MAIN FEATURES. OF THE PEP up PROTOCOL. All patients will receive Peptamen 1.5 initially. All patients will start on Beneprotein
|
|
- Lisa Cox
- 5 years ago
- Views:
Transcription
1
2 MAIN FEATURES OF THE PEP up PROTOCOL All patients will receive Peptamen 1.5 initially All patients will start on Beneprotein - 2 packets (14 g) mixed in 120ml water administered bid via NG All patients will be given metoclopramide on day 1 of enteral feeding - 10 mg IV q 6h * Reassess formula, protein supplement, and motility agent daily
3 GET PEPPED UP! OPTION 1: Begin Volume-Based feeds 24 hour period begins at XX:XX h daily Patients receive Peptamen 1.5 initially Day 1: start feeding at 25 ml/hr Day 2: Feeding rate determined by 24hr target volume Consult dietitian to calculate 24hr target volume (if RD not available, use weight based goal until patient assessed) Determine hourly rate as per Volume Based Feeding Schedule Monitor gastric residual volumes as per Gastric Feeding Flowchart and Volume Based Feeding Schedule
4 GET PEPED UP! OPTION 2: Trophic feeds Begin Peptamen 1.5 at 10 ml/h after initial tube placement confirmed Do not monitor gastric residual volumes Reassess ability to transition to Volume-Based feeds next day 2 tsp per hour
5 GET PEPPED UP! OPTION 2: Trophic feeds Intended for patient who is: On vasopressors (regardless of dose) as long as they are adequately resuscitated Not suitable for high volume enteral feeding: Ruptured AAA Surgically placed jejunostomy Upper intestinal anastomosis Impending intubation
6 GET PEPPED UP! OPTION 3: NPO Only if contraindication to EN present: bowel perforation, bowel obstruction, proximal high output fistula. Recent operation and high NG output are not a contraindication to EN. Reassess ability to transition to Volume-Based feeds next day.
7 GASTRIC FEEDING FLOWCHART Place feeding tube or use existing gastric drainage tube. X-ray to confirm placement (as required) Replace 300 ml of aspirate, discard remainder. Reduce rate by 25 ml/h to no less than 10 ml/h. Step 1: Start metoclopramide 10 mg IV q 6 hr. If already prescribed, go to Step 2. Elevate head of bed to 45 (or as much as possible) unless contraindicated. Start feed at initial rate or volume ordered. Step 2: Consider adding erythromycin 200 mg IV q12h (may prolong Qt interval). If 4 doses of erythromycin are ineffective, go to Step 3. Step 3: Consider small bowel feeding tube placement and discontinue motility agents thereafter. Measure gastric residual volumes q4h. Is the residual volume > 300 ml? NOTE: Do not aspirate small bowel tubes. NO YES Replace up to 300mL of aspirate, discard remainder. Set rate of EN based on remaining volume and time until X am (max rate 150mL/hr). Reassess motility agents after feeds tolerated at target rate for 24 hours. NO YES Was the residual volume greater than 300 ml the last time it was measured?
8 CASE STUDY 73 year old male is admitted to ICU at 2100 hours with a three day history of shortness of breath and weakness.
9 CASE STUDY: He is in respiratory distress with oxygen saturations of 88% on 15 liters with a respiratory rate of 36/min He is intubated and placed on FiO2 of 50%, PEEP 15 and PSV of 12 His saturations have improved and his respiratory rate is 14/min
10 CASE STUDY: His past medical history is significant for COPD and alcohol dependence He is admitted to ICU with a diagnosis of community acquired pneumonia He does not have bowel sounds and is NPO His weight is 75kg and height is 1.8m
11 CASE STUDY: ADMISSION What do you anticipate will be ordered for feeding on admission? A. B. C. D. NPO because no Bowel Sounds Volume based feeding because he is not receiving any vasopressors Start trophic feeds at rate per PEP up protocol Start metoclopramide and wait for bowel sounds
12 CASE STUDY: ADMISSION What do you anticipate will be ordered for feeding on admission? A. B. C. D. NPO because no Bowel Sounds Volume based feeding because he is not receiving any vasopressors Start trophic feeds at rate per PEP up protocol Start metoclopramide and wait for bowel sounds
13 CASE STUDY: PEP up Initial Orders: Protein Supplements Does he require protein supplements? A. B. Yes. He requires protein supplements because we want to avoid a nutrition deficit. No. Protein supplements are not required because he is a new admission.
14 CASE STUDY: PEP up Initial Orders: Protein Supplements Does he require protein supplements? A. Yes. He requires protein supplements because we want to avoid a nutrition deficit. B. No. Protein supplements are not required because he is a new admission.
