Methods of Nutrition Support KNH 411. Oral diets “House” or regular diet Therapeutic diets – soft or manipulated consistency to deal with mechanical.

Slides:



Advertisements
Similar presentations
Nutrition & Diet Orders Oral Diets Qualitative (e.g. texture modifications or gluten- free) Quantitative (nutrient-level modifications, e.g. 2 gm sodium/day.
Advertisements

Nutrition & Diet Orders
Hanadi Baeissa Therapeutic Nutrition. Therapeutic nutrition = Medical nutrition therapy The role of food and nutrition in the treatment of various diseases.
Parenteral Nutrition Graphic source:
Ch. 21: Parenteral Nutrition
ENTERAL AND PARENTERAL FEEDINGS. TUBE FEEDING ENTERAL NUTRITION Definition  Feeding via tube into the gastrointestinal tract (GIT), bypassing the oral.
Enteral Nutrition NFSC 370 McCafferty A. Definition: Utilization of the GI tract to supply nutrients l l l.
Mosby items and derived items © 2005 by Mosby, Inc. Chapter 43 Nutrition.
Adult Health Nursing II Block 7.0. Parenteral Nutrition Adult Health II Block 7.0 Block 7.0 Module 1.4.
Parenteral nutrition in neonate. Goals minimizes weight loss improves growth and neurodevelopmental outcome reduce the risk of mortality and NEC.
Department of Biochemistry Faculty of Pharmacy Suez Canal University.
Prior to 1968, many chronically/critically ill pts died of malnutrition; not 1˚ condition Parenteral nutrition, meeting all or part of pts nutritional.
Mosby items and derived items © 2005, 2002 by Mosby, Inc. CHAPTER 53 Nutritional Supplements.
Methods of Nutrition Support
Nutrient Delivery  Chapter 14  J Pistack MS/Ed.
Parenteral Nutrition Designing the Solution Mark H. DeLegge, MD, FACG, AGAF, FASGE Digestive Disease Center Medical University of South Carolina.
Copyright © 2003 Delmar Learning, a Thomson Learning company Section 3 Medical Nutrition Therapy.
Intestinal Failure Unit
Presented by : Dr. Mohammad Tarawneh. The human body is an engine designed to burn fuel in order to perform work. The fuels we utilize are called nutrients.
Optimizing Nutrition Therapy
Parenteral Nutrition This session will provide an overview of parenteral nutrition. Please see the associated chapter in the Manual, titled Parenteral.
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 54 Nutritional Supplements.
Slide 1 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing.
Clinical Nutrition When animals do not fall into a “healthy” category and direct involvement with a health professional is needed.
NutritionNutrition NUR 102 Lab Module I. Enteral Nutrition Definition—administration of nutrients directly into the GI tract Beneficial when oral feedings.
-- Aim for a healthy weight. -- Become physically active each day. -- Let the (Food Guide) Pyramid guide your food choices. -- Eat a variety of grains.
MNA M osby ’ s Long Term Care Assistant Chapter 25 Nutritional Support and IV Therapy.
Parenteral NS Fluid and electrolyte requirements. Calculate enteral and parenteral formulations.
Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Focus on Tube Feeding (Relates to Chapter 40, “Nursing.
Feeding methods. Enteral & parenteral nutrition -enteral nutrition is needed for persons with underlying chronic disease or traumatic injury. -also elderly.
Adult Medical- Surgical Nursing Gastro-intestinal Module: Enteral and Parenteral Feeding.
Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 24 Nutritional Support and IV Therapy.
Metabolic Stress KNH 413 Level of injury depends on amount of calories and protein.
Methods of Nutrition Support
Chapter 9 Enteral Nutrition. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Enteral Tubes An enteral tube is a catheter, stoma, or tube.
Methods of Nutrition Support KNH 411. Oral diets “House” or regular diet In hospital for testing before any diagnoses have been made Therapeutic diets.
Enteral Nutrition Support Fluid and electrolyte requirements. Calculate enteral and parenteral nutrition formulations.
Parenteral Nutrition Chapter 15. General Comments on Parenteral Nutrition Infusion of a nutritionally complete, isotonic or hypertonic formula Peripheral.
Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 55 Nutrition Supplements.
Methods of Nutrition Support KNH 411. Oral diets “House” or regular diet Therapeutic diets Maintain or restore health & nutritional status Accommodate.
Exam 180 minutes 120 multiple choice questions-120 points -4 short answer question-60 points multiple choice-lecture 7a onwards short answer-whole year.
Lecture 10b 21 March 2011 Parenteral Feeding. Nutrients go directly into blood stream bypassing gastrointestinal tract Used when a patient cannot, due.
Dietary Modifications TUBE AND IV FEEDING. Dietary Modifications 1.Standard diet: a diet that includes all foods and meets the nutrient needs of healthy.
1 بسم الله الرحمن الرحيم. 2 Parenteral Nutrition monitoring & complication management Dr Mohammad Safarian.
© 2004, 2002 Elsevier Inc. All rights reserved. Enteral Nutrition Definition Nutritional support via placement through the nose, esophagus, stomach, or.
NUTRITION Level 3, Academic Year (AY) 1435—1436 H Ahmad Albalawi, MSN Lecturer.
Manual of I.V. Therapeutics, 6 th Edition Copyright F.A. Davis Company Copyright © F.A. Davis Company CHAPTER 12 Parenteral Nutrition.
Feeding Routes.
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 34 Nutrition.
Lecture 10b 18 March 2013 Parenteral Feeding. Parenteral Feeding (going around ie circumventing the intestine) Nutrients go directly into blood stream.
ENTERAL and PARENTERAL FEEDING
Nutrition Support for ICU Patients Enteral and Parentral Nutrition A. Afaghi, MPH, PhD Qazvin University of Medical Science, School of Medicine.
© 2007 Thomson - Wadsworth Methods of Nutrition Support Chapter 7.
Dr. Mahamed Hussein General Surgery Azadi Teaching Hospital
NUTRITION Alternative Methods.
Dr Amit Gupta Associate Professor Dept.of Surgery
Total Parenteral Nutrition
Metabolic Stress KNH 413.
Special nutritional needs
NUTRITIONAL SUPPORT IN SURGICAL PATIENTS
Metabolic Stress KNH 413 Work with hormones, proteins in the body and in nutrition therapy, immune system, and altered cellular metabolism due to stress.
Metabolic Stress KNH 413.
كارگاه آموزشي اصول حمايتهاي تغذيه اي در بيماران آي سي يو دانشگاه علوم پزشكي قزوين معاونت درمان اداره امور بیمارستانها – گروه تغذيه باليني ندا دهناد.
Nutrient Delivery To determine Kcal and protein needs, along with appropriate diet medical nutrition therapy is needed SCREEN is a series of nutrition.
Inflammatory bowel disease(IBD)-ulcerative colitis and Crohn’s
Metabolic Stress KNH 413.
Metabolic Stress KNH 413.
Metabolic Stress KNH 413 Level of injury will dictate the amount of energy/protein ** work with hormones present **imune system **Protein status **altered.
Metabolic Stress KNH 413.
Nutrition for Older Adults
Presentation transcript:

Methods of Nutrition Support KNH 411

Oral diets “House” or regular diet Therapeutic diets – soft or manipulated consistency to deal with mechanical or nutrient problems Maintain or restore health & nutritional status Accommodate changes in digestion, absorption, or organ function Provide nutrition therapy through nutrient content changes

Oral diets Changes from the house diet Caloric level Consistency Single nutrient manipulation Preparation Food restriction Number, size, frequency of meals Addition of supplements

Oral diets Texture modifications (progresses from clear liquid, to full liquid, to soft diet) Soft diets Liquid diets Clear liquid Full liquid Consider osmolality Preparation for a specific medical test

Oral Supplements Goal: Increase nutrient density without increasing volume Snacks Liquid meal replacement formulas Modular products Commercial supplements

Appetite Stimulants Drugs that stimulate appetite Prednisone Megestrol acetate Dronabinol

Administration of nutrients with therapeutic intent Enteral- if the gut works, use it (should be primary way of feeding) Parenteral- used if the gut is not working Ethical considerations Specialized Nutrition Support (SNS)

© 2007 Thomson - Wadsworth

Enteral Nutrition Feeding through the GI tract via tube, catheter or stoma delivering nutrients distal to oral cavity “Tube feeding”- feed by tube through nose to stomach/small intestine Indicated for patients with functioning GI but unable to self- feed Contraindications- if vomiting or diahhrea occur Advantages- cost, improve wound healing, maintain GI function Disadvantages- discomfort, infection, difficult to administer/placement complications

Enteral Nutrition Decisions for the nutrition prescription GI access Formula Feeding technique Equipment needed

Enteral Nutrition GI Access Access route described by where it enters the body and where the tip is located Nasogastric- nose (adv: patient can still talk) Orogastric- mouth Nasointestinal- nose to jejunum in small intestine Typically used for short term Disadvantages- discomfort, tubes can clog

Enteral Nutrition GI Access – “Ostomy” Gastrostomy Jejunostomy PEG- months, years, lifetime More permanent

© 2007 Thomson - Wadsworth

Enteral Nutrition Formulas Based on substrates, nutrient density, osmolality, viscosity Protein Soy or casein 10-25% kcal Elemental or chemically defined- protein from peptides Specialized amino acid profiles- renal formulas, status- post for healing (in a stress state)

Enteral Nutrition Formulas- when GI tract is compromised Carbohydrate Monosaccharides, oligosaccarides, dextrins, maltodextrins Lactose & sucrose free FOS- help with intestinal function Fiber- soluble, improved bowel function May use insoluble- soy polysaccharides Constipation big concern

