The patient is hypertensive with a blood pressure of 160/100 during hospitalization. She was diagnosed with Cerebrovascular disease or mild Stroke affecting the left side of her body. The patient cannot swallow food very well so a nasogastric tube was inserted for NGT feeding.Diet History24 Hour Food Recall and Food Frequency questionnaire was given. The patient consumes vegetables and fruits, including, meat, fish and poultry products but she is also fond of fatty and salty foods.
NUTRITION MANAGEMENT
Identified Nutrition Problems:
1. Swallowing difficulty
2. Undesirable Weight Status
3. Undesirable Food Choices
INTERVENTION
1. Swallowing difficulty
Management:
> Osteorized food items for nasogastric feeding
> Provided with a meal replacement formula with 135 calories
> Provided with high-quality protein foods and formula like casein, egg whites, soya milk, or whey protein
> The patient was administered with physical therapy to improve functional capacity
> Sun basking at 10 AM sunlight for body Vitamin D activation.
2. Undesirable Weight Status
Management:
> Height: 160 cm; weight: 73 kg; BMI: 28.52 Kg/m2
> Total Caloric Requirement for Weight Management: 1600 Calories
>Total Protein Requirement for body regeneration and body functions: 72 grams
> Provided with enough Calories from 75-100 % for optimum nutrition status and for weight management.
3. Undesirable Food Choices
Management:
> The patient was given nutrition counseling on low fat, low cholesterol, and low sodium diet. This is for her long term goal especially when the oral diet is applicable and resumed.
> Avoided foods high in sodium such as processed foods and meats, seasonings, cheeses, canned goods, and instant noodles.
> Checked labels of counter foods, check for healthy levels such as less than 7% saturated fat, low cholesterol or zero cholesterol, zero trans-fat, low fat and low sodium with the content of less than 400 mg per serving.
> Avoided fatty, oily, and salty foods. Limited saturated fat intake to less than 5% a day. Limited sodium intake to less than 4 grams a day.
> The patient was given Omega-3 fatty acids supplementation, 1 capsule per day for heart and vascular health among others.
> Encouraged consumption of High Potassium-rich foods
Sources
1. Green leafy vegetables,
2. Root crops such as Potatoes, Sweet Potatoes and Taro
3. Yogurt
4. Bananas
5. Watermelon
6. Squash
7. Coconut water
8. Avocados
9. White Beans
10. Black Beans
> Consume sources of healthy Nuts as these are sources of monounsaturated fats that are good for the heart and the veins. They also lower the “bad” blood cholesterol levels (LDL) and increases “good” cholesterol levels (HDL). Examples of these are Walnuts, Almonds, Cashews, Macadamia nuts, Brazil nuts, and Peanuts among others. They also contain fiber, and a number of vitamins and minerals such as magnesium and Vitamin E.
MONITORING
The patient was monitored on a weekly basis.
The patient underwent physical therapy for six months. The patient improved to oral diet in 2 months and the Ngt feeding was unnecessary. The patient religiously followed her nutrition counseling and diet plan.
The patient has improved condition and went to work after 12 months.
EVALUATION
The diet plan, meal guide, and diet counseling was effective. The patient religiously followed her nutrition care plan and regular monitoring was conducted. The patient has improved her condition, religiously followed her medications and is physically able to work after 12 months.
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