ELDORET POLYTECHNIC

KORIR CHEPKOECH BENCY

2017/06462

DEPARTMENT OF NUTRITION

DIPLOMA IN NUTRITION AND DIETETICS

A REPORT ON FIELD ATTACHMENT AT KAPKATET SUB COUNTY

HOSPITAL

FROM 2ND SEPTEMBER TO 29TH NOVEMBER 2019

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 DECLARATION
I declare that this is my original work and it has never been submitted to any other institution.

Signature Date

………………………………………….. ………………………………………

KORIR CHEPKOECH BENCY

Submitted to,

Name…………………… Signature………………….

Date…………..

LECTURER ON FOLLOW UP

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 DEDICATION

I dedicate this attachment report to my lovely family for their tireless, inspiration financial support

determination and encouragement which made me achieve this goal. Special thanks goes to my

sister for the encouragement and prayers throughout the study.

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 ACKNOWLEDGEMENT

I would like to acknowledge my parents and my entire family for financial and moral support.

Moreover, it is through the department of nutrition within KAPKATET that I successfully

completed the attachment. I would like to thank my lecturers for the support before and during

the attachment. I also acknowledge my fellow attaches for their cooperation.

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 TABLE OF CONTENTS

DECLARATION ............................................................................................................................ ii
DEDICATION ............................................................................................................................... iii
ACKNOWLEDGEMENT ............................................................................................................. iv
ACRONYMS ................................................................................................................................. vi
CHAPTER ONE ............................................................................................................................. 1
1.1 HISTORICAL BACKGROUND OF KAPKATET DISTRICT HOSPITAL ...................... 1
1.2 ORGANIZATIONAL STRUCTURE OF THE HOSPITAL ............................................... 2
1.3 MISSION OF THE HOSPITAL ........................................................................................... 3
1.4 VISION OF THE HOSPITAL .............................................................................................. 3
1.5 OBJECTIVES ....................................................................................................................... 3
CHAPTER TWO ............................................................................................................................ 5
2.1 Burn Unit............................................................................................................................... 5
2.2 Pediatric ward ....................................................................................................................... 7
2.3 Surgical ward ........................................................................................................................ 8
2.3.2 Pre-operative diet ............................................................................................................... 8
2.4 Mother and child health care [MCH] .................................................................................. 10
2.5 Medical ward....................................................................................................................... 12
2.6 Hospital kitchen ................................................................................................................. 14
CHAPTER THREE....................................................................................................................... 15
3.0 DISCUSSION ..................................................................................................................... 15
3.1 Challenges ........................................................................................................................... 15
3.2 Recommendation ................................................................................................................ 16
3.3 Conclusion .......................................................................................................................... 16

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 ACRONYMS

AMPATH: Academic Model Providing Access to Health

BMI: Body Mass Index

CCF: Congestive Cardiac Failure

CS: Cesarean Section

CVD: cardiovascular Disease

KMTC: Kenya Medical Training College

ICU: Intensive Care Unit

UEC: Urea Electrolytes

NBU: Newborn Unit

SVD: Spontaneous Vaginal Delivery

PET: Pre-Eclampsia Toxemia

DM: Creatinine Diabetes Mellitus

HTN: Hypertension

Kcal: Kilocalories

NGT: Nasogastric tube

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TB: Tuberculosis

MUAC: Mid Upper Arm Circumference

RBTC: Regional Blood Transfusion Center

HOD: Head of Department

TBSA: Total Burn Surface Area

WHO: World Health Organization

ART: Antiretroviral therapy

HAART: Highly Active Antiretroviral Therapy

SAM: Severe Acute Malnutrition

MAM: Moderate Acute Malnutrition

PMTCT: Preventing Mother to Child Transmission

ORS: Oral Rehydration Salt.

OPV; oral polio vaccine.

PCV: pneumococcal vaccine.

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 CHAPTER ONE

1.1 HISTORICAL BACKGROUND OF KAPKATET DISTRICT HOSPITAL

Kapkatet district hospital was started as a cottage hospital it was upgraded level of district

hospital in 1998 when Bureti district was created. Before then it was a sub district under Kericho

district hospital it serves as a catchment population of 136,760 most people in community are

tea growers and subsistence farmers

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1.2 ORGANIZATIONAL STRUCTURE OF THE HOSPITAL

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 DEPARTMENTS OF THE HOSPITAL

Administration

Medical wards

Outpatient department

eye clinic

Nutrition clinic

pediatrics

physiotherapy

Hospital kitchen

Nutrition department

Nutrition department is one of the departments in kapkatet under clinical services offering

preventive, curative, and training services. All patients who attend the hospital are entitled. The

key message is “Good Nutrition for General wellbeing.”

1.3 MISSION OF THE HOSPITAL

To provide high quality accessible and acceptable healthy services and excellent training facilities.

