Answer to Question 1
Power packing is the process of making foods and beverages more calorically dense without significantly increasing the amount. Some examples include powdered nonfat milk, vegetable oil, butter, , mayonnaise, cheese, peanut butter, and wheat germ.
This might be a useful intervention for Olivia due to the difficulty she has consuming larger portions within a shorter time frame and the observed decline on her weight-for-age and BMI-for-age curves.
Suggestions for Olivia include:
- Using butter or oil to cook her scrambled egg or to add to cooked vegetables
- Consuming whole milk instead of 1 milk
- Adding 2 tbsp cream or 1 pkt Carnation Instant Breakfast to her milk
- Adding powdered milk to her yogurt
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- Adding more cinnamon sugar to her apple sauce
- Adding cheese to the rice and black bean casserole
It should also be noted that calorically dense products are often high in fat. Because Olivia is taking medication for GERD and a higher fat diet may exacerbate these GI symptoms, her tolerance to power packing should be monitored.
Answer to Question 2
Inadequate energy intake
- Enteral nutrition support or increasing the caloric density of the foods she consumes (though, this may not properly address her inadequate protein intake)
Inadequate protein intake
- Enteral nutrition support or increase consumption of oral meal replacement beverages (e.g. increase Ensure consumption throughout the day)
Inadequate oral intake
- Enteral nutrition support and attempt to increase oral consumption by eating 5-6 small meals each day
Unintended weight loss
- Increase energy intake via enteral nutrition support or increased oral intake