Ppt on total parenteral nutrition administration

Nutritional support in NICU/PICU A Norouzy Assistant Professor in Clinical Nutrition Mashad Medical School.

=200-400mg/kg/day (NOTE: mg not mEq and Ca cannot be infused at >200mg/kg/day through a central line) Total Parentral Nutrition Other added nutrients Lipids Cystein Phosphrous Magnesium Trace Minerals MVI Heparin Total Parenteral Nutrition Central TPNPeripheral TPN Easy to meet nutrition needs No limits on osmolarity Little risk of phlebitis Long term use May require general anesthesia Greater risk of infection Increased/


Review of Nutritional Requirements

acute kidney injury Li Y, Tang X, Zhang J, Wu T Main results Compared to lower calorie-total parenteral nutrition (TPN), higher calorie-TPN did not improve estimated nitrogen balance, protein catabolic rate, or urea generation rate, but increased serum triglycerides, glucose, insulin need and nutritional fluid administration. Urea nitrogen appearance was lower in the low nitrogen intake group than in the high nitrogen intake/


Williams Basic Nutrition & Diet Therapy

administration Wide variety of commercial formulas available Rate: bolus or continuous Monitoring for complications: diarrhea is most common complication Adding fiber-rich formulas may improve bowel function and help reduce diarrhea. Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 20 Parenteral Feedings (p. 458) Definition: any method other than the normal GI route Peripheral parenteral nutrition/small intestine is removed, total parenteral nutrition is used with small /


Williams Basic Nutrition & Diet Therapy

Alternative Route Formulas (p. 456) Generally prescribed by the physician Important to regulate amount and rate of administration Wide variety of commercial formulas available Rate: bolus or continuous Monitoring for complications: diarrhea is most common complication/ required in cases involving tumors, lesions, or obstructions When most of the small intestine is removed, total parenteral nutrition is used with small allowance of oral feeding Stoma may be created for elimination of fecal waste (ileostomy/


Nutritional Support Surgical Nutrition Advisory Team Dept of Surgery Yong Loo Lin School of Medicine National University of Singapore.

by enteral feeding  Are anticipated to not be able to eat orally by 5 days  Prognosis warrants aggressive nutritional support Two Main Forms of Parenteral Nutrition Peripheral Parenteral Nutrition Central (Total) Parenteral Nutrition Both differ in  composition of feed  primary caloric source  potential complications  method of administration Peripheral Parenteral Nutrition Given through peripheral vein Short term use Mildly stressed patients Low caloric requirements Needs large amounts of fluid/


Methods of Nutrition Support KNH 411. Oral diets “House” or regular diet Therapeutic diets – soft or manipulated consistency to deal with mechanical.

total calorie amount 6.Calculate calories from lipid 7.Calculate calories from carbohydrate 8.Electrolyte needs 9.Vitamin and mineral needs 10.Look at fluids Enteral Nutrition Complications Mechanical complications Clogged or misplaced tubes GI complications Diarrhea Aspiration Enteral Nutrition/ 2007 Thomson - Wadsworth Parenteral Nutrition Determining the nutrition prescription – clinical application - sample form Parenteral Nutrition Administration techniques Initiate 1 L first day; increase/


Parenteral Nutrition By Dr. Hanan Said Ali. Objectives. Define parenteral nutrition. Explain how to prepare the patient. Explain how administer parenteral.

By Dr. Hanan Said Ali Objectives. Define parenteral nutrition. Explain how to prepare the patient. Explain how administer parenteral nutrition.. Demonstrate the care of patient with a parenteral nutrition. Identify complications of it. Parenteral Nutrition It has two forms:  Total Parenteral nutrition Is the intravenous infusion of water, protein, carbohydrates, electrolytes, minerals and vitamins through a central vein.  Peripheral Parenteral nutrition Delivered into the smaller peripheral veins, cannot/


Case Report: Nutritional Management of Small Bowel Obstruction By Christine Bannon ARAMARK Dietetic Internships December 14, 2014.

