1. Nutrient Delivery
To determine Kcal and protein needs, along with appropriate diet medical nutrition therapy is needed
SCREEN is a series of nutrition related questions that determine risk factors
ASSESSMENT is the use of anthropometric, biochemical, clinical data to determine nutrition status
INTERVENTION is the plan of care instituted to address nutrition problems identified in assessment
MONITORING is the tracking of nutritional markers for efficacy of treatment course

14. Nutrient Delivery
Diet manuals are institutional set meal plans or formularies determined to address a variety of nutritional needs
Currently a diet is A PHYSICIAN ORDER, with medical implications for patient safety
Diet modifications are often needed for chronic illness and food textures, including clear, soft, full, purée, mechanical, and regular
Often diets must be held for procedures, such as CT, MRI, and cath lab, but NOT for surgery until <2hrs before
Pts NPO greater than >4 days are considered at risk and will require a nutrition consult

19. Nutrient Delivery
Nutrition support can be given enterally or parenterally depending on clinical status
Oral intake is ALWAYS preferred and can be encouraged with assistance, food quality, bed positioning, and supplements
Supplements can be given orally or enterally and are SPECIFIC for disease states, in concentrated amounts
Modular formulas provide single nutrients while element formulas have isolated peptides and FAs
For GI patients, ideally trials of standard formula is preferred and then as tolerated elemental formulas made be needed

25. Nutrient Delivery
For patients with a functional gut but are unable to take PO, consider enteral nutrition
For patients requiring nutrition support FOR <2 WEEKS, a NGT, NJT, OGT is appropriate
For patients needing long term EN a PEG, PEJ is appropriate if the patient is a surgical candidate
Tube feeding can begin 2-4 hours after PEG in the adult patient, or after x-ray confirmation of NGT, OGT

29. Nutrient Delivery
Tube feeding should be >45 degrees to prevent aspiration, and should advanced to GOAL as directed
Bolus feeding is typically for patients who have functional lives and can tolerate larger volumes
Continuos feeds are for bed bound patients or risk for aspiration which require low volume
Gastric Residual Volume (GRV) should be checked q 4hrs with a HOLD of EN only when >500ml

32. Nutrient Delivery
Always wear gloves, clean the top of cans, label the bag, discard in 24hrs, can hang for 8hrs
Never add free water or medications to EN formulas, give with separate flushes
Take strict I/Os of total volume, fluids, urine output, GRV, and bowl movements
Consideration for bowel regimen, diuretics, steroids, sedation, and prokenetics

35. Nutrient Delivery
Parenteral Nutrition, indicated for NPO >7 days, GI surgery, pancreatitis, emesis, esophageal varices
PPN via arterial line, TPN via central line or PICC depending on access and concentration
Composed of AA, CHO, and separate Lipids, with micronutrients and vitamins
PPN is for short term support with mOsol <900, typically not providing 100% of kcal needs

39. Nutrient Delivery
PO > EN > TPN, if the gut works use it, always consider clinical status
TPN risk of infection, hyperglycemia, liver damage, hyperlipemia, renal damage, gut ischemia
Cost is >1000$/day and must be ordered <24hrs for compounding by pharmacy
Pt can be discharged on TPN in extreme cases, with some cases of >20 years