Ppt on total parenteral nutrition procedure

Spotlight Case Total Parenteral Nutrition, Multifarious Errors.

Describe methods to reduce PN-related errors 4 Case: Errors with PN A 3-year-old boy on chronic total parenteral nutrition (TPN) due to multiple intestinal resections was admitted to an academic medical center for anemia. The boy had /PN label against original order 26 Take-Home Points PN is a high-alert medication requiring safety-focused policies, procedures, and systems Institutions should incorporate all appropriate ASPEN clinical guidelines and best practices documents To enhance safety and reduce/

Case Report: Nutrition Support in Pancreatic Cancer Neha Bhakta ARAMARK Dietetic Internship St. Luke’s Medical Center December 20,2013.

reported weight loss of approximately ten pounds over last two months. Biochemical Data, Medical Tests, and Procedures The x-ray confirmed pancreatic head and uncinate process mass. The repeat CT of the abdomen showed /unintentional weight as evidence d by increased energy needs Nutrition Care Process: Intervention(s) Enteral and Parenteral Nutrition: Parenteral Nutrition/IV Fluids- Formula/Solution (ND-2.2.1). Recommended parenteral nutrition: For TPN Total Volume: 1080 mL Amino Acid: 70 grams 10/

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

Interventions Risk for Aspiration –Assess LOC –Decrease or absent gag or cough reflex –Surgical procedures –Neuromuscular impairments –Sensory impairments Nursing Interventions Upright position Food placed stronger side of mouth / cold formula Diarrhea Impaired skin integrity Nosocomial infections Parenteral Nutrition Total parenteral nutrition (TPN) Partial parenteral nutrition (PPN) Total Parenteral Nutrition TPN- Total Parenteral Nutrition complete form of nutrition – protein –CHO – fat – vitamin –/

Fluids and Nutrition in the ICU

Total Parenteral Nutrition Involves the provision of complete nutrition via CVC in patients who are unable to tolerate enteral nutrition Requires the provision of macronutrients, micronutrients and fluid Indications General EN contraindicated EN fails to meet nutritional/intolerance -> NG not in correct position -> intra-abdominal pathology -> opioids -> interruptions of feed for procedures/OT -> gastric paresis -> ileus -> sepsis -> electrolyte abnormalities Feed intolerance : treatments Gastric residual /

Nutrition in Patients with Gastrointestinal Disorder.

the circulatory system. This is sometimes referred to as TPN – Total Parenteral Nutrition when the nutrient is exclusively given via IV. Parenteral nutrition may be given as TPN or as supplemental. This nutrition provides large quantities of fluids, and nutrients which include proteins, fats, water, electrolytes, vitamins and minerals. GASTRIC SURGERIES TOTAL OR SUBTOTAL GASTRECTOMY: Surgical procedure to remove part of or the entire stomach Postoperative complications include/

Intravenous Admixture System

(and it is continue raising!) replacing fluids and electrolytes, provide nutrition and administer medication Intravenous Admixture System It can be provided to the/Coordinating Committee on Large Volume Parenteral (NCCLVP) To identify problems associated with large parenteral in hospitals (LVPs) Developed procedures to be used by hospital/of the pharmacy are: Total Pharmaceutical care Many patients may be receiving the majority of their medication by parenteral route Centralizing the preparation as/

The Science of Effective Pediatric Inpatient Nutrition 2005 Kevin M. Creamer M.D., FAAP Medical Director, PICU WRAMC Chief, Pediatric Nutrition Support.