15 CASE STUDY: Admission Orders The resident orders volume-based feeds for him because he is adequately volume resuscitated and is not receiving vasopressors It is now 2200 hours
16 CASE STUDY: Volume-based feeds: Getting Started For day 1 only, feeds will start at 25 ml/h Day 1 is only 9 hours long, and ends when the flow sheet for that day ends On day 2, volume-based feeds begin
17 CASE STUDY: Setting the 24 hour rate At 0700 hours, a dietitian still has not yet assessed the patient. You will recalculate the hourly enteral feeding rate for the next 24 hours, or until he is reassessed at rounds. What will the new rate be? A. B. C. D. 46 ml/hr 62 ml/hr 67 ml/hr 70 ml/hr
18 CASE STUDY: Setting the 24 hour rate At 0700 hours, a dietitian still has not yet assessed the patient. You will recalculate the hourly enteral feeding rate for the next 24 hours, or until he is reassessed at rounds. What will the new rate be? A. B. C. D. 46 ml/hr 62 ml/hr 67 ml/hr 70 ml/hr
19 CASE STUDY: Admission Day 2 He continues to receive volume based feeds per PEP up protocol. He has developed diarrhea and is having 4 to 5 loose stools per day. Which of the following would be an appropriate action? A. B. C. D. Stop the tube feeds Stop the metoclopramide Implement the diarrhea management guidelines Increasing the tube feeding rate
20 CASE STUDY: Admission Day 2 He continues to receive volume based feeds per PEP up protocol. He has developed diarrhea and is having 4 to 5 loose stools per day. Which of the following would be an appropriate action? A. B. C. D. Stop the tube feeds Stop the metoclopramide Implement the diarrhea management guidelines Increasing the tube feeding rate
21 CASE STUDY: Admission Day 3 He is now receiving 1500 ml in 24 hours volume based feeding after the dietitian reassessed. The feeds were stopped while going for a test and were not started upon return to the unit. At 1700h the feeds have been off for 4 hours. What rate will you run the feeds for the remainder of the time? A. B. C. D. 62 ml/hr 75 ml/hr 80 ml/hr 115 ml/hr
22 CASE STUDY: Admission Day 3 He is now receiving 1500 ml in 24 hours volume based feeding after the dietitian reassessed. The feeds were stopped while going for a test and were not started upon return to the unit. At 1700h the feeds have been off for 4 hours. What rate will you run the feeds for the remainder of the time? A. B. C. D. 62 ml/hr 75 ml/hr 80 ml/hr 115 ml/hr
23
Second Generation Enteral Nutrition Feeding Protocols: Taking us the the next level of performance
Second Generation Enteral Nutrition Feeding Protocols: Taking us the the next level of performance Mr CD 47 renal transplant Severe CAP Septic shock, ARDS, MODs Requires vasopressors for days Admitting
More informationDivision of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Enteral Nutrition Algorithm Clinical Practice Guideline
Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Enteral Nutrition Algorithm Clinical Practice Guideline Original Date: 08/2011 Purpose: To promote the early use of
More informationFeeding Protocols Enteral or Parenteral. AM Poleÿ 2012
Practical aspects on Feeding Protocols Enteral or Parenteral AM Poleÿ 2012 Enteral Feeding Facts A reduction in mortality Prophylaxis for stress ulcers Full-strength Time to start enteral nutrition If
More informationVanderbilt University Medical Center Trauma ICU Nutrition Management Guidelines
Vanderbilt University Medical Center Trauma ICU Nutrition Management Guidelines Trauma Critical Care Nutrition Guidelines Clinical judgment may supersede guidelines as patient circumstances warrant ASSESSMENT
More informationSTRATEGIES TO IMPROVE ENTERAL FEEDING TOLERANCE. IS IT WORTH IT? ENGELA FRANCIS RD(SA)
STRATEGIES TO IMPROVE ENTERAL FEEDING TOLERANCE. IS IT WORTH IT? ENGELA FRANCIS RD(SA) DEFINITION OF ENTERAL FEEDING INTOLERANCE Gastrointestinal feeding intolerance are usually defined as: High gastric
More informationSECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION
SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION DEMOGRAPHIC INFORMATION Given name Family name Date of birth Consent date Gender Female Male Date of surgery INCLUSION & EXCLUSION CRITERIA YES
More informationPOST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT
PHYSICIAN S SHEET Automatically Activate, if not in agreement, cross out and initial Activated by Checking Box ALLERGIES: None known YES Patient s Height: Patient s Weight: ALL MEDICATION and INTRAVENOUS
More informationSECTION 4: RECRUIT PARTICIPANTS
SECTION 4: RECRUIT PARTICIPANTS Contents Participant Eligibility & Enrollment... 2 Screening... 2 Study ID Numbers... 2 Inclusion Criteria... 2 Exclusion Criteria... 4 Co-Enrollment... 5 Informed Consent