/U #4 (11/17)  PES: Parenteral Nutrition Administration Inconsistent with Needs (NI-2.10) related to SBO as evidenced by elevated glucose in the 200’s.  Intervention: Recommend modify composition of parenteral nutrition (ND-2.2.1) (decreased dextrose, increased lipid). Nutrition-Related Medication Management (ND-6) to add 0.15units of insulin/gm of dextrose.  Modified TPN order: 1800mls total volume, 75ml/hr X 24 hrs/


Clinical Practice of Total Parenteral Nutrition in Pediatrics Division of Nutrition & Metabolic Disease Department of Child Health-

Total Parenteral Nutrition in Pediatrics Division of Nutrition & Metabolic Disease Department of Child Health- TPN: Total Parenteral Nutrition IVH: Intravenous Hyperalimentation TNA: Total Nutrient Admixture TPA: Total Parenteral Admixture 3-In-1 Admixture All-In-One Admixture PPN: Peripheral Parenteral Admixture NOMENCLATURE Nutritional/ mg/dl Controversies –Sepsis Χ LCFA may have immunosupressant effect ∞ Avoid rapid administration –Liver Failure Χ TG broken down by capillary enzymes ∞ Helps prevent liver /


Nutrition Support of the Surgical Patient

inflammatory diseases, intractable diarrhea. Total Parenteral Nutrition Indication In patients who are able to ingest food, but refuse to do so. e.g.: Geriatric post-operative patients, adolescents with anorexia nervosa, some psychiatric patients with prolonged depression. In patients who, as a consequence of their illness are going to be, or have been NPO for 5 – 7 days. Administration Parenteral Nutrition Central Nutrition Subclavian line Long period/


Case Report: Nutrition Support in a Critically Ill Patient at risk for Essential Fatty Acid Deficiency Rebecca Scofield, MS ARAMARK Dietetic Internship.

day), 1000 ml 10% amino acids, and 200 ml 20% lipid to provide 1633 kcal, 100 gm protein, and 1690 ml total volume. To meet approximately 100% of kcal and protein needs and 97% fluid needs. Lipids not administered for 10 days due to /use enteral protocol to flush during medication administration. NCP: Monitoring and Evaluation Ongoing monitoring of: Weight AD-1.1 Body composition/growth/weight EN/PN regimen intake FH-1.3.2 Parenteral Nutrition Intake FH-1.3.1 Enteral Nutrition Intake FH-3.1 Medication and /


PARENTERAL NUTRITION IN HAEMATOPOIETIC STEM CELL TRANSPLANTATION BY DR. IDEMUDIA J.O DEPARTMENT OF CHEMICAL PATHOLOGY UBTH, BENIN CITY.

NUTRITIONAL CONTENT BEGINNING TPN ADMINISTRATION MONITORING COMPLICATIONS CONCLUSION INTRODUCTION Parenteral nutrition is feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulation that contains nutrients such as salts, glucose, amino acid, lipids, vitamins etc. Parenteral nutrition is divided into two; (1) Partial parenteral nutrition/. BASIC ADULT DAILY REQUIREMENTS FOR TOTAL PARENTERAL NUTRITION NUTRIENTAMOUNT Water (/kg body wt//


Nutrition Assessment and Post-Surgical Advancement Rebecca Cohen, MS, RD, LDN Transplant Dietitian Tulane Transplant Institute.

bolus to goal volume Every 3-8 hours Complications of Enteral Nutrition Support Access Administration GI complications Metabolic complications Enteral Nutrition Case Study 78-year-old woman admitted with new CVA Significant/paralytic ileus, mesenteric ischemia, small bowel obstruction, enteric fistula distal to enteral access sites TPN (total parenteral nutrition) PPN (peripheral parenteral nutrition) High glucose concentration (15-25% final dextrose concentration) Similar nutrient components as TPN, but /


Nutritional Support and Hydration for Patients near the End-of-Life Barry M. Kinzbrunner, MD Chief Medical Officer Vitas Innovative Hospice Care Miami,

Parenteral nutritional support –Total parenteral nutrition (TPN) Enteral nutritional support –Oral supplementation with or without dietary counseling –Gastrointestinal intubation Nasogastric tube Percutaneous endoscopic gastrostomy Operative gastrostomy Pharmacologic interventions Non-Pharmacologic interventions Parenteral Nutritional/ Requirement for parenteral medication Cultural or religious need Bruera E, Brenneis C, Michaud M, et al: Use of the subcutaneous route for the administration of narcotics /


NFSC 470 Seminar MNT Review of Clinical Nutrition.