Airway management –22/26 PICU pts had feeds held for extubation that only 5 got Diagnostic procedures –Some ventilated patients fed right up to OR McClave SA, CCM, 1999,DeJonghe, CCM, / and overall poor outcome Energy Requirements u 12 Septic and 12 Traumatized patients Total energy expenditure and REE measured for 2 separate 5-day periods TEE Sepsis/in TPN pts was 6.8% vs. 12.4% u Meta Analysis 11 studies Parenteral nutrition vs. delayed enteral improved mortality Increased infectious risk (OR 1.65 CI1.1-2,/


or effect of BMT on pancreatic β cell function TIMING of TPN TPN is often considered to be an expensive procedure and it is therefore started only when it becomes necessary In some centres TPN is initiated before commencement of chemotherapy/ lipids (1 to 2g/kg/day depending on the degree of catabolism) vitamins and minerals. BASIC ADULT DAILY REQUIREMENTS FOR TOTAL PARENTERAL NUTRITION NUTRIENTAMOUNT Water (/kg body wt/day)30–40 mL ENERGY (/kg body wt/day) Medical patient30 kcal Postoperative patient30–45 /

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

irradiation to suppress immune function and 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 bone marrow transplantation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cancer (cont’d) The impact of cancer treatments (cont/

Dr. Reham Khresheh 1 Nutritional care of clients.

illness and surgery can affect the nutrition of clients Identify and describe three or more nutrition-related health problems that are common among elderly clients needing long-term care Demonstrate correct procedures for feeding a bed-bound client/abnormalities (obstruction, peritonitis) After surgery or trauma, burn, sepsis Acute renal or liver failure AIDS Bone marrow transplantation Total parenteral nutrition (TPN) 33 A typical order of TPN specifies 3 L of solution daily with a final concentration of 25/


reduce the risk of iatrogenic malnutrition ( Iatrogenic malnutrition-malnutrition due to medical treatment or procedure) The specific nutrition interventions recommended will depend on a variety of factors, including age, life expectancy, comorbidities/Dysphagia management- see special diets  Can also include enteral feeding by tube, or parenteral feeding (peripheral parental nutrition, and total parenteral nutrition)  Keep track of input/output regardless of how patient is receiving nutrients Helping to/

Section K Swallowing / Nutritional Status MDS 3.0

of dehydration. IVF’s given as a routine part of an operative or diagnostic procedure or recovery room stay. IVF’s given solely as flushes. Parenteral/IVF’s given in conjunction with chemo or dialysis. Enteral Feeding Formulas: Should/by mouth w/ supervision, but not enough to maintain hydration. She received the following daily fluid totals by supplemental tube feedings (including water, prepared nutritional supplements, juices) during the last 7 days. Example continued: Sunday: 1250cc Monday: 775cc Tuesday/

Nutrition in Surgical Patients

at high risk of aspiration, swallowing problems, unconscious. Supplementary to oral nutrition – poor appetite, increased nutritional requirements. Supplementary to parenteral nutrition. Nasal Bridal A nasal bridal is a device to secure a NG/ Neck cancer Indications / contraindications Long term nutrition support required Swallowing impairment Contraindications Absolute Total gastrectomy Portal hypertension with gastric varices Relative Unfit for procedure Partial gastrectomy PD Ascites Active gastric ulcer /

NFSC 470 Seminar MNT Review of Clinical Nutrition.

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/ Peripheral Parenteral Nutrition (PPN) Utilization of peripheral veins for the administration of nutrients Indications for use: 1.Short term PN 2.No access to central vein 3.Malnourished pts with frequent NPO for procedures/tests /

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/ recovery period? Mosby items and derived items © 2006 by Mosby, Inc. Types of Procedures Compare and contrast the different procedures shown in Figure 22-4. Mosby items and derived items © 2006 by Mosby, Inc/

Enteral Nutrition: A Clinical Case Study using the Nutrition Care Process By Yingying Yip February 25, 2015.

., Braunschweig, C., Miles, J., & Compher, C. (2012). A.S.P.E.N. Clinical Guidelines: Nutrition Support of Adult Patients With Hyperglycemia. Journal of Parenteral and Enteral Nutrition.  Stroud, M., Duncan, H., & Nightingale, J. (2003). Guidelines for enteral feeding in adult hospital patients. Gut.  http://www.summitgastro.com/endoscopic-procedures/peg-placement Thank You! Any Questions? Delivery Methods  Continuous  Uses a pump, low infusion rate/

Nutrition for Patients with Cancer or HIV/AIDS Chapter 22.