More informationThe Meat and Potatoes of Critical Care Nutrition ROSEMARY KOZAR MD PHD SHOCK TRAUMA UNIVERSITY OF MARYLAND
The Meat and Potatoes of Critical Care Nutrition ROSEMARY KOZAR MD PHD SHOCK TRAUMA UNIVERSITY OF MARYLAND 2013 Canadian Clinical Practice Guidelines www.criticalcarenutrition.com NEJM March 27, 2014 Use
More informationNutrition Supplementation in the ICU
Nutrition Supplementation in the ICU ROSEMARY KOZAR MD PHD SHOCK TRAUMA UNIVERSITY OF MARYLAND Canadian Clinical Practice Guidelines www.criticalcarenutrition.com NEJM March 27, 2014 1 Use of Enteral vs
More informationVOLUME-BASED VS. RATE-BASED FEEDING
VOLUME-BASED VS. RATE-BASED FEEDING Amanda Holyk Critical Care Pharmacist Mount Nittany Medical Center Society of Critical Care Medicine Annual Symposium November 10, 2017 0 Disclosure I have no actual
More information2.0 Early vs. Delayed Nutrient Intake May 2015
2.0 Early vs. Delayed Nutrient Intake May 2015 There were no new randomized controlled trials since the 2013 update and hence there are no changes to the following summary of evidence. 2013 Recommendation:
More informationCase Discussion. Nutrition in IBD. Rémy Meier MD. Ulcerative colitis. Crohn s disease
26.08.2017 Case Discussion Nutrition in IBD Crohn s disease Ulcerative colitis Rémy Meier MD Case Presentation 30 years old female, with diarrhea for 3 months Shool frequency 3-4 loose stools/day with
More information5.2 Strategies to Optimize Delivery and Minimize Risks of EN: Motility Agents May 2015
5.2 Strategies to Optimize Delivery and Minimize Risks of EN: Motility Agents May 2015 There were no new randomized controlled trials since the 2009 and 2013 updates and hence there are no changes to the
More informationNO DISCLOSURES 5/9/2015
Annette Stralovich-Romani, RD, CNSC Adult Critical Care Nutritionist UCSF Medical Center NO DISCLOSURES Incidence & consequences of malnutrition Underfeeding in the ICU Causes/ consequences Nutrition intervention
More informationNutrition Care Process: Case Study B Examples of Charting in Various Formats
Nutrition Care Process: Case Study B Examples of Charting in Various Formats Case: JG is a 68 year old woman with a history of type 2 diabetes, chronic renal failure which is treated with hemodialysis
More informationL.Mageswary Dietitian Hospital Selayang
L.Mageswary Dietitian Hospital Selayang 14 15 AUG ASMIC 2015 Learning Objectives 1. To understand the importance of nutrition support in ICU 2. To know the right time to feed 3. To understand the indications
More informationCrit Vent Bundle for Mechanical Ventilation (337) [337] Physician - Also, enter Critical Care Admission Orders
Crit Vent Bundle for Mechanical Ventilation (337) [337] Physician - Also, enter Critical Care Admission Orders Initial Vent Settings (Single Response) [6360] If no previous orders and no choice made by
More informationApproach to type 2 Respiratory Failure
Approach to type 2 Respiratory Failure Changing Nature of NIV Not longer just the traditional COPD patients Increasingly Obesity Neuromuscular Pneumonias 3 fold increase in patients with Ph 7.25 and below
More informationChapter 29 Gastrointestinal Intubation
Chapter 29 Gastrointestinal Intubation Intubation Intubation: placement of a tube into a body structure Types of intubation Orogastric: mouth to stomach Nasogastric: nose to stomach Nasointestinal: nose
More informationProviding Optimal Nutritional Support on the ICU common problems and practical solutions. Pete Turner Specialist Nutritional Support Dietitian
Providing Optimal Nutritional Support on the ICU common problems and practical solutions Pete Turner Specialist Nutritional Support Dietitian ICU Nutritional Support ACCEPT study showed improved ICU survival
More informationNUTRITIONAL MANAGEMENT OF CHYLOTHORAX. Lekha.V.S Senior Clinical Dietitian HOD- Department Of Dietetics Apollo Children's Hospital
NUTRITIONAL MANAGEMENT OF CHYLOTHORAX Lekha.V.S Senior Clinical Dietitian HOD- Department Of Dietetics Apollo Children's Hospital INTRODUCTION Nutrition therapy is a key component in the care of patients
More informationNottingham Children s Hospital
High Flow Nasal Cannula Therapy Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Guide line for the use of HFNCT (High Flow Nasal Cannula Therapy) Contact Name
More informationNutrition and Sepsis
Nutrition and Sepsis Todd W. Rice, MD, MSc Associate Professor of Medicine Vanderbilt University 2017 DNS Symposium June 2, 2017 Case 55 y.o. male COPD, DM, HTN, presents with pneumonia and septic shock.