) –Modular Kcals: –Standard –Concentrated Osmolality Routes of Administration –NG –ND –NJ –PEG –PEJ Enteral Calculations Volume: rate (ml/hr) x 24 hours = ml total volume/day Kcals: volume x kcal/ml = kcals Protein: g_ x volume (L) = g prot/day L Water: volume x %free water (plus flushes) = ml/day (Review Homework Problems) Parenteral Nutrition TPN = Total Parenteral Nutrition Provision of nutrients intravenously –Central –Peripheral (PPN) For/


Administration of Medications in Pediatrics

who wt. is 14 kg. Routes of drug’s administration 1. Oral administration Routes of drug’s administration 2. Topical route (eye, oral, nose, ear, / to their purpose: Nutrient solutions. Electrolyte solutions. Volume expanders. Parenteral Nutrition (PN) Parenteral nutrition is a form of nutritional support that supplies protein, carbohydrate, fat, electrolytes , vitamins, /Hours total infusion volume = ml/h total infusion time Drip factor (cont.) Drops per Minute: = total infusion volume in drop factor total /


Mosby items and derived items © 2005, 2002 by Mosby, Inc. CHAPTER 53 Nutritional Supplements.

known as total parenteral nutrition (TPN) or hyperalimentation Formulations will vary according to individual patient nutritional needs –Amino acids –Carbohydrates –Lipids –Trace elements Mosby items and derived items © 2005, 2002 by Mosby, Inc. Figure 53-2 One gram of dextrose, fat, or protein will provide varying amounts of energy as calories. Mosby items and derived items © 2005, 2002 by Mosby, Inc. Parenteral Nutrition (contd) Peripheral administration –Temporary/


New Ideas in the Nutrition of the ELBW Infant Reese H Clark, MD 1.

Nutrition 22 Median Total Calories (cal/kg/day) 23 to 26 weeks27 to 28 weeks29 to 31 weeks 23 Factors that Influence Amino Acid and Acylcarnitine Profiles in Premature Infants From The Pediatrix-Obstetrix Center for Research, Education and Quality Parenteral Nutrition/day 2 was significantly greater in both intervention groups compared with the control group. Greater amounts of AA administration did not further improve nitrogen balance compared with standard AA dose plus lipids and was associated with high /


Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 55 Nutrition Supplements.

, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Parenteral Nutrition (contd)  Also known as total parenteral nutrition (TPN) or hyperalimentation  Formulations will vary according to individual patient nutritional needs  Amino acids  Carbohydrates  Lipids  Trace elements Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Parenteral Nutrition (cont’d)  Peripheral administration  Temporary, short term (less than 2 weeks)  Dextrose concentration/


ENTERAL AND PARENTERAL NUTRITION IN CRITICALLY ILL CHILDREN Mudit Mathur, M.D. SUNY Downstate Medical Center.

NUTRITION: OVERALL GOALS ACCP Consensus statement, 1997 Provide nutritional support appropriate for the individual patient’s – Medical condition – Nutritional status – Available routes for administration NUTRITION: OVERALL GOALS Prevent/treat macro/micronutrient deficiencies Dose nutrients compatible with existing metabolism Avoid complications Improve patient outcomes ENTERAL OR PARENTERAL/ Requirements Total Daily Energy Requirements (kcal/day) = Resting Energy Expenditure (REE) + REE  (Total Factors)/


ENTERAL AND PARENTERAL NUTRITION UPDATE WITH THE NUTRITION CARE PROCESS Suzanne Neubauer, PhD,RD,CNSC Framingham State University Overlook Health Center,

x 1000 mg/g = 5 mg/kg/min 70 kg x 1440 min 13 CHO in Peripheral Parenteral Nutrition  PPN:  Maximum of 10%; 5% most common  Osmolality Maximum = 900 mOsm (10 x g pro) + (6 x g CHO) + (.3 x ml fat) total L 14 Lipids: Administration  Slow and continuous 24-hour infusion can improve hepatic reticuloendothelial function  As opposed to short, < 10 hrs/


ENTERAL AND PARENTERAL NUTRITION DR.ANOOP RAJ GOGIA HOD DEPARTMENT OF ANAESTHESIOLOGY & INTENSIVE CARE VMMC & SAFDARJANG HOSPITAL, NEW DELHI NEW DELHI.

