1. Feeding methods

2. Enteral & parenteral nutrition -enteral nutrition is needed for persons with underlying chronic disease or traumatic injury. -also elderly person,these patients expose to burn,or malignant cancer need enteral nutrition to restore some of their health. --

3.  ** mode of enteral nutrition support :  oral supplements.  -add energy –nutrient food as Ensure with or between  Meals.  2-tube feeding :  -insufficient food intake either as supplement or as the complete meal.

5. -- ** nutrient component : carbohydrate protein amino acid fat vitamins & minerals. ** ways of formula feeding : nasogastric tube : indicated in short term theorpy. 2- esophagostomy { cancer neck } or traumatic injury 3-gastrostomy : tube placed in the stomach. 4- jejunostomy : Tube placed in the duodenum or jejunum of small intestine. Indicated in case of cancer stomach

6.  ** nursing care :  check for gastric residuals.  note any signs of abdominal distension.  monitor vital signs as temperature,pulse,respiration.  monitor the flow rate & record intake & output.  report patient response to the formula.  monitor state of hydration.  follow up of lab investigation as needed.  **N.B: - vomiting,abdominal distension, frequency of bowel movement after formula feeding,if developed better to give intermittent bolus feeding until tolerance to formula occur

7.  ** parenteral feeding :  total parentral nutrition.  any feeding methods other than by the normal gastro-intestinal route.  given through central or peripheral veins.  when the GIT cant be used.  ** indication for TPN:  problems in the gastro-intestinal tract.  sever mal nutrition.  patient expose to sepsis,chemotherapy.  malabsorption & inadequate oral intake.  massive burn.  comatose patient.  hepatic insufficiency.

8.  Nutrition during pregnancy & lactation  ** factors determining nutritional needs :  @ age & parity :  teenage mother  number of pregnancy & interval between pregnancies,reflect on outcome of pregnancy.  @preconception nutrition :  Diet,food habits  General health & fitness.  State of nutrition at time of conception.  @fetus,mother,placenta interaction.  ** energy need during pregnancy,calories increased to nourish baby,with appropriate weight gain.  ** protein need60gm \ day help in rapid growth of the fetus,enlargement of uterus.  ** calcium 1200 gm\day,essential for skeletal tissue growth.  drink cup of milk daily is essential.  ** iron 30gm \day.  supplementary iron given because of insufficient maternal stores.  vitamins A,B,C,D,with adequate exposure to sunlight.

9.  ** general dietary problems :  nausea & vomiting.  hyper emesis gravid rum.  constipation.  hemorrhoids.  heart burn or gastric pressure.  ** weight gain during pregnancy : 10-12 Kg  -fetus : 3.400 gm  -placenta : 450 gm  -amniotic fluid : 900 gm  -uterus : 1100 gm  Breast 1400gm  -blood volume : 1800 gm  - maternal body : 1800 gm

10.  ** nutritional risk factors in pregnancy :  age : less than 15 yrs,more than 35 yrs.  frequent pregnancy 3 or more during two years period.  poor obstetrical history.  poverty.  abuse of nicotine,alcohol,or drugs  inadequate weight,less than 85 % of standard weight,more than 120% of standard weight.  ** complications of pregnancy :  anemia : common problem during pregnancy { iron deficiency,folate deficiency,hemorrhagic anemia }

11.  pregnancy induced hypertension { PIH }:  -low to free salt diet.  -low cholesterol.  -high protein,vitamins,& minerals.  -normal CHO.  - monitor of body weight.  - restriction of fluid.  3- gestational diabetes mellitus :  - low CHO diet especially glucose.  -low cholesterol diet.  -normal protein diet.  Exercise  stress reduction.  insulin therapy.  maternal phenylekentonuria.  ** nutrition during lactation :  -because mother breast feeding, she need good nutrition in form of protein,milk,milk product,minerals,& vitamins.  -finally mother need period of rest & relaxation to take care of her self,her baby & her family

12. Thank you