Presentation is loading. Please wait.

Presentation is loading. Please wait.

Methods of Nutrition Support

Similar presentations


Presentation on theme: "Methods of Nutrition Support"— Presentation transcript:

1 Methods of Nutrition Support
KNH 411

2

3 Oral diets “House” or regular diet Therapeutic diets
Maintain or restore health & nutritional status Accommodate changes in digestion, absorption, or organ function Provide nutrition therapy through nutrient content changes usually soft texture change consistency change manipulating nutrients

4 Oral diets Changes from the house diet
Caloric level (calculated through mifflin equation) Consistency (anywhere from regular diet to soft diet to pured diet Single nutrient manipulation--ex: low fat diet Preparation--look at nutrients and how you will manipulate them Food restriction Number, size, frequency of meals Addition of supplements

5 Oral diets post surgery/post procedure Texture modifications
Soft diets Liquid diets Clear liquid Full liquid Consider osmolality Preparation for a specific medical test

6

7

8 Oral Supplements status post any GI surgery
Goal: Increase nutrient density without increasing volume Snacks Liquid meal replacement formulas Modular products Commercial supplements

9

10 Appetite Stimulants Drugs that stimulate appetite Prednisone
Megestrol acetate Dronabinol--derivative of marijuana (creates the munchies)

11 Specialized Nutrition Support (SNS)
Administration of nutrients with therapeutic intent Enteral--if the gut works, use it Parenteral--gut doesn’t work; zero GI tolerance; use the veins Ethical considerations

12 © 2007 Thomson - Wadsworth

13 Enteral Nutrition Feeding through the GI tract via tube, catheter or stoma delivering nutrients distal to oral cavity “Tube feeding” Indicated for patients with functioning GI but unable to self-feed-- altered mental status; swallowing dysfunction Contraindications Advantages / Disadvantages? very cost effective; decreased rate of infection; improved wound healing and surgical intervention; helps maintain GI function difficult to administer; poor tolerance(patient may pull out tube); placement of the tube(have to keep checking on it); vomiting/diarrhea;

14 Enteral Nutrition Decisions for the nutrition prescription GI access
Formula Feeding technique--bolus or continuous Equipment needed

15 Enteral Nutrition GI Access
Access route described by where it enters the body and where the tip is located Nasogastric--nose into stomach Orogastric--mouth into stomach Nasointestinal--nose into small intestine (ND tube or NJ tube) Typically used for short term Disadvantages?

16

17 Enteral Nutrition GI Access – “Ostomy” More permanent Gastrostomy
Jejunostomy PEG More permanent

18

19 © 2007 Thomson - Wadsworth

20

21 Enteral Nutrition Formulas
Based on substrates, nutrient density, osmolality, viscosity Protein Soy or casein 10-25% kcal Elemental or chemically defined Specialized amino acid profiles

22 Enteral Nutrition Formulas Carbohydrate
Monosaccharides, oligosaccarides, dextrins, maltodextrins Lactose & sucrose free FOS Fiber ?

23 Enteral Nutrition Formulas Lipid Corn or soy oil
Long- and medium-chain TG Omega-3 fatty acids Structured lipids

24 Enteral Nutrition Formulas Vitamins and minerals
Meet DRI Supplemental amounts Fluid and nutrient density kcal per mL Difference depends on water content Ensure adequate fluid - 80% water for 1 kcal per mL Osmolality and osmolarity

25 Enteral Nutrition Other considerations
Formulas Other considerations Considered medical food – not drug No test for efficacy or benefit Cost

26 © 2007 Thomson - Wadsworth

27 Enteral Nutrition Feeding techniques/ delivery methods Bolus feedings
Intermittent feedings Continuous feedings © 2007 Thomson - Wadsworth

28 Enteral Nutrition Equipment Feeding tubes - french size
Cans or sealed containers Pumps

29 Enteral Nutrition Determining the nutrition prescription
- clinical application Determine dose weight, calorie goal adjust injury/activity factor that would increase needs identify calories from protein, lipids, and carbs consider electrolyte needs consider vitamins and minerals look at fluids--are they fluid restricted or can they recieve normal amount

30 Enteral Nutrition Complications Mechanical complications
Clogged or misplaced tubes GI complications Diarrhea Aspiration

31 Enteral Nutrition Monitoring for complications Dehydration
Tube Feeding Syndrome Electrolyte Imbalances Underfeeding or Overfeeding Hyperglycemia Refeeding Syndrome Monitor serum phosphorus, mg, potassium

32

33

34

35 Parenteral Nutrition Administration by “vein”
7-14 days a.k.a. – PN, TPN, CVN, IVH TPN vs. PPN Indicated if unable to use oral diet or enteral nutrition Certification of medical necessity

36 Parenteral Nutrition Venous access Short-term access Long-term access
CVC inserted percutaneously Using subclavian, jugular, femoral veins PICC most common can be used bedside Long-term access Tunneled catheters Implantable ports(lie completely below the skin)

37 © 2007 Thomson - Wadsworth

38 Parenteral Nutrition Solutions
Compounded by pharmacist using “clean room” Two-in-one Dextrose & amino acids Lipids added separately Clear - easier to identify precipitates Three-in-one Dextrose, amino acids & lipids Single administration

39

40

41 Parenteral Nutrition Solutions Protein Individual amino acids
Modified products for renal, hepatic and stress Commercial amino acids % 3%--peripheral; 20%--kidney or heart patients needing smaller volume g/kg is desired amount depending on condition status post surgery, burn patients, trauma, healing of wounds restrict with renal; look at BUN and creatine and fluid status

42 Parenteral Nutrition Solutions Carbohydrates
Energy source – dextrose monohydrate 3.4 kcal/g 1 mg/kg/min minimum 5%, 10%, 50%, 70% concentrations peripheral is normally 10% >10% will need TPN or central line concerns--hyperglycemia, excessive CO2, fatty liver

43 Parenteral Nutrition Solutions Lipids
10% solution--1.1 kcal/cc of solution (.1 extra comes from glycerin 20% solution--2 kcal/cc of solution 30% solution--3 kcal/cc of solution (rarely used) Emulsion of soybean or safflower oil Essential fatty acids need to be present Source of energy Minimum of 10% kcal 1-1.2 g/kilo shouldn’t go above 60% of daily kcals (very high; normally 20-30%)

44 Parenteral Nutrition Solutions Electrolytes Vitamins/Minerals
sodium and potassium--1-2 g/kilo Chloride--as needed magnesium milequivalents per kilo phosphorus millequivalents per kilo DRI standards used Vitamins/Minerals A, C, D, E, K, and compliment of B vitamins Trace minerals--zinc, copper, chromium, iodide, molibdium Medications may add more insulin; albumin to support blood pressure need to be looking at drug/nutrient interaction

45

46 © 2007 Thomson - Wadsworth

47 Parenteral Nutrition Determining the nutrition prescription
– clinical application - sample form

48

49 Parenteral Nutrition Administration techniques Patient monitoring
Initiate 1 L first day; increase to goal volume on day 2 Patient monitoring Intake vs. output Laboratory monitoring

50 Parenteral Nutrition Complications GI complications Infections
cholestasis Infections can occur at site where TPN is being delivered


Download ppt "Methods of Nutrition Support"

Similar presentations


Ads by Google