PUMP,PREFERRED MODE IN INTESTINAL FEEDING INSTRUCTIONS NAME OF FORMULANAME OF FORMULA MODE OF ADMINISTRATIONMODE OF ADMINISTRATION WASH HANDS & WEAR GLOVESWASH HANDS & WEAR GLOVES CONFIRM POSITION OF NG TUBECONFIRM POSITION OF /NUTRITION, SEVERE CATABOLIC STATE,SEPSIS & BURNS1.2- 1.6 gm/ kg/24 hrs- POOR NUTRITION, SEVERE CATABOLIC STATE,SEPSIS & BURNS PARENTERAL NUTRITION LIPIDS-NOT >30% OF TOTAL CALORIES & 2.5% OF TOTAL CALORIES AS ESSENTIAL FATTY ACIDSLIPIDS-NOT >30% OF TOTAL CALORIES & 2.5% OF TOTAL/


Nutritional Problems Lewis, S., Dirksen, S., Heitkemper,M., Bucher, L. & Camera,I.(2011). Medical Surgical NursinG. St Louis, MO:Mosby.

nutrition is Safer than parenteral nutrition Nasogastric Tubes Small diameter, soft and flexible Radiopaque to assess position with X-ray Smaller than standard decompression NG tube Assess for patency as easily clogged, flush regularly, *flush following medication administration/fluid overload Monitor for jugular vein distention, elevated B/P, crackles during lung auscultation, SOB Total Parenteral Nutrition (TPN) Hypertonic solution (vesicant) = glucose, crystalline amino acids, fat emulsion, minerals, /


SURGICAL NUTRITION Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of Dundee.

to gastric feedings. For duodenal or jejunal feedings, consult the dietitian to determine formula selection and maintain continuous administration rate. 5. If the patient is starting on interval feedings and shows any signs of intolerance, consider/TPN Can be given by either a peripheral or central line Indications for total parenteral nutrition Absolute indications –Enterocutaneous fistulae Relative indications –Moderate or severe malnutrition –Acute pancreatitis –Abdominal sepsis –Prolonged ileus/


Basic Nutrition and Nutrition Therapy Chapter 21 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier.

ed.]. St. Louis: Mosby.) Slide 87Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Nutritional Support Parenteral Nutrition Support  Parenteral nutrition (hyperalimentation) Intravenous feedings May be administered through peripheral veins  Total parenteral nutrition (TPN) Administration of hypertonic solution into a large central vein  Composed of glucose, amino acids, vitamins, minerals, and electrolytes; fats also given as a supplement to/


Copyright © 2003 Delmar Learning, a Thomson Learning company Section 3 Medical Nutrition Therapy.

developing customized formulas for certain clients. Not nutritionally complete by themselves. Chapter 22Copyright © 2003 Delmar Learning, a Thomson Learning company21 Tube Feeding Methods of administration: Continuous: On-going over 16- to /for the client’s needs. Total parenteral nutrition (TPN) or hyperalimentation is when parenteral nutrition is used to provide total nutrition. Chapter 22Copyright © 2003 Delmar Learning, a Thomson Learning company25 Parenteral Nutrition Peripheral vein used for nutrient /


Nutritional Management of Diverticulitis with Abscess & Colon Resection Jessica Lacontora ARAMARK Dietetic Internship Southern Ocean Medical Center March.

5 days. Oral intake was monitored when diet order present. Parenteral nutrition orders and tolerance were monitored with each follow-up.  Food and Nutrition-Related History Food and Nutrient Intake  Energy intake - Total energy intake (FH-1.1.1.1) Meet needs  Protein intake - Total protein (FH-1.5.2.1) Meet needs Food and Nutrient Administration-  Parenteral nutrition intake – Formula/solution (FH- 2.1.4.2). Evaluated/


Nutritional support Dr. Abdul-Monim Batiha Assistant Professor Critical Care Nursing Philadelphia university.

totalparenteral nutrition (TPN)and administration of intravenous fluids Enteral feeding should be prescribed whenever oral intake is inadequate for the patient who has a functional gastrointestinal tract. Enteral feeding has several advantages over total parenteral nutrition:/, air way intubation and this can be managed by checking tube placement before administering feeding. Parenteral Nutrition A variety of locations can serve as sites for catheter insertion including: subclavian, internal jugular,/


Nutrition Support Dr. Ahmed Mayet Associate Professor King Saud University.

and vomiting or osmotic diarrhea Enteral nutrition (EN) Long-term nutrition: Long-term nutrition: Gastrostomy Gastrostomy Jejunostomy Jejunostomy Short-term nutrition: Short-term nutrition: Nasogastric feeding Nasogastric feeding Nasoduodenal feeding Nasoduodenal feeding Nasojejunal feeding Nasojejunal feeding Intact food Predigested food TF = tube feeding Total Parentral Nutrition Purpose To maintain positive nitrogen balance through the intravenous administration of required nutrient such as glucose/


Dallas, TX November 2–4, 2012 Metabolic Effects of Cyclical Parenteral Nutrition Deborah Pfister, M.S., R.D., C.N.S.C. Director of Nutrition, ThriveRx.