1.4 VISION OF THE HOSPITAL

To be a prime hospital of choice in south rift valley

1.5 OBJECTIVES
i To find out the effects of diets in disease management

ii To find out the importance of a balanced diet in people

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iii To evaluate the outcome of nutrition counseling

iv To apply the principle of nutrition care process in management of medical as well as nutrition

condition both inpatient and outpatient department.

v To implement the principle of therapeutic process at clinical nutrition in practical situation.

vi To make observation, analyze and apply critical thinking in providing solution that may

improve the quality of service delivery in nutrition department.

vii To comply with hospital goals, vision, mission and policies in order to enhance effective

nutrition practice and health promotion.

viii To partner with other health professional in coordinating our synergy to optimize nutritional

service and care delivery.

ix To participate in educational training set by the nutrition department and other medical

department that essentially boasts my professionalism and competence.

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 CHAPTER TWO
2.0 WORK EXPERIENCE

2.1 Burn Unit

This unit deals with severe burns. Primarily, this unit focuses on burns over 30%.

2.1.1 Nutritionist role in burn unit

i Attain and maintain nutrition status of patient

ii Promote wound healing

iii Minimize infection by maintain proper hygiene

iv Correct metabolic disorders e.g. fluid electrolyte balance

Calculation of energy and protein requirements of patients

1. Energy Needs:

In adults:

= [24 kcal x kg usual body weight] + [40 cal x TBSA {%burn}]

In children:

= [60 kcal x kg usual body weight] + [35 kcal x TBSA {%burn}]

2. Protein Needs:

In adults:

= [1g x body weight] + [3g x TBSA]

For children

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= [3g x body weight] + [1g x TBSA]

2.1.2 Activities

▪ Filling food distribution sheets

▪ Filling food requisition sheets

▪ Formulating diet sheets for patients on NGT

▪ Attending ward rounds

▪ Nutrition counseling

1. Advised patients to continue with supplements

2. Eat high protein food e.g. milk, eggs for albumin provision

3. Observe hygiene to prevent other infections

4. Take plenty of fluids to prevent dehydration

5. Take fruits and vegetables to promote wound healing

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2.2 Pediatric ward
2.2.1 Activities

✔ Weighed the patient

✔ Took their height and MUACs

✔ Counsel patients depending on their diagnosis

✔ Calculated z-scores

✔ Fixed nasogastric tubes(NGT)

✔ Administered NGT feeds.

For malnourished children and the ones with edema we calculated their expected weights.

Formulas used:

0-12months [age + 9]/2

1-5 years [2 age + 8]

5-9 years [7 age – 5]/2

10-14 years [3 age]

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2.2.2 Feeds used

❖ F 75 for the malnourished children

❖ F100 starting feed for malnourished children

❖ Infant

❖ porridge, and milk for NGT.

2.3 Surgical ward

This ward deals with patients before and after operation. It also deals with bone fractures,

tumors, deformities, infection, and amputees.

2.3.1 Activities

● Formulated diet plans for patients on NGT

● Counsel patients depending on their diagnosis

2.3.2 Pre-operative diet

The patients were in NPO (Nil Per Oral) for 24 hours.

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2.3.3 Post-operative diet

It depends with the part of surgery, but if it is abdominal surgery oral sips were given for the first

6 hours after surgery, then liquid for the next 7-12 hours e.g. soup, a light diet for 13-18 hours,

after 24 hours a normal diet.

Surgical patients are advised on the following:

▪ High calorie foods for energy

▪ High protein for growth and repair of damaged tissues

▪ Balanced diet for normal body needs

▪ Plenty of fluids to keep the body well hydrated and to keep the electrolytes balanced

▪ Iron-rich foods to increase the HB levels lost during bleeding

▪ Provide calcium and phosphorus to enhance strong bone formation

▪ Fruits and vegetables to provide Vitamin C & A for wound healing

▪ Enhance hygiene

Different nutrition and counseling was given depending on the diagnosis and biochemical data.

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2.4 Mother and child health care [MCH]

I participated in weighing the children of 0-60 months.i weighed 167 children in a week.some of

the children were under weight,overweight,wasted,stunded.most of them were of normal

nutrition status

Out of 167 children, 13 were underweight which amounted to 7.8%

Out of 167 children, 2 children were stunted which amounted to 1.2%

0ut of 167 children, 4 children were wasted which amounted to 2.4%

Out of 167 children, 148 children were normal which amounted to 88.6%

Mother and child health care clinic is divided in sub-departments as follows;

I. Well baby clinic

II. PMTCT

III. Family planning

IV. Triage-weighing bay

V. Antenatal care clinic

VI. Immunization room

● It deals with pregnant mothers, lactating mothers, and their children below five years.

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2.4.2 Activities

● Monitoring of pregnant mothers progress through Weight monitoring, blood pressure,

dietary intake and palpation for early detection of complication.