More informationOrgan Donor Management Recommended Guidelines ADULT CARDIAC DEATH (DCD)
Date: Time: = Always applicable = Check if applicable ADMISSION INSTRUCTIONS Move to Comfort Care Note in chart. Contact initiated with BC Transplant Consent for Organ Donation obtained Code Status: Full
More information1.1.2 CPAP therapy is used for patients who are suffering from an acute type 1 respiratory failure (Pa02 <8kPa with a normal or low Pac02).
Guidelines for initiating and managing CPAP (Continuous Positive Airway Pressure) on a general ward. B25/2006 1.Introduction and Who Guideline applies to 1.1.1 This document provides guidance for Healthcare
More informationSmall Bowel Obstruction after operation in a severely malnourished man. By: Ms Bounmark Phoumesy
Small Bowel Obstruction after operation in a severely malnourished man By: Ms Bounmark Phoumesy Normal length of GI tract Normal length(achieved by age 9) Small bowel 600cm (Men: 630 cm; Women: 592 cm)
More informationENTERAL NUTRITION IN THE CRITICALLY ILL
ENTERAL NUTRITION IN THE CRITICALLY ILL 1 Ebb phase Flow phase acute response (catabolic) adoptive response (anabolic) 2 3 Metabolic Response to Stress (catabolic phase) Glucose and Protein Metabolism
More informationSTATE OF OKLAHOMA 2014 EMERGENCY MEDICAL SERVICES PROTOCOLS
3K NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) ADULT EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC Indications: 1. Dyspnea Uncertain Etiology Adult. 2. Dyspnea Asthma Adult. 3. Dyspnea Chronic
More informationSARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE
SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE TITLE: ISSUED FOR: ADMINISTRATION OF A FEEDING (CONTINUOUS OR INTERMITTENT) OR MEDICATION VIA A GASTROSTOMY TUBE-ADULT Nursing DATE: REVIEWED: PAGES: 07/82
More informationPATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1).
PATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1). 1 Inform Consent Date: / / dd / Mmm / yyyy 2 Patient identifier: Please enter the 6 digit Patient identification number from your site patient log
More informationASPEN Safe Practices for Enteral Nutrition Therapy
ASPEN Safe Practices for Enteral Nutrition Therapy Ainsley Malone, MS, RDN, CNSC, FAND, FASPEN Nutrition Support Dietitian Mt. Carmel West Hospital ASPEN Clinical Practice Specialist Disclosure I have
More informationI. Subject: Continuous Aerosolization of Bronchodilators
I. Subject: Continuous Aerosolization of Bronchodilators II. Indications: A. Acute airflow obstruction in which treatment with an aerosolized bronchodilator is desired for an extended period of time, i.e.