, total-body irradiation, and immunosuppressant medications, which are given before and after the procedure oNutrition/ side effects include anorexia, taste alterations, dry mouth, nausea, vomiting, thick saliva, esophagitis, stomatitis (sore mouth), constipation; intestinal damage may cause diarrhea and malabsorption and all of above nutrition side effects which can reduce IDATME and hence WWFQ and thus the benefits of good nutrition when one has cancer. oTotal parenteral nutrition/

Eating Disorders. Which of the following surgical weight loss procedures does not alter stomach hormone levels? (A) Gastric bypass (B) Gastric banding.

steatohepatitis [NASH]) is only based on liver histology, but NAFLD patients are generally asymptomatic [so] invasive procedures are not easy to propose [or] to accept," she told Medscape via email. "Surrogate markers (/ excessive conversion of carbohydrates and proteins to triglycerides (eg, secondary to overfeeding or use of total parenteral nutrition).total parenteral nutrition Impaired VLDL synthesis and secretion can result from abetalipoproteinemia, protein malnutrition, or choline deficiency. Patients/

Nutritional management of the patient with chronic obstructive pulmonary diseases Prof. Entesar Sayed Ahmed Professor Of Chest Diseases Faculty Of Medicine.

the respiratory muscles. NUTRITION THERAPY IN COPD  The treatment for COPD includes a series of procedures, from prophylactic measures/patients with COPD ranges between 50% and 60% of the total energy expenditure of the patient.  An amount of carbohydrates /nutrition therapy should be chosen.  However, when it is impossible to use the gastrointestinal tract, or when enteral nutrition is counter indicated, parenteral nutrition therapy should be implemented.  Parenteral nutritionParenteral nutrition/


replacement. PROBLEMS limiting ability to meet nutritional requirements in critically ill patients such as: Diuretics Restricted fluid intake Haemofiltration Glucose intoleranceGood control Delayed gastric emptying Reduced feed absorption Parenteral Diarrhea Fasting for procedures DAILY NITROGEN LOSS  Loss in / and 1g of L- rhamnose administred via the nasogastric tube. 4. All urine collected over 5h. Total volume noted and a 20 ml sample frozen for future analysis. 5. Concentration of sugrs in urine /

Nutrition Interventions for Pediatric Patients with Short Bowel Syndrome Jackie Costantino Sodexo Dietetic Intern.

▫ Intestinal lengthening procedures Substances indicated to promote adaptation ▫ Growth hormone (GH) ▫ Glutamine ▫ Glucagon-like peptide 2 (GLP-2) Intestinal Lengthening Procedures Bianchi ProcedureSTEP Procedure http://surgery.med./ need for parenteral nutrition support. Interventions Parenteral Nutrition ▫ Cycling ▫ Lipid Reduction Therapy ▫ Omega-3 fatty acids for PN lipids ▫ Ethanol lock therapy Enteral NutritionNutrition source ▫ Continuous vs. Bolus ▫ Modulars Total Parenteral Nutrition (TPN) /

Nutritional therapy. Provide a life sustained therapy for the patient who can not take adequate food by mouth who consequently at risk for malnutrition.

Is more expensive Has more complications Needs more technical expertise Who Will Benefit From Parenteral Nutrition? Patients with/who  Abnormal gut function  Cannot consume adequate amounts of nutrients by enteral feeding  Prognosis warrants aggressive nutritional support Two Main Forms of Parenteral Nutrition Peripheral Parenteral Nutrition Central (Total) Parenteral Nutrition Peripheral Parenteral Nutrition Given through peripheral vein Short term use Mildly stressed patients Low caloric requirements/


(36415) CBC (CPT 85027) $13.08 Total Cost Blood Draw (CPT 36415) $164.24 Total Cost Oral Antibiotics Cephalexin cap $54 Total Cost Levofloxacin tab $111 Total Cost Augmentin tab $174.60 Total Cost Oral Antibiotics: One of the following is/time X 2 (85730); Electro Cardiogram X 1 (93000).;Complete Parenteral Nutrition: Adult (CPT Code – not listed). Operative room drain placement: 1.Anesthesia cost (Spinal Anesthesia); 2. Anesthesia supplies; 3. Procedure cost; 4. Operative room cost; 5. PACU cost. /

Short bowel syndrome and nutritional consequences Alastair Forbes University College London.

