Patient Profile

Patient A requires urgent nutritional intervention to address her severe acute malnutrition (SAM) and
support her recovery. Ongoing monitoring of her growth and dietary intake will be crucial for effective
management.

(2-Year-Old Female)

.Patient Information:

Detail Information

NAME Patient A

GENDER Female

AGE 2 years

LOCATION Gatundu, Kiambu County

MEDICAL HISTORY Known case of severe acute malnutrition

CONDITION Recently treated for diarrhea

Chief Complaint

 Severe acute malnutrition

 Recent episodes of diarrhea

History of Presenting Illness

Patient A has been experiencing symptoms of severe acute malnutrition, characterized by significant
weight loss and weakness. She was recently treated for diarrhea, which has contributed to her current
nutritional status.

History of Past Illness

The patient has a known history of severe acute malnutrition but no significant chronic illnesses
reported.

Psychosocial Status

The patient is a young child who is dependent on her caregivers for nutrition and care. Her family is
supportive, but they may lack access to sufficient resources to provide adequate nutrition.

Family History
The patient's family does not have a significant history of chronic illnesses. However, there may be
concerns regarding dietary practices within the household that contribute to her malnutrition.

Patient Economic History

The patient's family faces economic challenges as they may have limited access to nutritious food
options, which is common in the region.

Current Health History

Patient A has been diagnosed with severe acute malnutrition and was recently treated for diarrhea. She
exhibits signs of weakness and irritability, indicating her poor nutritional status.

Medical History

No significant medical history reported prior to this admission.

Biochemical Analysis

Analysis Lab Results Normal Ranges

Haemoglobin 9.5 g/dL 11.5-15.5 g/dL

Total Protein 4.8 g/dL 6.0-8.5 g/dL

Albumin 1.8 g/dL 3.5-5.0 g/dL

Urea 20 mg/dL 10-20 mg/dL

Creatinine 0.4 mg/dL 0.3-0.7 mg/dL

Electrolytes

Electrolyte Lab Results Normal Ranges

Sodium (Na+) 130 mEq/L 135-145 mEq/L

Potassium (K+) 2.8 mEq/L 3.5-5.0 mEq/L

Chloride (Cl-) 85 mEq/L 98-106 mEq/L

Anthropometric Assessment

 Weight: 9 kg
  Height: 80 cm

 BMI: Calculated as follows:

BMI=Weight kg Height m 2=9(0.8)2=14.1 kg / m2

Clinical Assessment

 General Condition: Weak and irritable

 Appetite: Very poor

 Gastrointestinal Tract: Functional but recovering from diarrhea

Dietary Assessment (Using 24-Hour Recall)

The patient reports a decreased appetite due to gastrointestinal distress but is able to consume
some foods:

1. Breakfast:

 Porridge made with milk: Provides carbohydrates and protein.

 1 small banana: Rich in potassium.

2. Morning Snack:

 ¼ cup of yogurt: Rich in probiotics to support gut health.

3. Lunch:

 ½ cup of rice: Provides carbohydrates for energy.

 30g of cooked chicken: Lean protein for tissue repair.

 ½ cup of boiled mixed vegetables: Provides vitamins and minerals.

4. Afternoon Snack:

 1 apple: Provides fiber and hydration.

5. Dinner:

 ½ cup of mashed potatoes: Rich in carbohydrates for energy.

 30g of baked fish: Provides omega-3 fatty acids beneficial for brain health.

 ½ cup of steamed carrots: Provides essential nutrients.

6. Evening Snack:

 1 glass of electrolyte-enhanced water or coconut water: To replenish lost fluids and

electrolytes.

Nutritional Diagnosis
Diagnosis: Inadequate nutrient intake related to poor feeding, as evidenced by low BMI of 14.1 kg / m2.

