Mosby items and derived items © 2005, 2002 by Mosby, Inc. CHAPTER 53 Nutritional Supplements

Mosby items and derived items © 2005, 2002 by Mosby, Inc. What to Know About

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nutritional Supplements Dietary products used to provide nutritional support Can be given in a variety of ways Vary in amounts and complexity of carbohydrates, protein, and fat content Electrolytes, vitamins, minerals, and osmolality may also vary

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nutritional Supplements (cont'd) Malnutrition: the body’s nutritional needs are not met by nutrient intake Enteral nutrition –Provision of food or nutrients through the GI tract Parenteral nutrition –Nutrients are delivered directly into the circulation by means of an intravenous solution

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Enteral Nutrition Provision of food or nutrients through the GI tract Oral consumption is the most common and least invasive route Feeding tubes through various routes can be used for enteral nutrition

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Enteral Nutrition (cont'd) Feeding tubes are used for those with: –Abnormal esophageal or stomach peristalsis –Altered anatomy secondary to surgery –Depressed consciousness –Impaired digestive capacity

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Four Enteral Formulation Groups Provide the basic building blocks for anabolism Supply complete dietary needs through the GI tract by oral route for by feeding tube –Elemental –Polymeric –Modular –Altered amino acid

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Enteral Formulation Group: Elemental Vivonex Plus, Peptamen, Vital HN Minimum digestion needed; residual is minimal Used for partial bowel obstruction, irritable bowel disease, other conditions Hyperosmolarity of formulas may cause GI problems

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Enteral Formulation Group: Polymeric Complete, Ensure, Ensure-Plus, Isocal, Osmolite, Sustacal Preferred over elemental formulations for patients with fully functional GI tracts and few specialized nutrient requirements; causes fewer GI problems

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Enteral Formulation Group: Modular Three types –Carbohydrate: Moducal, Polycose –Fat: MICT oil, Microlipid –Protein: Casec, ProMod, Stresstein Single nutrient formulas Can be added to other formulas if needed

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Enteral Formulation Group: Altered Amino Acid Amin-Aid, Hepatic-Aid, Lonalac, Stresstein, Travasorb Renal Contain varying amounts of specific amino acids Used for patients with genetically altered metabolism problems

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Enteral Nutrition Interactions Various nutrients can interact with drugs to produce significant food-drug interactions Enteral nutrition can delay absorption of some medications Enteral nutrition may inactivate some medications (i.e., tetracycline and nutrient formulations that contain calcium)

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Parenteral Nutrition Totally digested nutrients are given intravenously, directly into the circulatory system The entire GI system is bypassed, eliminating the need for absorption, metabolism, or bowel elimination

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Parenteral Nutrition (cont'd) Amino acids –Nonessential amino acids –Essential amino acids –Semiessential amino acids Trace elements –Chromium– Copper –Iodine– Manganese

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Parenteral Nutrition (cont'd) Also known as total parenteral nutrition (TPN) or hyperalimentation Formulations will vary according to individual patient nutritional needs –Amino acids –Carbohydrates –Lipids –Trace elements

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Figure 53-2 One gram of dextrose, fat, or protein will provide varying amounts of energy as calories.

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Parenteral Nutrition (cont'd) Peripheral administration –Temporary, short term (less than 2 weeks) –Dextrose concentration generally less than 10% Central administration –Long-term use (7 to 10 days) –Dextrose concentrations may be 10% to 50%

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Peripheral TPN Used to provide nutrients to patients who need more nutrients than present oral intake can provide –Procedures that restrict oral feedings –Anorexia caused by chemotherapy or radiation treatments –GI illnesses that prevent oral food intake –After surgery –When nutritional deficits are minimal, but oral nutrition will not be started for more than 5 days

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Peripheral TPN: Side/Adverse Effects PHLEBITIS is the most devastating adverse effect –Can lead to loss of a limb Fluid overload

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Central TPN Delivered through a large central vein –Subclavian –Internal jugular Long-term use (more than 7 to 10 days)

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Central TPN (cont'd) Disadvantages are the risks associated with central line insertion, use, and maintenance Higher risk for infection, catheter- induced trauma, metabolic alterations

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Central TPN (cont'd) Delivers total dietary nutrients to patients who require nutritional supplementation –Patients with large nutritional requirements (metabolic stress or hypermetabolism) –Patients who need nutritional support for more than 7 to 10 days –Patients who are unable to tolerate large fluid loads

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Central TPN: Side/Adverse Effects Most common are those surrounding the use of the central line for the delivery of TPN –Infection –Catheter-induced trauma Greater chance for hyperglycemia due to the larger and more concentrated volumes given

Mosby items and derived items © 2005, 2002 by Mosby, Inc. 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

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nursing Implications Assess baseline laboratory studies, such as total protein, albumin, BUN, RBC, WBC, cholesterol, etc. Collect anthropometric data Assess for allergies to components of enteral nutritional supplements (such as whey, egg whites) Assess for lactose intolerance

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nursing Implications If administering enteral nutrition by tube feedings, follow facility policy for ensuring proper tube placement and for checking residual before giving a feeding Follow procedures for flushing tubing to prevent clogging the feeding tube with formula

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nursing Implications Monitor how the patient is tolerating enteral feedings carefully Most enteral feedings are started slowly and the rate is increased gradually Monitor for signs of lactose intolerance –Cramping, diarrhea, abdominal bloating, flatulence

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nursing Implications Follow facility policies and procedures for care and maintenance of TPN IV lines, including tubing changes Monitor patient’s temperature; report any increase immediately

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nursing Implications Monitor blood glucose levels with a glucometer Monitor for hyperglycemia –Headache, dehydration, weakness Monitor for hypoglycemia –Cold, clammy skin, dizziness, tachycardia, tingling of the extremities

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nursing Implications While on TPN, the pancreas is providing increased amounts of insulin to cover the increased glucose levels If TPN is discontinued abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels If TPN must be discontinued abruptly, then infuse 5% to 10% glucose to prevent hypoglycemia

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nursing Implications Monitor for fluid overload while on TPN –Weak pulse, hypertension, tachycardia, confusion, decreased urine output, pitting edema Monitor daily weights and intake and output volumes

Mosby items and derived items © 2005, 2002 by Mosby, Inc. Nursing Implications Monitor for therapeutic responses to nutritional supplementation –Improved well-being, energy, strength, and performance of activities of daily living –Increased weight –Laboratory studies that reflect a more positive nutritional status