivery* . • Avoid smoking as it results in *placental abnormalities and low birth weight (LBW).* • Avoid Alcohol as it causes *LBW, growth retardation, and mental retardation* [2/16, 12:20 PM] +92 311 5939250: *During Lactation* • *Protein Requirement:* • Protein need increases in lactation as mother’s milk contains *1.15g of protein/100 ml.* ✍️• During *first 6 months* of lactation *75. g/d* is required. ✍️• During *6—12 months* of lactation *65 g/d* is required. [2/16, 12:20 PM] +92 311 5939250: *Calcium* : • Additional calcium is required for breast milk secretion as *30—40 mg/100 ml* is secreted per day. 🤷‍♂️• *Iron* : • Iron intake should be increased to *30 mg/d* to make up the iron secreted milk. • Note: *1 mg of iron/d* is lost during menstrual period. [2/16, 12:21 PM] +92 311 5939250: *Vit A (950mcg/d):* • Breast milk is rich in vit A. • About *350 mcg /d* of vit A is secreted in mother’s milk. [2/16, 12:21 PM] +92 311 5939250: Maternal age, especially *<16* years old • Pregnancy less *than 2 years* after onset of menarche • Poor nutrition, low prepregnancy weight, poor weight gai [2/16, 12:21 PM] +92 311 5939250: *Pica* : • Pica is a disorder that causes cravings for items that contain no nutritional value. • Pregnant women with pica may want to eat clay, cigarette ashes, or starch, among other strange substances [2/16, 12:21 PM] +92 311 5939250: When a woman has pica during pregnancy, it may indicate a *lack of a specific vitamin* or *mineral* [2/16, 12:21 PM] +92 311 5939250: *Food Aversions:* • During pregnancy, many women experience aversions to particular foods, means they never want to eat them. [2/16, 12:21 PM] +92 311 5939250: *Food Cravings:* • The sudden, irresistible, and intense urge to eat something specific is referred to as a food craving. Common cravings during pregnancy include: • *Chocolate* • *Spicy foods* • *Fruits* • *Mashed potatoes and pizza * [2/16, 12:22 PM] +92 311 5939250: Low pre-pregnancy weight and low maternal weight gain are risk factors for: – *Intrauterine growth retardation* – *Low birth weight baby* – *Increased incidence of perinatal death* [2/16, 12:22 PM] +92 311 5939250: The average birth weight is *3.5 kg* though the range of normal is between *2.5 and 4.5 kg* (all but *5 %* of newborns will fall into this range). [2/16, 12:22 PM] +92 311 5939250: Average weight gain i *s 25—35* lbs during pregnancy. [2/16, 12:22 PM] +92 311 5939250: *Gestational Diabetes* • *Carbohydrate intolerance* of variable severity with onset or first recognition during pregnancy. • Every year *2% to 10%* pregnancies are effected by gestational diabetes . • It usually goes away after birth. But up to *10%* of women who have gestational diabetes get type 2, weeks or even years later. [2/16, 12:23 PM] +92 311 5939250: *Iron Deficiency Anemia* • A pathological condition in which oxygen carrying capacity of RBCs is insufficient to meet the needs of the body. • WHO recommends the HB %age should not fall below *11 g/dl* throughout pregnancy. • Centers for Disease Control and Prevention (CDC) refers the value of *10.5 g/dl .*