Nutrition Intervention

Goals:

1. Improve nutritional status and overall health.

2. Correct protein and albumin levels.

3. Restore electrolyte balance.

4. Ensure adequate hydration.

Plan:

1. Initiate a high-calorie, nutrient-dense diet tailored for SAM.

2. Include easily digestible foods to minimize gastrointestinal distress.

3. Ensure adequate fluid intake to combat dehydration.

4. Monitor and adjust dietary intake based on tolerance.

Energy Needs Calculation

Using the Schofield equation for estimating caloric needs for children:

Energy Needs=22×Weight kg +500

For Patient A:

Energy Needs=22×9+500=198+500=698 kcal

Fluid Estimation

Fluid needs can be estimated using the following formula:

Fluid Needs=100 ml kg for the first 10 kg

For Patient A:

Fluid Needs=100×9=900 ml day

Nutritional Composition

Macronutrient Distribution:

Nutrient Percentage Calories Grams

Carbohydrates 55-60% ~400 kcal ~100 g

Proteins 15-20% ~140 kcal ~35 g

Nutrient Percentage Calories Grams

Fats <30% ~160 kcal ~18 g

Diet Description

Daily Intake:

 Carbohydrates: ~100 g

 Proteins: ~35 g

 Fats: ~18 g

 Total Calories: ~698 kcal

Food Items

Food Items No. of Servings CHO (g) PROTEIN (g) FATS (g) TOTAL KCALS

Starch (Rice) 2 50 4 0 200

Milk 2 24 16 8 240

Meat (Chicken) 1 0 20 5 100

Fruits (Banana) 1 30 1 0 120

Vegetables 1 - - - -

Total 104 41 13 660

Menu Plan

Breakfast:

1. Porridge made with milk (rich in carbohydrates and protein).

Snack:

1. One banana (rich in potassium).

Lunch:

1. Rice with chicken (carbohydrates and protein).

2. Boiled vegetables (vitamins and minerals).

Snack:

1. A small serving of yogurt or fruit puree.

Supper:

1. Mashed potatoes with fish (carbohydrates, protein, and omega-3 fatty acids).

This structured approach provides a comprehensive framework for addressing the severe acute
malnutrition in Patient A, ensuring targeted interventions that promote recovery and long-term health
outcomes while considering her specific needs as a young child in a maternal and child health setting.
Case Study 2
Patient Profile
Patient J is a 3.5-year-old male from Gatundu, Kiambu County, diagnosed with severe pneumonia
and bronchitis. The patient is currently receiving treatment in the Pediatric Ward.Patient Information:

Detail Information

NAME Patient J

GENDER Male

AGE 3.5 years

LOCATION Gatundu, Kiambu County

DIAGNOSIS Severe pneumonia and bronchitis

Chief Complaint

 Severe respiratory distress characterized by wheezing and difficulty breathing.

 High fever (temperature may exceed 38°C).

 Decreased appetite due to respiratory fatigue.

History of Presenting Illness

Patient J presents with severe respiratory distress characterized by wheezing and difficulty breathing. He
has experienced symptoms such as nasal congestion and a productive cough over the past week. The
patient has a high fever and appears lethargic but responsive.

Medical History

 No significant past medical history reported.

Family History
The patient is married and has two children. There is no significant family history of respiratory disorders
or chronic illnesses reported.

Economic History

The patient's family relies on a modest income from informal employment. Financial constraints may
impact their ability to access healthcare services consistently.

Psychological Status

The patient appears anxious due to his condition but is responsive during interactions. His family is
supportive, providing emotional comfort during his hospitalization.

