Parenteral nutrition Flashcards
what is the composition of IV fluids ?
water
electrolytes
glucose
Na+ and K+
when are IV fluids used?
when oral routes are not suitable for the patient.
Used to maintain hydration, organ function and metabolic activities
what are some of the negatives of IV fluids?
it cannot provide all the daily calorie intake and increasing fluids in the body can cause low sodium (hypotranemia)
how can you reach adequate calories with IV fluids ?
by infusing hypertonic glucose solution but it can cause damage to the blood vessel used
what is enteral nutrition?
it is a tube that goes through the nose and down the osophagus and is good at delivering carbohydrates, proteins, fats , vitamins, electrolytes and trace elements. As iv cannot deliver these.
why are nasogastric tubes better than nasoentric tubes?
they both offer feeding but nasogastric also can quantify gastric residuals AND are less likely to become clogged BUT are less comfortable for the patient.
what are some of the reasons for enteral feeding tubes?
- trauma
- stroke ( nurological disorders)
- oesophageal reflux disease
- Gi tract disruption
- anorexogenic encalpahy
who is enteral nutrition best for?
best for patients who have a healthy gut but cannot gain sufficient nutrition by mouth
what are the enteral nutrition routes ?
nasogastric , nasaljuogenal or gastronomy or jejustomy tubes.
what are the advantages of enteral nutrition?
- maintains a healthy gut function until normal feeding has resumed
- cheaper
- less risk of error
what are the disadvantages of enteral nutrition?
- has a high risk of infection if the tube is in place for long periods of time
when is parenteral feeding best and for which types of patients ?
best for a patient who needs long term supplement nutrition (more than 7 days)
best for patients who are unable to meet there daily nutritional requirement such as critically ill patients , preterm infants , patients with server gut dysfunction and patients who cannot tolerate enteral nutrition
what is the aim for parenteral nutrition?
to be able to provide sufficient nutrition to certain patient groups with carbs (plc and dextrose) lipids amino acids , electrolytes, vitamins, water , trace elements and even drugs
where is partial parental nutrition administered?
it is IV into the vein in the arm and bypassed the normal GI tract processes
where is total parenteral nutrition administered?
it is IV and into a vein near the heart and a mechanical pump delivers the nutrition
what are the monitoring parameters for parenteral nutrition?
- body weight
- complete blood count
- blood urea nitrogen
- glucose ; input and output monitoring for hyperglycaemia
- liver function tests
what is the best choice of nutrition for the critically ill?
enteral nutrition
what are the considerations when making a parenteral nutrition regime?
- fluid intake
- energy requirement
- nitrogen requirement ( proportion of fast , proteins and carbs
- type of IV available- central or peripheral
- heather or not a standard regime is suitable for therapy
- electrolyte and trace elements requirements
what are the considerations for fluid volume ?
- fluid assessment status has to be done before and after TPN
- no other fluid intake (2-3L)
- fluid intake must increase with burns , vomiting , diahorrea , fever, stoma, pulmonary disease, renal function decline and CHF .
what are the considerations In energy requirements ?
- calculated by age, sex and weight , height ad clinical condition
- better to under feed rather than over feed to avoid metabolic complications and organ damage
why is dextrose included in parenteral nutrition?
it is used as an energy supply instead of plc as plc can damage the BV.
use with lipids to reduce the incidence of hypoglycaemia., fatty liver and acidosis
why are lipid used in parenteral nutrition?
- a better energy source
- acts as a carreir for fat soluble vitamins (D and E)
- reduces the excessive need for glc
- provides essential fatty acids
- caution with neonates
why must lipids be handled with care in parenteral nutrition?
- take car in 3 in 1 emulsions ( dextrose , amino acids and fatty emulsions) as the STABILITY of IV fatty emulsions decreased and can cause cracking
why is nitrogen added to parenteral nutrition?
- protein source and under metabolic stress acts as an energy source
- can also be a buffer
- acts as calories so the amino acids aren’t used for energy
