Initiative Nutritional Assessment

Date of Visit:

Date of Birth or age in months

Name:

Sex:

Weight:           gm     Height                  cm      Weight/Height ZSMUAC             cm

Edema:               +       ++        +++

Interpretation:

SAM         MAM         mild malnutrition              

Clinical Assessment

                   Yes/No

Dietary Assessment

Laboratory Assessment

·        Alertness:

Conscious

Semi-conscious

Apathetic

Unconscious

Shock if Yes

-   Give Oxygen

-   Sterile 10 % glucose (5 ml/kg) by IV

-   Keep the child warm

-   measure and record pulse and RR/10 m

-   If improved over a period of 1 hour (pulse and RR rates fall)

-   Repeat IV 15 ml/kg for 1 more hour Then give 5−10 ml/kg ORS in alternate hours with F-75 for up to 10 hours

·        Attitude:

Irritable

Response to others

Toxic look

else

• Appetite test:

use RUT formulae according to schedule:

amount that should be eaten

=

pass/fail

amount left over

• Last 24 hours Recall

• Blood Glucose:

mg/dl

(Hypoglycemia <54 mg/dl)

-   Give a bolus of 50ml (10% glucose) orally Or via nasogastric tube (if unable to drink), Or

-   (if unconscious) first give glucose (IV) (5 ml/kg of sterile 10% glucose) then nasogastric bolus

-   Start feeding with F-75 immediately following the Feeding schedule (2-hourly feeds)

-   For all children: Feed straight away and then every 2–3 hours, day and nigh

Hypothermia   Rectal/axillary

Take temperature every 30 minutes until it becomes normal and stop rewarming when it rises above 36.5ºC (or 36ºC axillary)

Fever 

·        Breathing:

Distress

Respiratory Rate:

<2 months:

< 60 breaths/minute**

2–11 months:

< 50 breaths/minute**

12–59 months:

< 40 breaths/minute

Dietary History:

·     Weaned/not

·     Breast Feeds

(complete Evaluation Sheet when appropriate)

·        Correct positioning

·     ArtificialFormula

No. /day

Volume/Feed

Scoops/30 ml

·     Supplementary Food

Amount/d

• Hemoglobin

     Hb                    g/dl

Anemia

Septic Shock:

Treat 1ry cause +

§  Give maintenance fluids          (4 ml/kg/h) and

§  Order 10 ml/kg fresh whole blood and when blood is available, stop IV fluids

§  Give a diuretic

§  Transfuse whole fresh blood (10 ml/kg) slowly (over 3 hours)

§  If signs of heart failure:

ü Give packed cells instead of whole blood

ü Treat septic shock

·        Circulatory:

Cold extremities

Capillary refill

Pulse Rate:

Frequency Pattern

(For Food Groups)

(When applicable)

·        Dehydration:     

Recent sunken Eye

Skin integrity

Tongue/mouth

Tears                    Thirsty

Eczema

Skin infections/wounds

Diarrhea 

watery  

bloody

Vomiting

Passed Urine

If Dehydrated:

§  Give 5 ml/kg every 30 minutes for 2 hours (orally or by nasogastric tube)

§  (if the child has already received IV fluids for shock and is switching to ORS Then give ORS 5–10 ml/kg for up to 10 hours (in alternate hours with F-75 formula)

§  Stop giving ORS when there are 3 or more hydration signs (less thirsty, less lethargic, slowing of respiratory and pulse rate, passing urine, not thirsty) or

§  if the child has reached any signs of Over hydration:

-   Increasing pulse (25 beats/m) and respiratory rate                      (5 breaths/m)

-   Increasing edema and puffy eyelids

Thereafter: -

Check at least hourly

• Handicapping:

Physical

Mental

Delayed Growth

Delayed Development

• Infection:

From day 1 and for all children:

Gentamicin*  IV or IM

7.5 mg/kg ONCE per day

For 7 days              

Ampicillin:IM or IV

50 mg/kg/6 hr for 2 days

Followed then by

Amoxicillinorally

25–40 mg/kg /12 hr

For 5 days

If serious complications(e.g. severe sepsis, shock) orresistance to amoxicillin and ampicillin, give:

•        CefotaximeIV children &

Infantsolder than 1 month

50 mg/kg/8–12 hr

•        Ciprofloxacinorally

10–20 mg/kg/day for 5 days

For staphylococcal infection ADD

Cloxacillin

25–50 mg/kg/6 hr per day for14 to 21 days

Plan for Feeding

Support Breast Feeding as possible:

-   Mother/care giver

-   Relactation

-   Wet nursing

Supplementary Food:

No Edema:

• Expressed Breast Milk
• Commercial Infant formula
• F-75 or
• diluted F-100

Edema:

Commercial (generic) infant formula or F-75

(Full-strength F-100 should not be given if they are clinically unstable and/or have diarrhea or dehydration and/or nutritional edema (due to the renal solute load of this therapeutic milk and risk of hyponatremia dehydration)