INTERNSHIP DONE AT

CARE HOSPITAL
NAMPALLY.
BY

ZOYA NUREEN
&
SANA FARHEEN
 INTRODUCTION

• CARE Hospitals, Nampally, Hyderabad,

is the first hospital established by the
CARE Hospitals Group focusing on
cardiac care in 1997 with 266 beds
facility. Dr D N Kumar is the Medical
Director and Dr Srinivas Kare is the
Facility COO of CARE Hospitals,
Nampally.
 SPECIALITIES AT CARE
HOSPITAL.
CARDIAC SCIENCES. PLASTIC SURGERY
CRITICAL CARE ONCOLOGY
DENISTRY ORTHOPEDICS
DERMATOLOGY UROLOGY
DIETITICS AND NUTRITION RADIOLOGY
ENDOCRINOLOGY PSYCHIATRY
ENT
GASTROENTRONOLOGY
NEPHROLOGY
NEUROOGY
GYENOLOGY
PULMONOLOGY
 DIETITICS AND
NUTRITION DEPARTMENT
• The chief dietician at CARE hospital,
Nampally is Ms Madhurima Sinha. The
department handles both inpatient and
outpatient services. Four junior
dieticians assist the chief in imparting
the dietary services to patients. The
dieticains provide dietary care service
by counselling then at the time of
discharge and provides then a diet
chart to follow thereafter.
Pulmonary tuberculosis (TB) is a caused by the
bacteria called mycobacterium tuberculosis. The
bacteria usually attacks the lungs but they can
also damage other parts of the body such as
intestine, meninges, bones and joints.
Accompanied by wasting of tissue, exhaustion,
cough, expectoration and fever.
ACUTE PHASE: resembles pneumonia with high
fever, increased circulation and respiration.
CHRONIC PHASE: accompanied by low fever
than acute phase, worsening cough & wasting is
considerable.
 CASE STUDY
• Patient profile:
• Patient name:xyz age:66 years gender –
female
• Anthropometric measurements:
• Height:5’2 weight: 48 BMI:19.5 IBW:57
• Complaints: loss of appetite, worsening cough,
pain in chest,expectoariation
• History of past illness: non diabetic and non
hypertensive .
• Diagnosis: left lung pleural effusions
• ( tuberculosis) Tb_cervical lyphadnopathy.
 PARAMETERS
• Vitals: Bp-110/60 INVESTIGATIONS DATE OF ADM.
• Pulse rate(PR) Haemoglobulin 10.2 mg/dl
-98/min ESR 68 MM/HR

• Respiratory Platelets count 3.18 lakhs

Blood sugar random 102 mg/dl
rate(RR):24/min 13 mg /dl
Blood urea
0.49 mg/dl
Serum creatinine 5.3mg/dl
Total bilirubin 3.7 mg/dl
Direct bilirubin 207 U/L
SGPT 1787 U/L
SGOT 7.0 g/dl
Serum total proteins 3.7 g/dl
Serum albumin 3.3 g/dl
Serum globulin 135 mEq/L
Serum sodium
3.22 mEq/L
Serum potassium
 DIETARY MANAGEMENT
DIET TAKEN DURING HOSPITAL STAY.
MEAL TIME FOOD STUFF NO. OF SERVINGS
Early morning Milk 100ml
Breakfast Idli 3 no’s
Chutney 1 cup
Sambhar 1 cup
Midmorning Apple milkshake 200 ml
Lunch Khichdi 1 cup
Veg.curries 2 cups
Sambhar 1 cup
Curd 1 cup
Evenings snacks Ragi porridge 200 ml
Dinner Upma 1 cup
Sambhar 1 cup
Curd 1 cup
 TREATMENT
• The treatment of TB consist of 1-rest in bed 2-provision of
suitable drug 3-high calorie and high protein diet;
• Principle of diet :high calorie , high protein , moderate fat , highly
vitaminisied and mineralised soft diet is suggested
• Dietary guidelines:
• Since patient have poor appetite initially food must be appetising and
patient likes and dislikes must be consider
• During the acute stage a high calorie fluid and soft diet are
prescribed.
• Half to one litre milk and 2-3 eggs per day are given
• As the patient progress ,normal attractive and palatable food should
be given. The patient should come back to ideal weight rest fresh air
and good nutrition are the key elements for recovery from
tuberculosis.
 SUGGESTED HOME MENU
MEAL TIME FOOD STUFF NO. OF SERVINGS
Early morning Milk with almonds 1 glass
Breakfast Idli 4
Chutney 1 cup
Boiled egg 1
Mid morning Steamed sprouts 1s
Orange juice 1 glass
Lunch Phulka 2 no’s
Rice 1 cup
Spinach dal 1 cup
Ridge gourd curry 1 cup
Curd 1 cup
Evening snacks Puffed rice poha 1s
Dinner Phulka 2 no’s
Rice 1 cup
Tomato curry 1 cup
Kovai curry 1 cup
Curd 1 cup
Thank you………
CASE STUDY II: VIRAL HEPATITIS
BY
SANA FARHEEN
MODE OF TRANSMISSION
 SYMPTOMS
• Mild & chronic may be asymptomatic
• Acute :
• Fatigue, nausea, anorexia
• Pain in liver area
• Enlarged liver & jaundice
• Fever, headache
• Muscle weakness, skin rashes
• Elevated liver enzymes
 Treatment
• Supportive care, bed rest,
nutritious diet
• Hepatitis B & C need antiviral
agents
• Non-viral: anti-inflammatory &
immunosuppressant drugs
 Nutrition Therapy
• Energy
• BEE + stress factor
• 4-6 feedings/day
• Protein
• High enough to maintain nitrogen balance
• 0.8-1.2 g/kg
• CHO & fat
• Complex CHO
• May need to restrict fat with steatorrhea
• Vitamins & minerals
• Multivitamin supplementation
Enteral & parenteral
Specialized enteral
products high in
kcalories
Parenteral if patient has
obstructions, bleeding,
vomiting
 CASE STUDY
NAME OF THE AGE ANTHROPOMETRIC DATE OF
AND MEASUREMENTS
PATIENT ADMISSION:
SEX
30.06.2014

