Parenteral Nutrition Therapy Flashcards
How to determine Nutritional Risk
-eyeball test (your clinical judgement, first impression)
- Lab tests:
- CBC (anemia)
- serum albumin
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
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
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
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
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
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
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
Dietary Instructions for Hyperlipidemia
- same basic principals (veggies, frits, low sat fat, increase fiber)
- limit cholesterol (
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
STUDY & DISCUSS THIS!
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