The Bag? Parenteral Nutrition Consists Of: 3 Main Calorie Sources (3-in-1 solution) - dextrose (carbohydrate source) - amino acids (protein source) - lipids (fat source) Electrolytes Vitamins & Minerals Other additives Dallas, TX November 2–4, 2012 Administration of HPN Infused/Dallas, TX November 2–4, 2012 Monitoring and Intervention for PNALD Monitoring Labs: AST, ALT, ALP, Total Bilirubin Biopsy – more accurate predicter of extent of involvement Intervention is aimed at cause Feed enterally when possible /


Basic Nutrition and Nutrition Therapy Chapter 21 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier.

ed.]. St. Louis: Mosby.) Slide 71Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Nutritional Support Parenteral Nutrition Support  Parenteral nutrition (hyperalimentation) Intravenous feedings May be administered through peripheral veins  Total parenteral nutrition (TPN) Administration of hypertonic solution into a large central vein  Composed of glucose, amino acids, vitamins, minerals, and electrolytes; fats also given as a supplement to/


Surgical Nutrition: TPN & Enteral Feeds Jason D. Sciarretta, M.D. Surgical Critical Care 2/2/11.

1900ml /24h = 81ml/h Total calories by dextrose Total calories by dextrose –Amt Dextrose = 250 (g/L) x 1.9 (L/d) = 475g/d –Dextrose calories = 475 (g/d) x 3.4 (kal/g) = 1615 kcal/d 17 Cyclic Parenteral Nutrition Satiety center constantly stimulated Satiety /resuscitation fluid volumes in severely burned patients using ascorbic acid administration. Arch Surg. 2000;135:326-331 29 30 Managing refeeding problems n provide Thiamine/MVI/trace elements n start nutrition support at 5-10 kcal/kg/day n increase levels/


NUTRITION Level 3, Academic Year (AY) 1435—1436 H Ahmad Albalawi, MSN Lecturer.

GI disorders (congenital anomalies, prolonged diarrhea) Short bowel syndrome 1.Partial Parenteral Nutrition – Supplies only part of daily nutritional requirements, supplementing oral intake – Dextrose or amino acids solutions 2.Total Parenteral Nutrition (Hyperalimentation) – Supplies all daily nutritional requirements – TPN solutions are highly concentration- central vein is used Types of Parenteral Nutrition Parenteral Nutrition Content  Standard TPN solution- 2 L  Most calories are supplied by/


Evaluation of Parenteral Nutrition Utilization in Oncology Patients

, Che Ton Saari Pharmacy Division, Hospital Kuala Lumpur (HKL) INTRODUCTION Parenteral Nutrition (PN) -therapeutic intravenous administration of nutrients Indicated in cases where oral or enteral feeding is:- Insufficient/ – December 2005 SELECTION CRITERIA INCLUSION CRITERIA EXCLUSION CRITERIA Adult (>18 years) patients Paediatric (<18years) patients Received Total Parenteral Nutrition Preterm neonates Patients with complete medical record STUDY FLOW CHART SCREENING OF PATIENTS’ RECORD IN TPN PHARMACY (n=/


Nutrition in the critically-ill Child. Past and Future. Dr. Rainer Paulino Basulto. Msc Dra.Mileidis Pupo Vera. Dr. Willians Rios. I Katima Mulilo. Caprivi.

30mls over a period of 10-30minutes and can be given 4- 6 times a day depending on patients individual feeding regime. Administration can be with a syringe using only the barrel as a funnel to allow the feed to infuse using gravity. Result. Table/:399–404. 2. Braga M, Gianotti L, Gentilini O, et al. Early postopera-tive enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit Care Med 2001;29:242–8. 3. de Lucas C, Moreno M, Lopez-Herce J, et /


Nutrition Teresa V. Hurley. MSN, RN. Factors Affecting Food Habits Physical — –geographic location, –food technology, –income Physiologic — –health, –

