Parenteral nutrition, Flashcards
what is the diagnostic criteria for needing parenteral nutrition
2+ of the following:
1. Insufficient caloric (energy) intake (estimated from dietary recall)
2. Weight loss (based on objective measurement of weight)
3. Loss of muscle mass (temporal/interosseous muscle wasting; clavicular prominence)
4. Loss of subcutaneous fat (cheeks/orbital area, or space between thumb and forefinger)
5. Localized or generalized fluid accumulation, that may mask weight loss (pitting edema)
6. Diminished functional status (assessed by handgrip strength with a dynamometer)
what can happen when you give excess carbohydrates to patients with lung disease
increased carbs = hyperglycemia = excess carbon dioxide production.
can cause respiratory acidosis
what equations can be used to determine nutrition requirements
- Harris Benedict Equation
- Mifflin-St. Jeor Equation
what can long-term overfeeding lead to
- hepatic steatosis
- ureagenesis
- immunosuppression (esp with lipid overload)
how much protein is required for the typical patient who is hospitalized
between 1.2 and 1.5 g/kg/day
how much protein is required for burn patients? what about critically obese patients?
- burn patients - up to 2 g/kg/day
- critically obese - up to 2.5 g/kg/day
when should you initiate parenteral or enteral nutrition?
Only after 7-10 days with no oral intake, and only if its going to be used for at least 5-10 days
what is enteral nutrition
tubes entering the GI system directly at the stomach or small intestines
if the gut works, use it!!
what are contraindications to enteral nutritions
- GI hemorrhage
- peritonitis
- severe ileus
- bowel obstruction
- fistula distal to access site
- intestinal ischemia
- malabsorptive disorders with high volume diarrhea
what are possible symptoms of intolerance for enteral nutrition
- N/V
- diarrhea
- abdominal pain
- bloating
if symptoms of intolerance develop, what is the treatment
hold feedings until symptoms resolve.
if symptoms persist an alternate route must be explored
patients who cannot tolerate enteral nutrition should be considered for parenteral nutrition
why is enteral nutrition preferred over parenteral nutrition
PN is associated with high rates of infectious and metabolic complications such as volume overload, hyperglycemia, and electrolyte abnormalities
what is refeeding syndrome
characterized by electrolyte abnormalities that occur during the reinstitution of carbohydrate calories to a starved patient.
serum mag, phos, potassium depletion