More informationSeptember 2014 V0.17. Paediatric Daily Fluid Prescription & Balance Chart
September 14 V0.17 Aims and outcomes of session. Aim: To provide guidance on correctly completing the paediatric daily fluid prescription & balance chart. Outcomes: Demonstrate the ability to: calculate
More information5.5 Strategies to Optimize the Delivery of EN: Use of and Threshold for Gastric Residual Volumes May 2015
5.5 Strategies to Optimize the Delivery of EN: Use of and Threshold for Gastric Residual Volumes May 2015 2015 Recommendation: Based on 3 level 2 studies, a gastric residual volume of either 250 or 500
More informationPresented by: Indah Dwi Pratiwi
Presented by: Indah Dwi Pratiwi Normal Fluid Requirements Resuscitation Fluids Goals of Resuscitation Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart
More informationApplicable to. Team Members Performing MD House Staff APRN/PA RN LPN
Protocol: Adult Burn Fluid Resuscitation Category Clinical Practice Protocol Number Approval Date vember 1, 2016 Due for review vember 1, 2018 Applicable to VUH Children s DOT VMG Off-site locations VMG
More informationOptimize vent weaning and SBT outcomes. Identify underlying causes for SBT failures. Role SBT and weaning protocol have in respiratory care
Optimize vent weaning and SBT outcomes Identify underlying causes for SBT failures Role SBT and weaning protocol have in respiratory care Lower risk of developing complications Lower risk of VAP, other
More informationWHEN To Initiate Parenteral Nutrition A Frequent Question With New Answers
WHEN To Initiate Parenteral Nutrition A Frequent Question With New Answers Ainsley Malone, MS, RD, LD, CNSC, FAND, FASPEN Dubai International Nutrition Conference 2018 Disclosures No commercial relationship
More informationPEDIATRIC ASTHMA INPATIENT CARE MAP
DATE PATIENT PEDIATRIC ASTHMA INPATIENT CARE MAP DOB HSC NO. PHIN Approved by the Winnipeg Regional Health Authority This Care Map is to be used as a guideline and in no way replaces sound clinical judgment
More informationMultidisciplinary Geriatric Trauma Care Guideline
Multidisciplinary Geriatric Trauma Care Background Traumatic injury in the geriatric population is increasing in prevalence and is associated with higher mortality and complication rates comparted to younger
More informationNutrition Intervention After Gastric Bypass Revision
Nutrition Intervention After Gastric Bypass Revision With an Anastomotic Leak Ali Fox- Montana Dietetic Intern Objectives 1. Describe the etiology of anastomotic leak post Roux-en-Y gastric bypass (G.B.)
More informationOrgan Donor Management Recommended Guidelines ADULT Brain Death (NDD)
Date: Time: = Always applicable = Check if applicable ADMISSION INSTRUCTIONS Neurological Determination of Death (NDD) has been performed by at least 2 licensed physicians Contact initiated with BC Transplant
More informationNutrition Rounds Enteral Nutrition Rotation By Hannah Griswold
Rounds Enteral Rotation By Hannah Griswold Introduction RJ is a 57 year old male with history of seizure disorder and adenocarcinoma of the duodenal bulb complicated by duodenal perforation status post
More informationGuidelines and Best Practices for High Flow Nasal Cannula (HFNC) Pediatric Pocket Guide
Guidelines Best Practices for High Flow Nasal Cannula (HFNC) Pediatric Pocket Guide Patient Selection Diagnoses Patient presents with one or more of the following signs or symptoms of respiratory distress:
More information1. Preparation a. Assemble equipment beforehand. b. Make sure that you have what you need and that it is functioning properly.
Module 5: Facilitator Instructions for Severe Dehydration Skills Station 1. Preparation a. Assemble equipment beforehand. b. Make sure that you have what you need and that it is functioning properly. 2.
More informationTracheostomy Sim Course
Patients Name: Robert Smith Patients Age / DOB: 45 year old gentleman on medical ward Major Medical Problem Displaced tracheostomy tube Learning Goal Medical Early recognition of displaced tracheostomy
More informationSECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION
SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION DEMOGRAPHIC INFORMATION Given name Family name Date of birth Consent date (DD/MMM/YYYY) (DD/MMM/YYYY) Gender Female Male Date of surgery (DD/MMM/YYYY)
More informationCSIM annual meeting Acute respiratory failure. Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018
CSIM annual meeting - 2018 Acute respiratory failure Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018 NRGH affiliated with UBC medicine Disclosures None relevant to this presentation. Also no
More informationPhysician Orders ADULT Order Set: Respiratory Failure Orders