V.PRIYANKA 19 HEIGHT:157 CMS DATE OF

YR
D/O: OLD
WEIGHT: 53 KGS DISCHARGE:
SIVASANKARA F BMI : 22.6 06.07.2014
RAO. IP NUMBER:
RESIDENT OF 26791
HYDERABAD
CONSULTANT:
DR. KIRIT PAREKH
 FINAL DIAGNOSIS:
• Acute viral hepatitis
• S/P Appendectomy (outside)
• SYMPTOMS:
• presented with H/O vomitings 5-6
episodes.
• TREATMENT:
• Treated with anti emetics, cis deoxy
cholic acid, IV fluids and other
supportive treatment
 LAB INVESTIGATIONS:

INVESTIGATIONS 01.07.2014 05.07.2014

Haemoglobulin 13.2 mg/dl 13.5 mg/dl
ESR 28 MM/HR 62 MM/HR
Platelets count 3.18 lakhs 3.18 lakhs
Blood sugar random 102 mg/dl 9.2 mg/dl
13 mg /dl 6.1 mg/dl
Blood urea
0.49 mg/dl 1369 U/L
Serum creatinine 6.5 mg/dl 576 U/L
Total bilirubin 3.7 mg/dl 6.5 g/dl
Direct bilirubin 2070 U/L 3.3 g/dl
SGPT 1747 U/L 3.2 g/dl
SGOT 7.0 g/dl
Serum total proteins 3.7 g/dl
Serum albumin 3.3 g/dl
Serum globulin 135 mEq/L
Serum sodium
3.22 mEq/L
Serum potassium
 DIETARY MANAGEMENT:
• PRINCIPLES OF THE DIET:
• A High protein, normal – moderate
complex carbohydrates, moderate to
low fat is recommended. Small
attractive meals at regular intervals
are better tolerated. Overfeeding
should be avoided.
 HOSPITAL MENU:
ORAL LIQUIDS+SOFT DIET
Total calories: 1538 k.cals Total protiens: 63 g

MEAL TIME FOOD STUFF NO. OF SERVINGS

Early morning Milk 100ml
Breakfast Idli 3 no’s
Chutney 1 cup
Sambhar 1 cup
Midmorning Apple milkshake 200 ml
Lunch Khichdi 1 cup
Veg.curries 2 cups
Sambhar 1 cup
Curd 1 cup
Evenings snacks Ragi porridge 200 ml
Dinner Upma 1 cup
Sambhar 1 cup
Curd 1 cup
 SUGGESTED HOME MENU
HIGH PROTEIN NORMAL DIET
Total calories:1744 k.cals Total protein: 67 g
MEAL TIME FOOD STUFF NO. OF SERVINGS
Early morning Milk 200 ml
Breakfast Dahlia upma 1 cup
Sambhar 1 cup
Chutney 1 cup
Banana 100 g
Mid morning Veg, suop 100 ml
Lunch Phulka 2 no’s
Rice 1 cup
Dhal 1 cup
Veg. curries 2 cups
Curd 1 cup
Evening snacks Poha 2 cups
Papaya 1 cup
Dinner Wheat rawa khichdi 1 cup
Dhal 1 cup
Veg.curries 2 cups
 CONCLUSION:

• 19 Yrs female admitted was with above complaints

and H/O Appendisectomy one week back. On
evaluation she was diagnosed as acute viral
hepatitis, treated with anti emetics, cis deoxy
cholic acid, IV fluids and other supportive
treatment.
• Patient’s appetite and intake was fair. Patient is
advised to have a high protien and low fat normal
diet at home.