1000kcal Needs 1000kcal parenterally Total 3000kcal administered Correct 2000kcal received Intestinal failure: parenteral nutrition Usually give more nutrition than predicted Example: patient needs 2000 kcal/day But has SBS and absorption of 50% Eats 2000kcal - absorbs 1000kcal Needs 1000kcal parenterally Total 3000kcal administered Correct / Operation From Thomson 2004 STEP - serial transverse enteroplasty procedure From Thomson 2004 151520 years10 Transplantation or HPN HPN vs “best” Tp 2007 Mange Takk

Nutrition in surgery Alexander Sunde. Overview  Nutrients and energy  Definition of malnutrition  Causes of malnutrition  Effects of malnutrition.

discribed in litterature but often overlooked in a clinical setting.  Surgical procedures (and subsequent fasting) after admisson can cause this pat. group to /usually assessed, eg. to exclude anemia Summary of nutritional assessment Assessment of nutritional requirements  As mentioned total daily energy requirement vary and depend on weight,/asymptomatically a promotility agent may be added to the feeding regimen. Parenteral feeding  Patient receives feeding intravenously either via a central vein or/

Nutrition Vema Sweitzer, MN, RN 1. Independent learning – The factors influencing Nutrition of the older adults (pg 1003) – The five components of a nutrition.

– Albumin: 3.5-5.0 g/dL (half life 21 days) – Transferrin and total iron-binding capacity (TIBC) – Hemoglobin (12-18%) – Prealbumin (half life 1.9 days/NGT), jejunal (JT) or gastric tube (GT). 13 Enteral Tube Feedings Procedure: Start at full strength Slow rate Increase every 8-12 hours as ordered/ 4 Observe aspirate color Do not use auscultation method 15 Parenteral Nutrition Parenteral nutrition (PN) is a form of specialized nutrition support in which nutrients are provided intravenously. A basic PN/

Chapter 44 Nutrition /Naso-Gastric Tubes Revised ATI Skill Checklist N/G Tube Insertion & Discontinuation-CANVAS Gastrostomy Tube Feeding/Med Administration.

management of enteral feedings. 2 Background  Food security is critical for all members of a household.  Food holds symbolic meaning.  Medical nutrition therapy uses nutrition therapy and counseling to manage disease.  Type 1 diabetes mellitus  Hypertension  Inflammatory bowel disease  Enteral nutrition (EN); total parenteral nutrition (TPN) Assessment  Screening a patient is a quick method of identifying malnutrition or risk of malnutrition using sample tools :  Height  Weight/

Chapter 10 Diet and Nutrition. Section 1 Introduction Section 2 Hospital Diets Section 3 Nutrition Assessment Section 4 Diet nursing Section 5 Special.

pace when patients are tolerated well then stabilize the prescription, dosage and transfusion rate. Follow sterile procedure and prevent contamination. Prepared feedings should be stored in refrigerator below 4°C and should be used/, and stop infusion for severe clients. The feedings is stopped gradually to prevent hypoglycemia. Parenteral Nutrition (PN) PN also referred to as total parenteral nutrition (TPN). PN is provided when the gastrointestinal tract is nonfunctional. PN is administered intravenously /

Nutrition for the Surgical Resident

8 – 95 % incidence Clinically significant aspiration resulting in pneumonia 1 – 4 % GI intolerance: N & V, abdo discomfort Clogged tubes Procedure related complications Parenteral Nutrition (TPN) TPN TPN is similar to 2/3 + 1/3 Only with amino acids, lipid and additives (Na, K, Ca, Mg/ requirements q 4 – 6 h Once stable, give ~ 70 – 100 % total requirements in TPN & review daily Insulin drip – add 2/3 of the total insulin infused during the previous TPN administration Alternate regimes 0.1 unit/g dextrose 10/