● Taking weight and height of children and plotting them on the child health card, the

measurements then tallied on the children’s health and nutrition information system

● Supplementation

▪ Vitamin A supplementation

6 to 12 months 1 blue capsule 1000,000 IU= 30,000ug

12 months and older 1 red capsule

Other supplements given are;

▪ Ferrous sulphate to prevent anemia

▪ Folate to prevent spine deformities e.g. spina bifida

At the immunization room I learned different vaccines used for immunization and how they are

stored in the fridge at a temperature of +2 to +8 degrees centigrade.

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The different vaccines are as follows;

▪ At birth; BCG against TB and the oral polio virus (OPV)

▪ At 6 weeks; OPV1, Rotavirus against diarrhea, pentavalent vaccine and PCV against

pneumonia

▪ At 10 weeks; OPV 2, Rota 2, pentavalent 2 and PCV2.

▪ At 14 weeks; OPV3, pentavalent 3, PCV 3 and IPV.

▪ Measles vaccine i.e. given at 9 and 18 months and 6 months in HEI

2.5 Medical ward

This medical ward is divided into two sections; female and male ward. Some of the

medical conditions catered for include: diabetes, hypertension, rheumatic heart disease,

peptic ulcer disease, ISS patients and other medical conditions such as tuberculosis.

2.5.1 Roles of a nutritionist in these wards

▪ Undertake nutrition assessment for patients with nutrition related illnesses.

▪ To provide individualized nutrition counseling and education.

▪ To carry out diet modification to patient in relation to the disease.

▪ To prepare diet distribution list and supervise meal service.

▪ Attend the doctors’ ward rounds.

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My experience in these wards was quite enriching. Among the things I learnt were nutrition care

for most of the above stated conditions. During ward rounds much was discussed and taught on

the various conditions. For all the cases their anthropometric measurements were of great value

during ward rounds. One valuable lesson learnt was that of weight loss and gain, that weight can

be lost or gained due to developing or resolving edema.

I also learnt the value of diet modification and supplementation, especially for wasted patients

such as ISS and tuberculosis patients. Patients suffering from PUD or hypertension or RHD

require their diets to be modified in such a way that they will be blank or with low salt

respectively. For diabetic patients their diets required much care and attention. Their caloric

needs, existence of other complications, reactions to drugs were all considered in their diet

modifications.

For all the patients their ability to feed orally or not also determined the nutrition support that

they would get. Most of those who were for one reason or another unconscious would be fed

enterally, while those who for one reason or another their GI could not perform its functions well

were always put on parenteral feeding.

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2.6 Hospital kitchen
Hospital kitchen is a L-Shaped

It is a section where meals are prepared for the admitted patients

2.6.1 My role in the kitchen

❖ Preparation of diet sheet

❖ Ensuring good hygiene at all time

❖ Preparation of fortified blended flour [FBF]

❖ Ensuring the patient’s diet are balanced

❖ Preparations of therapeutic feeds [F 100 and F 75]

2.6.2 Food preparation

Nutritionist supervise but cooks do the cooking

In Kapkatet hospital, there are processes to help maximize the use of time, material and people.

For example, all the beans are being cooked together,but those for low sodium, low cholesterol

do not get salted or buttered prior to serving.

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 CHAPTER THREE
3.0 DISCUSSION
In essence, nutrition department holds the core of any health care system and more so the

wellbeing of every individual. From such submission, it is clear that this sector walks hand in

with any hospital in facilitating the recovery of patients whilst providing crucial information and

advice for their health management. During the attachment, it comes out that hospitals have

since undermined the usefulness of department as evident in the poor facilities coupled with few

personnel in the department.

In reality, nutrition is the backbone of our health, thus the obligation of everyone to manage it.

The findings in the attachment create essential aspects such as the interlocking relationship of

recovery and quality diet. This attachment provides insightful findings that have since held a

death position in the world of research. I strongly believe that the attachment illuminates the

inherent aspect within the sector that shall in turn promote better care and nutrition management.

3.1 Challenges
▪Conducting nutritional assessment to critically ill patient

▪ Counseling patient who do not understand basic languages i.e. English or Swahili-

Language barrier ▪ Burnout.

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 3.2 Recommendation

From this attachment, the following recommendation from the findings comes out.

Fundamentally, this attachment delves in the critical aspects revolving within dietary and health.

▪ Increase the bed capacity Repair the worn out equipment e.g. weighing machines

▪ Increase the size of nutrition clinic and the MCH

▪ In the wards, there should be nutrition offices

3.3 Conclusion

Evidently, the field attachment equipped me with essential skills necessary in the field of study.

It is apparent that the aspect of nutrition is fundamental in the wellbeing of people. During the

attachment period, the inherent issues that link quality diet with the health of the patients were

evident. In this situation, the aspects of diet cut across all divisions within Kapkatet clearly,

dietary allocation is important in patients’ welfare, for instance, NPO is very important whilst

caring for surgery patients.

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