Nutritional Therapy Plan

Four Steps in Developing Optimal Nutritional Therapy

The overarching goal of nutrition therapy is to stabilize or to increase the weight of the patient and to improve their nutritional status. This means ensuring that the patient’s total nutrient intake provides sufficient energy, proteins, micronutrients, and fluid to meet the individual patient’s needs.1 Further objectives of nutritional therapy include maintaining immune functions and preventing metabolic complications.2

In developing a nutritional therapy plan, the following steps are recommended:

Define the Nutritional Goals for the Patient

The first step in developing a nutritional therapy plan is to define the nutritional goal for the patient. For some patients this may mean stabilizing body weight; for others it may mean increasing body weight. A target weight and a target body mass index (BMI) should be defined.

Define the Patient’s Individual Nutritional Needs

The second step in developing a nutritional therapy plan is to define the patient’s specific nutritional requirements. Energy requirements, protein, and fluid intake should all be determined.

The following guidelines will help determine energy requirements:3,4,5

The following guidelines will help determine protein requirements:5,6,7,8,9

The following guidelines will help determine fluid requirements (in ml) by the 100/50/15 formula:10

Define Nutritional Support and Implement Nutritional Therapy Plan

The third step is to evaluate the nutritional intake of the patient and compare it to clinically established requirements. This will reveal any energy and protein gaps for the patient and inform on the appropriate supplementation requirements needed to fill those gaps.

If hospital malnutrition is present, a range of strategies may be used, such as food fortification or the use of enteral or parenteral nutrition. According to the ESPEN Enteral Feeding Guidelines3 the term “enteral nutrition” is used to describe all forms of nutritional support that involve the use of ‘‘dietary foods for special medical purposes’’ independent of the route of administration. Enteral nutrition, therefore, includes oral nutritional supplements (ONS) and enteral tube feeding via nasogastric, -jejunal, or percutaneous tubes. The term “parenteral nutrition” (also known as intravenous nutrition) is used to describe the intravenous infusion of nutrients directly into the systemic circulation, bypassing the gastrointestinal (GI) tract.2

When Supplementation Is Required

The following is a rough guide of a treatment plan for supplementation:11

How to Calculate Fluid Substitution

Fluid substitution may be necessary if a patient does not receive adequate fluids from the food they are consuming. Fluid content of ONS/tube feeding and parenteral nutrition (PN) should also be included in the calculations. Fluid substitution requirements are equal to the total fluid requirement minus fluid intake.1

The following guidelines will help determine fluid substitution:

Define the Route(s) of Nutrition

The fourth step in developing a nutritional therapy plan is to determine the best route or routes of nutrition. The general rule of thumb is – “if the gut works, use it.” However, supplemental or total parenteral nutrition via a central or peripherally-placed line is indicated when nutritional requirements cannot be met via oral or enteral feeding.1

To read more about indications for clinical nutrition types, click here

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