ENTERAL AND PARENTERAL FEEDINGS. TUBE FEEDING ENTERAL NUTRITION Definition  Feeding via tube into the gastrointestinal tract (GIT), bypassing the oral.

dysphagia, surgical procedures, anorexia nervosa TF  Types: placement determines type of TF used:  Nasogastric  Nasoduodenal  Gatrostomy  Jejunostomy TUBE FEEDINGS – NON SURGICAL TUBE FEEDINGS-SURGICAL REQUIREMENTS  Nutritionally complete  Varying/ WORKS, USE IT! PARENTERAL NUTRITION  Peripheral parenteral nutrition  Short – term  Partially meets nutritional needs PERIPHERAL PARENTAL NUTRITION PARENTERAL NUTRITIONTotal parenteral nutrition  Long-term  Nutritionally complete TPN INDICATIONS  /

Parenterals & CGMP. What are parenterals? ► Sterile, pyrogen free preparations injected through skin or mucous membrane into internal body compartments.

anesthesiology) ► ► Prolonged action (e.g. intra- articular steroids, IM penicillins) ► ► Correcting serious fluids and electrolyte imbalance ► ► Total Parenteral Nutrition (TPN) Types Of Sterile ProductsTypes Of Sterile Products ► ► Terminally sterilised: prepared, filled and sterilised ► ► Sterilised by filtration ► ►/of 99.97%. DOP Testing ► HEPA filters are tested for efficiency by the "DOP" test procedure. DOP stands for Di- Octyl Phlalate. Because of concerns that DOP may have carcinogenic properties,/

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

oral intake is inadequate for the patient who has a functional gastrointestinal tract. Enteral feeding has several advantages over total parenteral nutrition: 1-EN has been shown to be easier, safer and cheaper than PN. 2- EF maintains the structure/ a significant cause of diarrhea. Potential contamination during checking residual volumes can occur, since this is not a sterile procedure. In addition to the formula which can become contaminated at any point in the preparation and delivery process as well/

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

a syringe, but not both ways in the same procedure Membrane filters-a filter that filters solution as the /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/

Nutrition and Special Diets

energy needs Provide heat Metabolize fats Preserve protein for uses other than energy production 50% to 60% of total caloric intake daily 1 gm = 4 calories Deficiency Weight loss Protein loss Fatigue Excess contributes to fat stores/timing Three smaller meals Timing in relation to a procedure Exclusions – for food intolerances Specific Modified Diets (cont.) Supplements and parenteral nutrition Oral – specially formulated to provide adequate nutrients Parenteral – given IV to bypass the digestive system /

CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 49 Nutrition and Special Diets.

and tissues –Maintaining water balance –Antibody production and disease resistance –Maintaining body heat 10% to 20% of total caloric intake daily 1 gm = 4 calories Deficiency –Weight loss/fatigue –Malnutrition –Lower resistance to infection –/to a procedure –Exclusions – for food intolerances © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 49-36 Specific Modified Diets (cont.) Supplements and parenteral nutrition –Oral – specially formulated to provide adequate nutrients –Parenteral – given/

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrition for Patients with Metabolic or Respiratory Stress Chapter 16.

intake is less than 75% of estimated need for over 3 days, EN should be used for total or supplemental nutritionTotal parenteral nutrition is used with extreme caution Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Respiratory Stress / 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins If possible, schedule debridement and other medical and surgical procedures at times when they are least likely to interfere with meals Provide pain medication as needed before meals Promoting/


diet Add High Calorie/High protein supplements Enteral Nutrition Can’t be fed orally or can’t meet needs orally Parenteral Nutrition Should only be initiated when medically necessary OTHER / satiety Recommendations: As able, GI to F/U with pt. referring increased anxiety with PEG procedure UPDATE! (4/19/12) Spoke with patient  now agreeable for PEG Consulted GI Will / rate of 40 ml/hr x 12 hr 480 ml total volume 576 kcal 27 g Pro 687 ml total H20 NUTRITION FOLLOW UP (4/21/12) A Pt. ordered clear/

Pediatric Traumatic Brain Injury: Metabolic Stress with Nutrition Support Ernesto Garcia, Angela Gomez Emily Montes, Valerie Obarski & Alexandro Valenzuela.