Anthropometric Data:

 Weight: 12 kg

 Height: 95 cm

Biochemical Analysis

Analysis Lab Results Normal Ranges

White Blood Cell Count 15,000/mm³ 5,000-15,000/mm³

C-reactive protein 20 mg/L <5 mg/L

Hemoglobin 11 g/dL 11.5-13.5 g/dL

Sodium 138 mEq/L 135-145 mEq/L

Potassium 4.2 mEq/L 3.5-5.0 mEq/L

Clinical Assessment

 Patient J presents with severe respiratory distress characterized by wheezing and difficulty
breathing. He exhibits signs of nasal congestion and is currently being fed via a nasogastric (NG)
tube due to respiratory fatigue and decreased appetite. The patient has a high fever and appears
lethargic but responsive.
Signs and Symptoms:

 Sneezing

 Nasal congestion

 Wheezy cough

 High fever (temperature may exceed 38°C)

 Rapid breathing (tachypnea)

 Shortness of breath during activity or at rest

 Fatigue and lethargy

Dietary Assessment

Patient is currently unable to feed orally due to respiratory distress; NG feeding is necessary to
ensure adequate nutrition and hydration.

NUTRITIONAL DIAGNOSIS

Increased nutrient needs related to severe pneumonia and bronchitis, as evidenced by clinical
assessment and dietary history.

NUTRITION INTERVENTION

Goals

1. Stabilize respiratory function.

2. Ensure adequate caloric intake through NG feeding.

3. Support immune function to combat infection.

4. Monitor hydration status closely.

Plan

1. Administer F-75 therapeutic milk via NG tube to provide essential nutrients while stabilizing the
patient.

2. Gradually transition to F-100 as the patient's condition improves and oral feeding resumes.

3. Include high-calorie, nutrient-dense foods once the patient can tolerate oral intake.
 4. Monitor fluid intake to prevent dehydration.

Energy Needs Calculation

Energy needs for pediatric patients with respiratory conditions are approximately 100 kcal/kg body
weight/day.

Energy Needs=100 kcal×12 kg=1200 kcal day

Fluid Estimation

Fluid requirements for infants and young children are approximately:

Fluid Needs=150 ml kg×12 kg=1800 ml day

Macronutrient Distribution

 Carbohydrates: Approximately 50-60% of total calories

 Proteins: Approximately 15-20% of total calories

 Fats: Approximately <30% of total calories

Carbohydrates Calculation

Assuming 55% of total calories from carbohydrates:

CHO=0.55×1200=660 kcal

CHO in grams=4660=165g

Protein Calculation

Assuming 20% of total calories from proteins:

Protein=0.20×1200=240 kcal

Protein in grams=2404=60 g

Fats Calculation

Assuming 25% of total calories from fats:

Fats=0.25×1200=300 kcal

Fats in grams=3009=33.33 g≈33 g

Diet Description

Macronutrient Grams Total (kcal)

Carbohydrates 165 660

Macronutrient Grams Total (kcal)

Proteins 60 240

Fats 33 300

Total 1200

Food Items and Servings

Food Items No. of Servings Carbohydrates (g) Protein (g) Fats (g) Total (kcal)

F-75 Therapeutic Milk As needed 12 0.9 2.5 75

F-100 Therapeutic Milk As tolerated 13 2.9 5.0 100

 F-75 Therapeutic Milk:

 Carbohydrates: Approximately 12 g per 100 ml, which provides about 64% of the total
energy.

 Protein: Contains 0.9 g per 100 ml, contributing about 5% of the total energy.

 Fats: Provides approximately 2.5 g per 100 ml, making up about 32% of the total energy.

 Total Energy: Each serving contains approximately 75 kcal.

 F-100 Therapeutic Milk:

 Carbohydrates: Approximately 13 g per 100 ml, providing about 52% of the total energy.

 Protein: Contains 2.9 g per 100 ml, contributing about 12% of the total energy.

 Fats: Provides approximately 5 g per 100 ml, making up about 53% of the total energy.

 Total Energy: Each serving contains approximately 100 kcal.

Daily Meal Plan

Daily Feeding Plan

1. F-75 Therapeutic Milk via NG tube, administered every few hours based on tolerance.
 2. Transition to F-100 Therapeutic Milk as the patient's condition improves.

This structured approach aims to meet Patient J's increased nutritional needs while addressing his
medical conditions related to severe pneumonia and bronchitis, ensuring he receives adequate nutrition
for recovery during his treatment in the Paediatric Ward.