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Nutrition Interventions for Children with Special Health Care Needs

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Chapter 20 - <strong>Nutrition</strong> <strong>Interventions</strong> <strong>for</strong> Short Bowel Syndrome<br />

Assessment Intervention Evaluation/Outcome<br />

Magnesium If deficiency, give Magnesium Protein Complex Indicators of magnesium are<br />

<strong>with</strong>in normal limits.<br />

Zinc If deficiency, give zinc supplement Indicators of zinc are <strong>with</strong>in<br />

normal limits.<br />

Indicators of vitamin B12 status<br />

are <strong>with</strong>in normal limits.<br />

Once vitamin B12 levels are in the low-normal<br />

range, begin intramuscular shots of vitamin B12<br />

(cyanocobalamin) every 1 to 3 months.<br />

Monitor serum level of vitamin B12 every 6 to 12 months<br />

<strong>for</strong> 3 to 5 years. (It can take years <strong>for</strong> vitamin B12<br />

deficiency to develop.)<br />

Clinical<br />

Stool or ostomy output is less<br />

than 40—50 mL/kg/day. 2<br />

If stool output is high, consider:<br />

Assess stool or ostomy output:<br />

• need <strong>for</strong> medical evaluation<br />

• need <strong>for</strong> intravenous fluid (patients <strong>with</strong><br />

SBS are at high risk <strong>for</strong> malabsorption and<br />

dehydration)<br />

• If stooling though anus, obtain in<strong>for</strong>mation regarding<br />

number and size of stools per day<br />

• If child has ileostomy or colostomy, obtain in<strong>for</strong>mation<br />

regarding approximate volume of output each day<br />

Evaluate need to alter feeding:<br />

• may need to decrease carbohydrate and/or<br />

long chain fats<br />

• infants may need to use a modular <strong>for</strong>mula<br />

so that carbohydrate and fat content can be<br />

manipulated<br />

If stool output is high, child may have bacterial<br />

overgrowth and need antibiotics. If severe, TPN<br />

may be necessary until bacterial overgrowth<br />

resolved.<br />

Child may have a viral gastroenteritis; there<strong>for</strong>e,<br />

needs careful management of fluid status until<br />

gastroenteritis resolves.<br />

234 <strong>Nutrition</strong> <strong>Interventions</strong> <strong>for</strong> <strong>Children</strong> With <strong>Special</strong> <strong>Health</strong> <strong>Care</strong> <strong>Needs</strong>

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