1 oz. American cheese, 1 tsp margarine); Jello-O c; 240 mL Carnation Instant Breakfast prepared with 2% milk Total calories: 1061 kcal with 39 g Protein Average: 902 kcal or 55% of her caloric needs Average: 39g protein /following is NOT a common therapeutic procedure for a patient suffering a TBI? A.Enteral/Parenteral Feeding B.Mechanical Ventilation C.Blood Pressure Medication D.Chemotherapy References Baker, S., Baker, R.D., Davis, A., (2007) Pediatric nutrition support. Jones and BartlettPublisher. /

Systematic nutritional evaluation increases financing of hospital care in children Dr Valérie Bertrand, Pediatric unit J.Monod Hospital Le Havre FRANCE.

is used to code diagnoses. -CCAM (medical acts classification) is used to code procedures (and to determine tariffs /public hospitals for the reimbursement rates; and is the positive/(+34%). UN coding has valued 21 hospital stays It represented 3.6 % (47678 €) of total hospital revenues for the period (1,324124 € ) € 137,560€185,238€ An audit quality/ of WHO growth curves in child healths books. American Society for Parenteral and Enteral Nutrition 2015 Becker et al Nutr Clin Practice 2015 WHO z score charts/

Swallowing Disorders Height and Weight Weight Change Nutritional Approaches SECTION K SWALLOWING/NUTRITIONAL STATUS June 9, 2015 1-3PM.

A. Parenteral/IV feedings do not include: IV medications IV fluids used to reconstitute or dilute meds IV flushes IV fluids administered: In conjunction with chemotherapy or dialysis as routine part of operative or diagnostic procedure or recovery room stay K0510: Nutritional Approaches - / would be coded 1, 500cc/day or less. K0710B3 would be coded 1, 500cc/day or less Continued Rationale: The total fluid intake within the last 7 days while Mr. K. was not a resident was 1,900cc (400cc+520CC+500cc+480CC/

The Safe Use of Nutritional Supplements April 2011

prevalence of nutritional deficiencies and excess and some of the associated risk factors Supplement Safety: Nutrients of Greatest Concern Percentage Contribution to Total Intake from/ oral copper 2mg per day Full haematological but only partial neurological recovery Parenteral copper might be required in severe cases Iodine Excess: Case History Mrs/ Rate Measurement of plasma homocysteine Assessment of MI, stroke, need for vascular procedure or all cause death = composite end point Baseline: 89% male, BMI/

Group 4 | Bolintiam, Cruz, Dela Cruz, Lu, Que, Rivera, Tai, Sioco, Valera, Veloso YL7 Integration Activity 1 GI, Pulmo, Nutrition, MBA, PH.

387cc Give 387 cc of D50W per day as starting solution PARENTERAL NUTRITIONDAILY NEEDS TOTAL CALORIC REQUIREMENT: 1050 CAL 1800cc fluid 10% amino acid solution of/ (possibly the ileocecal segment) Monitoring and follow-up  The patient’s nutritional status should be constantly monitored  Continuously assess whether oral feeding could already /administrative fees None INTERNAL BUSINESS PROCESS Improve competence in laboratory procedures Accurate detection and diagnosis Detection rates and number of true /

The Safe Use of Nutritional Supplements Dr Alan Stewart MRCP.

prevalence of nutritional deficiencies and excess and some of the associated risk factors Supplement Safety: Nutrients of Greatest Concern Percentage Contribution to Total Intake from/ oral copper 2mg per day Full haematological but only partial neurological recovery Parenteral copper might be required in severe cases Iodine Excess: Case History Mrs/ Rate Measurement of plasma homocysteine Assessment of MI, stroke, need for vascular procedure or all cause death = composite end point Baseline: 89% male, BMI/

Nutritional Support in Small Bowel Obstruction Lisa Sharp-Gomez, Dietetic Intern February 9, 2016.

