oral and parenteral nutrition Flashcards
define malnutrition
deficiency or excess of energy and nutrients
define cachexia
gerneral weight loss and wasting occurring in the course of a chronic or emotional disease
define nutrition support
provision of enteral or parenteral nutrients to treat or prevent nutrition
define enteral nutrition
feeding tube placed in Gi tract to deliver liquid formulas containing all essential nutrients
define parenteral nutrition
infusion of complete nutrient solutions into the bloodstream
prevalence of malnutrition *
malnutrition at admission is prevalent and associated with prolonged length of stay
complex disease and age related social factors are contributors
complications of malnutrition *
impaired immune response reduce muscle strength and fatigue reduced respiratory muscle function impaired thermoregulation impaired wound healing and delayed recovery depression increased risk of admin to hospital and LOS poor libido, fertility
nutritionally high risk patients
diagnosis of malnutrition significant weight loss conditions requiring increase calories BMI less than 18.5/23 intak eless than 50% of estimated energy needed for >3 days
diet suggestions for malnourished
promote intake of nutrient dense food liberalize diet preferred foods high energy protein shakes or drinks between meals snacks between meals
3 types of tube feedings
continuous
cyclic - over fixed period over night usually
bolus - 4-6 timesa day to mimic normal eating patterns
when do you use enteral nutrition *
oral intake inadequate or not recommended for long period of time
malnourished - after 2-5 days
prolonged inadequate intake - 7-10 days
why is enteral preferred over parenteral when the Gi tract is functioning *
more convenient lower cost decreased infectious complications may enhance immune function, maintain gut flora decrease metabolic complications allow access for meds
complications of enteral
NV
aspiration
refeeding
metabolic complications
contraindications of enteral
perforation of GI
mechanical or non-mechanical bowel obstruction
inability to access GI tract
GI ischemia
polymeric formualtion
intact milk or soy proetin based
elemental formulation
free amino acids or short chain peptides
incorrect med admin results in
clogged feeding tubes
decreased drug effectiveness
increase adverse effects
drug formula incompatibilities
how can you administer meds *
liquid dosage form when possible
dilute hypertonic meds wiht 10-30ml
crush tablets to powder and mix with 30ml water
administer each drug separately
flush tube with 15ml warm water before, 5ml between each drug, 15ml after last med given
indications of parenteral
where Gi tract not functional or cant be accessed
patient who cant be adequately nourished by oral diets or enteral
inadequate oral intake for 7-14 days
4 conditions that indication parenteral
Gi ischemia
small bowel/intestinal obstruction
GI fistula
short bowel syndrome
components of total peripheral nutrition
dextrose amino acids lipids electrolytes trace elements multivitamins
energy requirements
25-30 kcal/kg
fluid requirements
30ml/kg
what are the electrolytes
Na K Cl Ca phosphate Mg
what must you keep separate in TPN
phosphate and calcium
how does osmolarity determine route of admin
under 900 mOsm/L for peripheral
2 in 1 parenteral nutrition
mixture of dextrose and amino acids with lipids infused separately
medications that can be added to TPN
special insulin
ranitidine
zinc
iron
complications of TPN
infections blood clots foreign body in vascular hyperglycemia refeeding increased triglycerides hepatotoxicity fluid overload metabolic acidosis/alkalosis osteomalacia
what is cycling TPN
admin of full PN over the shortest tolerable time
role of pharmacist
asses patients nutritional status, comorbid disease states, medications
work with team to determine if TPN appropriate
review clinical parameters and make recommendations
work with team to manage complications
what is refeeding
intracellular shift of serum phosphorus as metabolism starts
stimulates insulin and internal transport of K and Mg
increased sodium and fluids
