Chapter 55 Pharmaconutrition Flashcards
Anabolism
Constructive metabolism characterized by the conversion of simple substances into more complex compounds of living matter
Catabolism
A complex metabolic process in which energy is liberated for use in work, energy storage, or heat production by the destruction of complex substances by living cells to form single compounds
Dumping syndrome
A complex bodily reaction to the rapid entry of concentrated nutrients into the jejunum of the small intestine
Enteral nutrition
The provision of food or nutrients via the GI tract, either naturally by eating or through a feeding tube in patients unable to eat
Essential amino acids
Amino acids that cannot be manufactured by the body
Essential fatty acid deficiency
A condition that develops if fatty acids that the body cannot produce are not present in the diet or in nutritional supplements
Hyperalimentation
Term formerly used to refer to parenteral nutrition; it is now discouraged and may be misinterpreted as overfeeding
Parenteral nutrition
Nutrients are delivered directly into the circulation by means of an intravenous solution
- The entire GI system is bypassed, eliminating the need for absorption, metabolism, or bowel elimination
- Formulations vary depending on the persons nutritional needs
- total parenteral nutrition (TPN)
- Central is used more than peripheral
Feeding tubes
- Feeding tubes through various routes can be used for enteral nutrition
- Used for Abnormal esophageal or stomach peristalsis, Altered anatomy secondary to surgery, Depressed consciousness, Impaired digestive capacity
Enternal formulation groups
- Elemental (Vivonex Plus, Peptamen, Vital HN) and is used for malabsorption, partial bowel obstruction, irritable bowel disease, other conditions
- Polymeric (Ensure) and is used for patients with fully functional GI tracts and few specialized nutrient requirements; cause fewer GI problems
- Modular (carbs, proteins, fats) is a single nutrient formula. Can be added to other nutrients.
- Altered amino acid (Magnacal Renal, Traumacal, Ultracal High Nitrogen, Vital High Nitrogen) and is used for Are used for patients with diseases associated with altered metabolism capabilities
- Impaired glucose tolerance (Glucerna) contains Contains proteins, carbohydrates, fat, sodium, potassium and is used in patients with impaired glucose tolerance
Central TPN
- Delivered through a large vein
- Most common risk is infection
- Used for long term (more than 2 weeks)
Nursing implications
- Ensure that a complete nutritional assessment is taken, including a dietary history, weekly and daily food intakes, and weight and height measurements
- Consult with a registered dietitian
- Assess baseline laboratory studies, such as total protein, albumin, urea, red blood cell count, white blood cell count, cholesterol
- Assess for allergies to components of enteral nutritional supplements (such as whey, egg whites)
- Assess for lactose intolerance
- Check residual stomach acids by withdrawing some fluid before a feeding. Use a litmus paper to check for the acidity
- Follow procedures for flushing tubing to prevent clogging the feeding tube with formula
- Adverse effects include Cramping, diarrhea, abdominal bloating, flatulence
Nursing implications for TPN
- Monitor blood glucose levels with a glucometer because they have a higher chance of developing glucose intolerance
- While a patient is on TPN, the pancreas is providing increased amounts of insulin to cover the increased glucose levels. Never stop TPN abruptly, but if it must be be done infuse 5 to 10% glucose to prevent hypoglycemia
- Monitor for fluid overload while on TPN and watch for Weak pulse, hypertension, tachycardia, confusion, decreased urine output, pitting edema
- Monitor daily weights and intake and output volumes