Parenteral Nutrition TPN- Total Parenteral Nutrition complete form of nutrition – protein –CHO – fat – vitamin –minerals = Indications for TPN Inability to eat –Ventilator dependency –Additional surgery –Altered mental status affecting ability to eat Diminished nutrient intake –Anorexia –Dyspepsia from medications –Gastrointestinal problems including nausea, vomiting, diarrhea, and distention Increased nutrient requirements –Hyper metabolism –Nitrogen loss caused by surgery and corticosteroid administration/


Surgery and Nutritional Support

Parenteral Feeding Routes Peripheral parenteral nutrition (PPN): uses less concentrated solutions through small peripheral veins when feeding is necessary for a brief period (10 days) Total parenteral nutrition (TPN): used when energy and nutrient requirement is large or to supply full nutritional support/or heparin be added? How is TPN stored? Mosby items and derived items © 2006 by Mosby, Inc. Administration of TPN Formula How is patient response to TPN assessed? Can an LPN/LVN administer TPN? What are /


Adult Health Nursing II Block 7.0. Parenteral Nutrition Adult Health II Block 7.0 Block 7.0 Module 1.4.

1.4 Learning Objectives Differentiate between Total Parenteral Nutrition and Partial Parenteral Nutrition Discuss Nursing Considerations for Clients with Complications in Parenteral Nutrition Discuss Age-Related Considerations Prioritize Nursing Care of Clients receiving Parenteral Nutrition Block 7.0 Module 1.4 Partial/Peripheral Parenteral Nutrition (PPN) Used when client unable to take nutrition through GI tract Need complete nutrition source, but are not totally depleted Usually used when client needs/


NURS2520 Health Assessment II

Demonstrate safe administration and discontinuation of TPN Parenteral Nutrition *Parenteral nutrition = intravenous delivery of nutrition via central venous catheter (CVC) Indicated for clients who can not ingest food or fluids through the GI tract Types of parenteral nutrition include partial or total Partial parenteral nutrition (PPN) is indicated for clients who can meet some of their nutritional requirements orally (i.e. shortened small bowel due to injury/disease) Total parenteral nutrition (TPN) is/


Nutritional support in NICU/PICU A Norouzy Assistant Professor in Clinical Nutrition Mashad Medical School.

Nutritional status Route of Administration: Enteral vs Parenteral Indications for TPN: SBS Ileus Severe dysmotility NEC Unable to provide adequate support with enteral nutrition The gut can be used in critical illness Journal of Pediatric Gastroenterology and Nutrition. 41: S1-S4 TPN initiation dependent on age, size, nutritional/Fat – depressed immune function – Reduced bacterial clearance – Increased triglycerides Total Parenteral Nutrition central vs peripheral line 1000 vs 2000 mosmols/L ++ electrolyte /


Nutrition Support of the Hospitalized Patient. Therapeutic Priorities Airway Control Breathing Circulatory support Tissue oxygenation Acid-base neutrality.

Components of Total Energy Expenditure Malnutrition and Critical Illness CLASSICAL - Months to years STRESSED - Days to weeks TPN Terminology TPN - Total Parenteral Nutrition PPN - Peripheral Parenteral Nutrition IVN - Intravenous Nutrition IVH - /nutrition Malnutrition and Critical Illness - Objectives “Cut Your Losses” What to Give? Enteral or Parenteral Nutrition Intravenous Nutrition Components Water Glucose Nitrogen (A.A.) Lipids Electrolytes Trace Minerals Vitamins Additives Route of Administration/


Introduction to Enteral Nutrition

Nutrition Support Enteral —Impaired ingestion —Inability to consume adequate nutrition orally —Impaired digestion, absorption, metabolism —Severe wasting or depressed growth Parenteral/Nutrition GI, metabolic, and mechanical complications—tube migration; increased risk of bacterial contamination; tube obstruction; pneumothorax Costs more than oral diets (not necessarily) Less “palatable/normal”: patient/family resistance Labor-intensive assessment, administration/40-90% of total calories Typically some /


PARENTERALS: COMPOUNDING STERILE FORMULATIONS CHAPTER 9.

