Parenteral Nutrition Therapy Flashcards Preview

ICM Week 2 > Parenteral Nutrition Therapy > Flashcards

Flashcards in Parenteral Nutrition Therapy Deck (11):
1

How to determine Nutritional Risk

-eyeball test (your clinical judgement, first impression)

-Lab tests:
-CBC (anemia)
-serum albumin

2

How to determine nutritional need for support

- bowel not functioning
-severe prolonged hypercatabolic states (burns, multiple trauma, mechanical ventilation)
-prolonged bowel rest required
-severe protein-calorie malnutrition who have lost >25% body weight

3

How to determine which types of nutrition to use?

Does GI tract work and is it safe to use?
-yes>>>support needed for >6wks?>>>yes=enterostomy,
>>>no=NG Tube if not at high risk for aspiration, nasoduodenal tube if at high risk for aspiration
*enteral nutrition begin w/in 48 hrs of when oral intake becomes absent.


-no>>>parentral nutrition through central line
*parenteral nutrition optimal time is unclear, within 1-2wks unless otherwise indicated

4

Enteral Nutrition:
-CI
-Complictions
-monitoring

-hemodynamically unstable (ischemia d/t bp too low)
-Bowel obstruction
-Upper GI bleeding
-Intractable vomiting/diarrhea
-GI fistula

Complications:
-diarrhea
-aspiration** (elevate head to avoid this)
-dehydration
-electrolyte imbalances
-mechanical obstruction of tube

Monitoring:
-daily electrolytes, glucose, phosphorus, magnesium, calcium, BUN, and creatinine until stable, then few times/week
-RBC, folate, copper, zinc monthly

5

Types of Enteral Nutrition

NG- need to be able to sit up in bed, no aspiration

Nasoduodenal- if unable to sit up in bed or protec airway

Gastroenterostomy- bolus feeding, need to be at low risk for aspiration

jejunostomy- infusion

6

Parenteral Nutrition:
-CI
-Complictions
-monitoring

- used when cannot absorb in GI, must be delivered via central venous catheter

CI-
-functioning GI tract
-lack of venous access

Complications:
-catheter site or bloodstream infection
-Metabolic derangements (hyperglycemia)
-refeeding sydrome ( when severely malnourished pt recieves TPN, Metabolism shifts from a catabolic to an anabolic state. Deprived cells reuptake electrolytes causing reduced levels in the blood leading to arrhythmia.)
-Hepatic Dysfunction

Monitoring:
-meausre fluid I/O
-daily electrolytes
-weekly liver profile and tirglycerides
-close monitor of blood glucose
-urine protein measurement
-watch for signs of infection
-RBC, folate, copper, zince monthly

7

Dietary Instructions for Diabetes

ABC's
-lower A1C
-Blood pressure control
-Cholesterol control

5key components
-caloric intake balanced with expenditure
-increase physical activity
-consistent carb intake
-nutritional content (veggies, fruits, whole grains, legumes, low fat milk)
-timing of meals and snacks

8

Dietary Instructions for HTN

-no more than 2 cups coffee
-less than 2g Na daily
-eat balanced healthy meals
-no more than 1 drink women, 2 drink men/day
-magnesium, potassium, and fish oil supplements

*DASH diet- dietary approach to stop hypertension


9

Dietary Instructions for Hyperlipidemia

* same basic principals (veggies, frits, low sat fat, increase fiber)

-limit cholesterol (

10

Dietary Instructions for chronic kidney disease

-Na & protein restriction
-Calcium, vit D, iron supplements
-low potassium and phosphate intake

Rationale:

-Na: build up and contribute to HTN and fluid retentions
-Protein- waste products are not procressed properly (ammonia urea uric acid)
-K+ levels increase and can lead to arrhythmia
-phosphate levels increase and lead to osteoporosis and hyperglycemia

11

STUDY & DISCUSS THIS!

slide 61