[R] = will be ordered Height: cm Weight: kg Allergies: [ ] No known allergies [ ]Medication allergy(s): [ ] Latex allergy [ ]Other: Admission/Transfer/Discharge [ ] Patient Status Initial Inpatient Attending
More informationICU NUTRITION UPDATE : ESPEN GUIDELINES Mirey Karavetian Assistant Professor Zayed University
ICU NUTRITION UPDATE : ESPEN GUIDELINES 2018 Mirey Karavetian Assistant Professor Zayed University http://www.espen.org/files/espen- Guidelines/ESPEN_Guideline_on_clinical_nutrition_in_-ICU.pdf Medical
More informationOrthopedic Admission Hip Fracture Version 2 1/25/2017
Patient Name: Initial each page and Sign/Date/Time last page Diagnosis: Allergies with reaction type: Orthopedic Admission Hip Fracture Version 2 1/25/2017 Patient Placement Patient Status If the physician
More informationCurrent concepts in Critical Care Nutrition
Current concepts in Critical Care Nutrition Dr.N.Ramakrishnan AB (Int Med), AB (Crit Care), MMM, FACP, FCCP, FCCM Director, Critical Care Services Apollo Hospitals, Chennai Objectives Why? Enteral or Parenteral
More informationPatient: Becky Smith DOB: 01/26/XXXX Age: 5 y/o Attending: Dr. D. Miles Allergies: NKA MR#: 203. Patient Chart #203 Becky Smith
Patient Chart #203 Becky Smith 1 Property of CSCLV CSCLV Rev: 06/04/2018 Chief Complaint: Abdominal pain. Informant: Parents. HISTORY & PHYSICAL HPI: Ill looking patient, healthy until 2 days ago when
More information1.40 Prevention of Nosocomial Pneumonia
1.40 Prevention of Nosocomial Pneumonia Purpose Audience Policy Statement: The guideline is designed to reduce the incidence of pneumonia and other acute lower respiratory tract infections. All UTMB healthcare
More informationOBSERVATION UNIT ASTHMA PATHWAY OUTLINE Westmoreland Hospital PAGE 1 OF 5
PAGE 1 OF 5 Exclusion Criteria: (Reason to admit to hospital) A. New EKG changes except sinus tachycardia B. Respiratory Rate > 40 C. Signs/symptoms of Heart Failure D. Impending respiratory failure or
More informationWeaning from Mechanical Ventilation. Dr Azmin Huda Abdul Rahim
Weaning from Mechanical Ventilation Dr Azmin Huda Abdul Rahim Content Definition Classification Weaning criteria Weaning methods Criteria for extubation Introduction Weaning comprises 40% of the duration
More information14-15 Aug ASMIC L.Mageswary Dietitian Hospital Selayang
14-15 Aug ASMIC 2015 Nurses Role L.Mageswary Dietitian Hospital Selayang Doctor Dietitian Pharmacist Nurse Physiotherapist Occupational therapist Patient Patient Centered Care Patients needs & preferences
More informationFacilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Care Unit (FELLOW)
Facilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Data Analysis Plan: Apneic Oxygenation vs. No Apneic Oxygenation Background Critically ill patients
More informationPediatric Intensive Care Unit (PICU) Pediatric Diabetic Ketoacidosis (DKA) Admission Order Set
Discontinue all previous orders Weight: kg DKA admit order set is for initial management Ongoing management required based on frequent reassessment of TFI, fluid balance and lab results. Admit to PICU
More informationSection K Swallowing/ Nutritional Status
Instructor Guide Section K Swallowing/ Nutritional Status Objectives State the intent of Section K Swallowing and Nutritional Status. Describe how to conduct an assessment of a resident s nutritional status.
More informationTBSA Burn Estimation Chart Adult Major Burn Clinical Practice Guideline
TBSA Burn Estimation Chart Adult Major Burn Clinical Practice Guideline Patient Label Anatomical Subunit Percent Total Percent One Side Anterior Posterior Injury Subtotal 3.5% 2nd and 3rd degree burns
More informationCase Scenarios. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity
Case Scenarios Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Case 1 A 36 year male with cirrhosis and active GI bleeding is intubated to protect his airway,
More informationLong Term Follow-up. 6 Month 1 Year Annual enter year #: What is the assessment date: / / Unknown. Is the patient alive? Yes No
Long Term Follow-up 6 Month 1 Year Annual enter year #: What is the assessment date: / / Unknown Is the patient alive? Yes No Was an exam performed by a bariatric physician or PA/NP? Yes No Was the patient
More informationICU ENTERAL FEEDING GUIDELINES
DISCLAIMER: These guidelines are intended to serve as a general statement regarding appropriate patient care practices based upon the available medical literature and clinical expertise at the time of
More informationI. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device
I. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device II. Policy: Continuous Positive Airway Pressure CPAP by the Down's system will be instituted by Respiratory Therapy personnel
More informationPlease inform the Diabetes Nurse Specialist that this patient has been admitted within 24hrs of admission.
