Parenteral Nutrition in Practice Flashcards
what are the ways we can artifically feed patients?
PPN TPN nasogastric tube gastrostomy tube jejunostomy tube nasojejunal tube nasoduodenal tube
what is enternal nutrition? when is it used?
enteral nutrrition delivered into the gut by a tube is used where nutrition cannot be taken normally by mouth, but the gut is otherwise
working.
what are some examples of when enteral nutrition is needed?
–Strokes or other neurological conditions which impair swallowing
–After some types of operations on the face, neck, throat, gullet or stomach
–Blockages of the gullet or stomach
–After radiotherapy to the throat or gullet
what is PN?
nutrition solution for IV admin
what makes up PN?
–Carbohydrate: 60-70%
–Fat: 30-40%
–Protein: 1g protein/30-40kcal from non-protein
sources
–Electrolytes, minerals, vitamins, trace elements
who can get PN?
PN is a POM and therefore needs to be
prescribed by a Dr or an approved prescriber
what are the indications for PN for adults?
consider parenteral nutrition in people who are malnourished or at risk of malnutrition:
–a BMI of less than 18.5 kg/m2
–unintentional weight loss greater than 10% within the last 3–6 months
–a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.
–have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for the next 5 days or longer
–have a poor absorptive capacity, and/or have high nutrient losses
and/or have increased nutritional needs from causes such as catabolism.
what other reasons would PN be given?
–inadequate or unsafe oral and/or enteral nutritional intake
–a non-functional, inaccessible or perforated (leaking) gastrointestinal tract
what should people who are not severely injured, ill nor at risk of refeeding syndrome, the suggested nutritional prescription for total intake should provide?
•25–35 kcal/kg/day total energy (including that derived from protein)
•0.8–1.5 g protein (0.13–0.24 g nitrogen)/kg/day
•30–35 ml fluid/kg (with allowance for extra losses from drains and fistulae, for example, and extra input from other
sources – for example, intravenous drugs)
•adequate electrolytes, minerals, micronutrients (allowing
for any pre-existing deficits, excessive losses or increased demands) and fibre if appropriate
how should nutritional support be administered in seriously ill patients/ injured?
It should be started at no more than 50% of the estimated target
energy and protein needs.
•It should be built up to meet full needs over the first 24–48 hours according to metabolic and GI tolerances
how should people who have eaten little or nothing for more than 5 days have nutritional support introduced?
ntroduced at no more than 50% of
requirements for the first 2 days, before increasing feed rates to meet full needs if clinical and biochemical monitoring reveals no refeeding problems.
what are the indications you would used PN for paedratics?
–Prematurity –Gastrointestinal tract anomalies –Low birth weight infants –Major surgery –Inflammatory bowel disease –Respiratory disorders –Sepsis –Burns –Major trauma –Mucositis and malabsorption
how do hospital patients energy requirements differe in paeds?
–Reduced physical activity
–Energy losses from ostomies, malabsorption,
diarrhoea, infection
what is the energy requirement for paeds?
–Pre-term: 110-120kcal/kg/day
–0-1yrs: 90-100kcal/kg/day
what are the fluid requirements for paed patients?
Holliday–Segar formula
•100 ml/kg/day for the first 10 kg of weight,
•50 ml/kg/day for the next 10 kg
•20 ml/kg/day for the weight over 20 kg
