Download Methods of Nutrition Support

Methods of Nutrition Support
KNH 411
Oral diets
 “House” or regular diet
 Therapeutic diets
 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
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Caloric level
Consistency
Single nutrient manipulation
Preparation
Food restriction
Number, size, frequency of meals
Addition of supplements
Oral diets
 Texture modifications
 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
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Snacks
Liquid meal replacement formulas
Modular products
Commercial supplements
Appetite Stimulants
 Drugs that stimulate appetite
 Prednisone
 Megestrol acetate
 Dronabinol
 Marijauna may help as well
 For cancer patients
Specialized Nutrition Support (SNS)
 Administration of nutrients with therapeutic intent
 Enteral
 Being first method
 If the gut works use it!
 Parenteral
 Ethical considerations
© 2007 Thomson - Wadsworth
Enteral Nutrition
 Feeding through the GI tract via tube,
catheter or stoma delivering nutrients distal
to oral cavity
 “Tube feeding”
 Indicated for patients with functioning GI
but unable to self-feed
 Contraindications
 Advantages / Disadvantages?
Enteral Nutrition
Decisions for the nutrition prescription
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GI access
Formula
Feeding technique
Equipment needed
Enteral Nutrition
GI Access
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Access route described by where it enters the body and
where the tip is located
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Nasogastric: patient can talk
Orogastric
Nasointestinal: basically going for the nose to the
duodenum to the jejunum
Typically used for short term
Disadvantages?
Enteral Nutrition
GI Access
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– “Ostomy”
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Gastrostomy
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Jejunostomy
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PEG
More permanent
© 2007 Thomson - Wadsworth
Enteral Nutrition
Formulas
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Based on substrates, nutrient density, osmolality,
viscosity
Protein
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Soy or casein 10-25% kcal
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Elemental or chemically defined
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Specialized amino acid profiles
Enteral Nutrition
Formulas
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Carbohydrate
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Monosaccharides, oligosaccarides, dextrins, maltodextrins
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Lactose & sucrose free
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FOS
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Fiber ?
Enteral Nutrition
Formulas
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Lipid
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Corn or soy oil
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Long- and medium-chain TG
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Omega-3 fatty acids
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Structured lipids
Enteral Nutrition
Formulas
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Vitamins and minerals
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Meet DRI
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Supplemental amounts
Fluid and nutrient density
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1.0-2.0 kcal per mL
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Difference depends on water content
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Ensure adequate fluid - 80% water for 1 kcal per mL
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Osmolality and osmolarity
Enteral Nutrition
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Formulas
 Other considerations
 Considered medical food – not drug
 No test for efficacy or benefit
 Cost
© 2007 Thomson - Wadsworth
Enteral Nutrition
 Feeding techniques/ delivery
methods
 Bolus feedings
 Intermittent feedings
 Continuous feedings
© 2007 Thomson - Wadsworth
Enteral Nutrition
 Equipment
 Feeding tubes - french size
 Cans or sealed containers
 Pumps
Enteral Nutrition
 Determining the nutrition prescription
- clinical application
Enteral Nutrition
 Complications
 Mechanical complications
 Clogged or misplaced tubes
 GI complications
 Diarrhea
 Aspiration
 Refluxing some of the formula
Enteral Nutrition
 Monitoring for complications
 Dehydration
 Tube Feeding Syndrome
 Loosing of ccs of fluid via dehydratio
 Electrolyte Imbalances
 Underfeeding or Overfeeding
 Hyperglycemia
 Increase glucose increased triglycerides increased LFTS
 Refeeding Syndrome
 Monitor serum phosphorus, mg, potassium
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 and can be placed at bedside with local
anesthia
 Using subclavian, jugular, femoral veins
 PICC
 Long-term access—requires surgery and can not be done at
bedside
 Tunneled catheters
 Lie completely below the skin
 Implantable ports
© 2007 Thomson - Wadsworth
Parenteral Nutrition
 Solutions
 Compounded by pharmacist using “clean room”
 Two-in-one
 Dextrose & amino acids
 Lipids added separately- piggy back seperately
 Clear - easier to identify precipitates
 Three-in-one
 Dextrose, amino acids & lipids
 Single administration
Parenteral Nutrition
 Solutions
 Protein
 Individual amino acids
 Modified products for renal, hepatic and stress
 Commercial amino acids 3.5-20%
 .8- 1.8 g/kg depending on condition
Parenteral Nutrition
 Solutions
 Carbohydrates
 Energy source – dextrose monohydrate
 3.4 kcal/g
 1 mg/kg/min minimum
 5%, 10%, 50%, 70% concentrations
Parenteral Nutrition
 Solutions
 Lipids
 Emulsion of soybean or safflower oil
 Essential fatty acids
 Source of energy
 Minimum of 10% kcal
Parenteral Nutrition
 Solutions
 Electrolytes
 DRI standards used
 Vitamins/Minerals
 Trace minerals
 Medications
© 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
 Infections