Enteral Nutrition Formulas Lipid Corn or soy oil Long- and medium-chain TG Omega-3 fatty acids- improve immune function Structured lipids- fish oils

Enteral Nutrition Formulas Vitamins and minerals Meet DRI with 1500 cc Supplemental amounts Fluid and nutrient density kcal per mL Difference depends on water content Ensure adequate fluid - 80% water for 1 kcal per mL Osmolality- (enteral) number of osmoles attracting molecules per water weight Osmolarity- number of milimole in liquid per liter of solution

Enteral Nutrition Formulas Other considerations Which type of formula works best for the patient Considered medical food – not drug No test for efficacy or benefit Cost

© 2007 Thomson - Wadsworth

Enteral Nutrition Feeding techniques/ delivery methods Bolus feedings cc, 3-6 times per day Intermittent feedings Feeding for mins X times per day Continuous feedings Only for hospital bound or can’t Tolerate other forms © 2007 Thomson - Wadsworth

Enteral Nutrition Equipment Feeding tubes - french size Cans or sealed containers Pumps

Enteral Nutrition Determining the nutrition prescription -clinical application -Steps for writing an enteral prescription 1.Dose weight 2.Calorie goal 3.Adjust for activity factor or injury 4.Calculate protein 5.State total calorie amount 6.Calculate calories from lipid 7.Calculate calories from carbohydrate 8.Electrolyte needs 9.Vitamin and mineral needs 10.Look at fluids

Enteral Nutrition Complications Mechanical complications Clogged or misplaced tubes GI complications Diarrhea Aspiration

Enteral Nutrition Monitoring for complications Dehydration Tube Feeding Syndrome Electrolyte Imbalances Underfeeding or Overfeeding Hyperglycemia Refeeding Syndrome Monitor serum phosphorus, mg, potassium, monitor pre- albumin, phosphorus levels Don’t overfeed client too quickly

Parenteral Nutrition Administration by “vein” a.k.a. – PN, TPN, CVN, IVH TPN vs. PPN Indicated if unable to use oral diet or enteral nutrition Certification of medical necessity

Parenteral Nutrition Venous access Short-term access CVC inserted percutaneously- most common can be placed at bedside Using subclavian, jugular, femoral veins PICC- per. Inserted central catheter Long-term access- requires surgery- cannot be done at bedside Tunneled catheters Implantable ports

© 2007 Thomson - Wadsworth

Parenteral Nutrition Solutions- hand in hand with the pharmacy Compounded by pharmacist using “clean room” Two-in-one Dextrose & amino acids- hung, clear solution Lipids added separately- 100 cc, 250 cc, or 500 cc Clear - easier to identify precipitates Can make sure none of the minerals fall out of solution Three-in-one Dextrose, amino acids, & lipids Single administration Cloudy solution- minerals can fall out, not concerned about calcium and phosphorus No other line- less opportunity for infection Cost, easy to use, used for someone that is stable

Parenteral Nutrition Solutions Protein- 3 (PPN) -20 (CONSENTRATED solution)% Individual amino acids Modified products for renal, hepatic and stress Commercial amino acids % g/kg depending on condition.8-??? For normal after surgery,burns trauma 4 calories/gram of amino acid Restrict with renal- look at BUN, creatinin

Parenteral Nutrition Solutions Carbohydrates Energy source – dextrose monohydrate 3.4 kcal/g 1 mg/kg/min minimum Use in ICU setting 5%, 10 (normal) %, 50%, 70 (small volumes of PN) % concentrations Grater than 10% need TPN

Parenteral Nutrition Solutions Lipids Emulsion of soybean or safflower oil Essential fatty acids Should be grams per kilo- no more than 60% grater than coming from FA Source of energy Minimum of 10% kcal (have 1.1 calorie per cc of solution) 20% has 2 calories per cc of solution 30% has 3 calories per cc of solution (rare) EFA need to be present after a month or so, a few weeks is not a huge deal

Parenteral Nutrition Solutions Electrolytes- not premade vila 1-2 ME per kilo, Na & K Cl or acetate- pH balance to determine ME per kilo, Ca 4-10 ME per kilo, Mg ME per kilo, P DRI standards used Vitamins/Minerals- premade vial- standard A,C,D,E,K,Bvit complex Trace minerals- Zn, Cu, Cr, I, Mb Medications- could add insulin, albumin, could have drug nut interactions

© 2007 Thomson - Wadsworth

Parenteral Nutrition Determining the nutrition prescription – clinical application - sample form

Parenteral Nutrition Administration techniques Initiate 1 L first day; increase to goal volume on day 2 Patient monitoring Intake vs. output Laboratory monitoring

Parenteral Nutrition Complications GI complications- long term GI complications- lack of GI use- billirubin increasing- increased bacteria- get them back on oral feels ASAP Infections- can occur at the site (must replace line in a different area) Cycle the TPN