9/20 NPO - surgery Surgical Intervention 9/21/15 CT scan definitively identified a small bowel obstruction Laparoscopic procedure identified sigmoid colon diverticulitis, sigmoid colon adhesions onto the bladder, a colovesicle fistula and small bowel adhesions in the/ that bowel rest was needed. A PICC line was placed on 9/21 and TPN was started. TPN Total Parenteral Nutrition ◦ Used to provide nutrition when the GI tract is not functioning. ◦ Provides proteins, carbohydrates and fats via a PICC line or /

Unit 6 Nutrition and Hydration

procedure for feeding a resident, and the effects of good nutrition and poor nutrition. DFS Approved Curriculum-Unit 6 Nutrition and Hydration Introduction (continued) Knowledge of nutrition/temperature Provides essential fatty acids High in calories Use sparingly Keep total fat intake between 20% to 35% of calories DFS /Unit 6 Parenteral Fluids (Intravenous Infusion) Fluids administered through vein. Little nutritional value Responsibility of licensed nurse DFS Approved Curriculum-Unit 6 Parenteral Fluids /


when administered parenterally. It is therefore desirable to avoid the inclusion of preservatives whenever possible. -The effectiveness of antimicrobial agents can be tested by challenging the product with selected organisms. The test procedure will evaluate /administration of o/w emulsions to provide controlled drug release. ■The IV administration of o/w emulsions as total paranteral nutrition emulsions. In these, 10–20% oil is emulsified within an aqueous phase using phospholipids and lecithin surfactants /

Nutritional Assessment. Definitions Estimated Average Requirements(EAR) are expected to satisfy the needs of 50% of the people in that age group based.

trace elements, to meet the caloric, protein, and nutrient requirements while maintaining water and electrolyte balance. 11.Total Parenteral Nutrition (TPN) o Because TPN administration bypasses normal absorption and circulation routes, careful laboratory monitoring of these patients is/metabolism. The most widely used assay for ascorbic acid is the 2,4-dinitrophenylhydrazine method. In this procedure, ascorbic acid is first oxidized to dehydroascorbic acid and 2,3-diketogulonic acid with the formation of/

PEN Group Nutritional Support – A vision for the future Fast Track approach to recovery after surgery August 2005 John MacFie MD FRCS.

30 days post-op Patients Control groupOptimisation groupP - value Total number2019 Age (years) *67 NS Sex ratio (M : / Values are median, NS (not significant) Surgical procedures OperationControl groupOptimisation group R/L hemicolectomy75 Sigmoid colectomy /parenteral nutrition optimal nutritional support should comprise a optimal nutritional support should comprise a combination of both enteral and parenteral routes of delivery of delivery Fast track surgery necessitates optimal nutritional/

Implementing Enteral Nutrition Therapy: Enteral Access.

Nutrition: Indications Patients unable or unwilling to consume adequate nutrition to meet metabolic requirements alone or with assistance Complement insufficient intake or increased demand Enteral Nutrition: Indications Requires total or partial GI tract function Anorexia Apoplexy Coma Sepsis Trauma/surgery Transition from parenteral nutrition Enteral Nutrition/ Indicated when PEG is contraindicated or during other surgical procedures Requires general anesthesia and full surgical team In observation during/

S&I Framework Nutrition & Diet Elements October 12, 2011.

to question 15). Not asked Nutrition Informatics Survey 2011 HIMSS Analytics IDNT-to-SNOMED Project Summary Total: 646 terms, 146 headings / as assessment: Food/Nutrition-Related History outcomes, Anthropometric measurements, Biochemical Data, Medical Tests, and Procedure Outcomes and Nutrition-Focused Physical Finding Outcomes/(Food) Goals (Nutrition Related) Patient Instructions (Food Modification/Enteral/Parenteral) Social History (Alcohol) Vital Signs (Ht/Wt/BMI with Date Stamp) Nutrition Data Elements & /

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