Adult Diabetic Ketoacidosis Care Bundle (V1. Issued October 2014 Review October 2015) Improving patient care This pack includes: DKA Management Guideline Name: (Patient Addressograph) DOB: Hospital No:
More informationSCVMC RESPIRATORY CARE PROCEDURE
Page 1 of 8 Rev. - 11/99, 11/05, 4/11 R-NC - 08/99,08/00, 04/03,10/08,04/09, 07/11, 6/12 B7180-43 OBJECTIVE Continuous Nebulization allows for continuous, controlled drug delivery to the lung, avoiding
More informationGENERAL SURGERY FOR SMART PEOPLE JOE NOLD MD, FACS WICHITA SURGICAL SPECIALISTS
GENERAL SURGERY FOR SMART PEOPLE JOE NOLD MD, FACS WICHITA SURGICAL SPECIALISTS CONFLICTS/DECLARATIONS I have no financial conflicts or declarations I AM always willing to see a consult for you TEXT TOPICS
More informationTitle: Aerophagia due to abdomino-phrenic dyssynergia in a 2-year-old child. Authors: Pablo Ercoli, Belinda García, Enrique del Campo, Sergio Pinillos
Title: Aerophagia due to abdomino-phrenic dyssynergia in a 2-year-old child Authors: Pablo Ercoli, Belinda García, Enrique del Campo, Sergio Pinillos DOI: 10.17235/reed.2018.5444/2017 Link: PubMed (Epub
More informationPAIN MANAGEMENT Person established taking oral morphine or opioid naive.
PAIN MANAGEMENT Person established taking oral morphine or opioid naive. Important; it is the responsibility of the prescriber to ensure that guidelines are followed when prescribing opioids. Every member
More informationOPTICS OPTimal nutrition by Informing and Capacitating family members of best nutrition practices OPTICS
OPTICS OPTimal nutrition by Informing and Capacitating family members of best nutrition practices Educational Booklet for Families Version June 16 2014 Page 1 of 11 This information booklet was originally
More informationEmergency Department Guideline. Asthma
Emergency Department Guideline Inclusion criteria: Patients 2 years old with: o Known history of asthma or wheezing responsive to bronchodilators presenting to the ED with cough, wheeze, shortness of breath,
More informationEnteral Nutrition. Presented by Melanie Farwell RD, LD Keene Medical Products Dietitian
Enteral Nutrition Presented by Melanie Farwell RD, LD Keene Medical Products Dietitian What is it? Liquid feeding provided to the gastrointestinal tract via nose, stomach or small intestine -Specifically
More informationAcute Stroke with Alteplase Administration Order Set
Review Due Date: 2017 October PATIENT CARE DERS Weight: Adverse Reactions or Intolerances Drug No Yes (list) Food No Yes (list) _ Latex No Yes Admission Admit to Neurology service: Dr. Critical Care Diagnosis:
More informationSample. Fractured Hip Post-Operative Orders. Legend < Mandatory fields o Optional fields. Height Allergies: List or o Up to date in electronic system
Legend Mandatory fields o Optional fields Height Allergies: List or o Up to date in electronic system cm Weight Diagnosis kg Date (yyyy-mon-dd) Time (hh:mm) Anticipated Date Of Discharge (ADOD) o Greater
More informationWestern General Hospital Tubefeeding Group Radiologically Inserted Gastrostomy Protocol, October 2008
Lothian University Hospitals Division Western General Hospital Protocol for the Care of Radiologically Inserted Gastrostomy Tube 14 FG Medicina G Tube CARE OF PATIENT FOLLOWING TUBE INSERTION OBSERVATIONS
More informationE S T A B L I S H I N G N U T R I T I O N I N Y O U R I C U The Need for a Protocol
E S T A B L I S H I N G N U T R I T I O N I N Y O U R I C U The Need for a Protocol Arthur RH van Zanten, MD PhD Gelderse Vallei Hospital, Ede, The Netherlands Learning objectives Develop an evidence based
More informationSimulation 1: Two Year-Old Child in Respiratory Distress
Simulation 1: Two Year-Old Child in Respiratory Distress Opening Scenario (Links to Section 1) You are the respiratory therapist in a 300 bed community hospital working the evening shift. At 8:30 PM you
More informationHOMES AND SENIORS SERVICES. APPROVAL DATE: February 2011 REVISION DATE: January 2015; July 2018
POLICY: Page 1 of 6 A resident requiring enteral (tube) feeding as a sole source or adjunctive nutrition support have access to a comprehensive enteral feeding program and receive appropriate support from
More informationMEDICAL NUTRITION THERAPY
MEDICAL NUTRITION THERAPY Goals of Nutritional Care Meet basic nutrient requirements Preserve LBM Restore respiratory muscle mass and strength Maintain fluid balance Improve resistance to infection Facilitate
More informationParenteral and Enteral Nutrition