.9% NS (sodium chloride) solution – Ringer’s solution – Lactated Ringer’s solution  Ports Administration port Medication port TYPES OF STERILE INTRAVENOUS SOLUTIONS - LVPs Image copyright Perspective Press and Morton Publishing Company/be copied, re-used, reproduced, or re-transmitted without express written permission from the publisher. TOTAL PARENTERAL NUTRITION (TPN) SOLUTIONS Nutritional support to patients who are unable to take in adequate nutrients Contains macro- and micronutrients – Macronutrients/


1  Must have medical record (MR) services and have an administrator responsible for MR who will sample 10% of daily census and at least 30 records  Must.

delivery  Accommodation of non-routine occurrences (parenteral nutrition, tube feeding, TPN, peripheral parenteral nutrition, early/late trays, nutritional supplements) 86 Dietary A-0618 (continued/ A-0958  Patient’s name, ID number  Date of surgery  Total time of surgery  Name of surgeons, nursing personnel, anesthesiologist, and assistants / interview staff to see if knowledgeable about blood, IV fluid, parenteral administration of electrolytes, injuries to extremities, CNS and prevention of infection /


NUTRITIONAL SUPPORT IN CRITICALLY ILL Prof. Mehdi Hasan Mumtaz.

in urine Rise of urea in blood G x 28/60 x 60% B.W Total N2 Loss = 1+2+3 ROUTES OF ADMINISTRATION EnteralParenteralRARE  Oral F  Tube F  Gastrostomy F  Jejunostomy F  I/V/ Bacteria.  Hospital Stay. NUCLEOTIDES   Resistance.   Immune response. EFFECT OF CRITICAL ILLNESS ON GIT  Starvation & Bowel rest.  Metabolic stress.  Entral/Parenteral nutrition.  Sepsis.  Shock. STARVATION Structural  Mucosal Atrophy    Villous height.   Mucosal thickness.   Crypt dipth.   Mucosal height.  /


Early Enteral Nutrition in the Critically Ill. Objectives To define early enteral nutrition To review the benefits of early enteral nutrition To explain.

reduced postoperative septic complications Moore F, et al. Ann Surg 1992;216:172-183 Total Septic Complications Pneumonia Others Catheter Sepsis Intra-abdominal Abscess Bacteremia p < 0.05 Percentage of Patients 010203040 Parenteral Enteral Parenteral Nutrition vs. Early Enteral Nutrition (a meta-analysis) Conclusions Fewer septic complications: – Enteral nutrition: 18% – Parenteral nutrition: 35% Early nutrition therapy is possible in the immediate postoperative period, and reduces morbidity from septic/


Parenteral Chapter 8 The Pharmacy Technician. Parenterals situated or occurring outside the intestine parenteral drug administration by intravenous, intramuscular,

instructions. Vials & Ampules 2 types of parenteral vials Vials Containing Solution Vials Containing Lypholized Powder Ampules-sealed glass containers with an elongated neck with a colored stripe **potential for coring vials Special Solutions Parenteral nutrition solutions are complex admixtures compose of dextrose, fat, protein, electrolytes, vitamins and trace elements used to meet patient nutritional needs. Total parenteral nutrition solutions (TPN) Dialysis solutions Irrigation solutions – Surgical/


Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrition for Patients with Cancer or HIV/AIDS Chapter 22.

treatments (cont’d) –Chemotherapy oChemotherapy drugs damage the reproductive ability of both malignant and normal cells oCyclic administration of multiple drugs is given in maximum tolerated doses oSide effects vary with the type of drug or combination/destroy cancer cells oNutritional side effects caused by high-dose chemotherapy, total body irradiation, and immunosuppressant medications, which are given before and after the procedure oTotal parenteral nutrition (TPN) may be needed for 1 to 2 months after /


A Randomized Trial of Supplemental Parenteral Nutrition in

first NO daily titration needed Use of Non Study Parenteral Nutrition Imp Manual p X Use of Non Study Parenteral Nutrition If parenteral nutrition is truly indicated In ICU: use Olimel until /Olimel can be stored for 24 hours under refrigeration followed by 24 hours administration Check non permanent seals Confirm the integrity of the bag and of the/ hospital discharge Whom? To be done by the Research Coordinator How? Calculate the total distance walked by patient in 6 minutes. On a patient that is able to/


Nutrition in Surgical Patients

Mousse (all) Squash Supper: Cup of tea What do you think of this intake?? Puree diet example Total: 1270kcal 52.5g protein 1135ml fluid This will be inadequate for most post operative patients Be aware that patients/of EN Nausea and vomiting Abdominal distension Diarrhoea Constipation Oesophagitis Aspiration Blocked tube Complications during tube insertion Parenteral nutrition (PN) Administration of nutrients, fluids and electrolytes directly into a central or peripheral vein Traditionally associated with  /


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