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Nutritional Mgt of ED (Monitoring and Evaluation (Weight (BMI banding…
Nutritional Mgt of ED
Assessment
(as per prior map)
Clinical
Diet
Biochem
NFPF
Anthro
Intervention considerations
No definitive method for calculating rqt's
Nut rqt's for wt gain = wide ranging/ unsubstantiated Dependant on:
Chronicity of ED
Consequences of ED
Compensatory behaviours
Compliance w meal plan
Changes in body composition and metabolic adaptations
Want to remain process focussed rather than reactive
Nut dx made as a team not on ward alone
Monitoring and Evaluation
Meal completion sheets to monitor intake - nursing staff involvement
Weight
Outpatients = 0.25-0.5/wk
Inpatient = 0.5-1.5kg/wk
BMI banding
Steady/stable
Moved up
Moved down
All compared against baseline wt
qid obs - HR, BP, T
qid BGLs
ECG
Daily bloods
DTN visit 1/7 only
Intervention Plan
4 stage nut rehab program (irrespective of BMI)
Day 3 = 8,400kJ
Day 5 = 10,500kJ
Admission - 6300kJ
Mental health ward = oral
Medical ward = continuous NGF
Continuous CHO supply
Easier to monitor intake (resources costs)
Day 7 = 12,600kJ
Day 9 = 14,700kJ (often rq for males) OR transition to oral meal plan
Aim to reach goal energy rqt's in 10 days
Plus thiamine, MVI and electrolyte replacement
The steps for oral nut.
Supplement replacement (if eating < 100% of meals)
Enteral feeds - bolus (if <100% of supplement taken orally)
Meal plan
Oral to oral + supplement to NGF (when not compliant)
Same menu as all pt's
Low fibre
Encourage high quality protein
Education and Counselling Strategies
Externalise the illness
Motivational Interviewing
Acknowledge ambivalence
United front against ED
Work with team, family and sensible part of pt