Parenteral and Enteral Nutrition Audis Bethea, Pharm.D. Assistant Professor Therapeutics I December 5 & 9, 2003 Parenteral Nutrition Definition process of supplying nutrients via the intravenous route
More informationNutrition Services at a glance
Nutrition Services at a glance Ragini Raghuveer, MS, RD, LD/N Systems Clinical Nutrition Manager Linette De Armas, RD, LD/N Clinical Dietitian Melissa Lorenzo, RD, LD/N Clinical Dietitian 1 Learning Objectives
More informationSimulation 3: Post-term Baby in Labor and Delivery
Simulation 3: Post-term Baby in Labor and Delivery Opening Scenario (Links to Section 1) You are an evening-shift respiratory therapist in a large hospital with a level III neonatal unit. You are paged
More informationPEDIATRIC ACUTE ASTHMA SCORE (P.A.A.S.) GUIDELINES. >97% 94% to 96% 91%-93% <90% Moderate to severe expiratory wheeze
Inclusion: Children experiencing acute asthma exacerbation 24 months to 18 years of age with a diagnosis of asthma Patients with a previous history of asthma (Consider differential diagnosis for infants
More informationMetabolic Control in Critical Care: Nutrition Therapy
LOGO Metabolic Control in Critical Care: Nutrition Therapy ผศ.นพ.พรพจน เปรมโยธ น สาขาโภชนาการคล น ก ภาคว ชาอาย รศาสตร คณะแพทยศาสตร ศ ร ราชพยาบาล 2016 SCCM/ASPEN Guidelines Nutrition Therapy in the ICU
More informationMECHANICAL VENTILATION PROTOCOLS
GENERAL or SURGICAL Initial Ventilator Parameters Ventilator Management (see appendix I) Assess Patient Data (see appendix II) Data Collection Mode: Tidal Volume: FIO2: PEEP: Rate: I:E Ratio: ACUTE PHASE
More informationCaring Practice: Evidence-based Terminal Ventilator Withdrawal
1 Caring Practice: Evidence-based Terminal Ventilator Withdrawal Margaret L Campbell PhD, RN, FPCN 2 Webinar Goals Describe the processes for ensuring patient comfort during terminal ventilator withdrawal
More informationSurviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality
More informationTACO CASE STUDIES RTC JUNE Kerry Dowling Blood Transfusion Laboratory Manager Jonathan Ricks Blood Transfusion Nurse Practitioner
TACO CASE STUDIES RTC JUNE 2017 Kerry Dowling Blood Transfusion Laboratory Manager Jonathan Ricks Blood Transfusion Nurse Practitioner RISK FACTORS - TACO Age over 70 years although also seen in younger
More informationCLIP: Checklist for Lung Injury Prevention. US Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG LIPS)
CLIP: Checklist for Lung Injury Prevention US Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG LIPS) USCIITG-Lung Injury Prevention Group A collaborative research
More informationIDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Sample Pediatric Admission Orders 2015
Purpose: To provide guidance to practitioners caring for pediatric patients who need inpatient hospital care during a disaster. Disclaimer: This guideline is not meant to be all inclusive, replace an existing
More information6.4 Enteral Nutrition (Other): Gastrostomy vs. Nasogastric feeding January 31 st, 2009
6.4 Enteral Nutrition (Other): Gastrostomy vs. Nasogastric feeding January 31 st, 2009 Recommendation: There are insufficient data to make a recommendation on gastrostomy feeding vs. nasogastric feeding
More informationDURATION: 3 HOURS TOTAL MARKS: 150. External Examiner: Ms J. Visser Internal Examiner: Mrs J. Galliers, Mrs S. Kassier
DURATION: 3 HOURS TOTAL MARKS: 150 External Examiner: Ms J. Visser Internal Examiner: Mrs J. Galliers, Mrs S. Kassier NOTE: THIS PAPER CONSISTS OF NINE (9) PAGES, PLUS TWELVE (12) REFERENCE PAGES (ON YELLOW
More informationFull details and resource documents available:
Clinical & Regulatory News by Pharmerica Urinary Tract Infection (UTI) Second Most Common Cause of Hospital Readmission within 30 days UTIs are prevalent and account for up to 22% of infections in LTC,
More informationWhere Emergency Medicine Meets Critical Care: Next Level Resuscitation
Where Emergency Medicine Meets Critical Care: Next Level Resuscitation Rob Green, BSc, MD, DABEM, FRCPC, FRCP(Edin) Professor, Dalhousie University Departments of Emergency Medicine,Critical Care Medicine
More informationSample Case Study. The patient was a 77-year-old female who arrived to the emergency room on
Sample Case Study The patient was a 77-year-old female who arrived to the emergency room on February 25 th with a chief complaint of shortness of breath and a deteriorating pulmonary status along with
More informationCapnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017
Capnography: The Most Vital of Vital Signs Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Assessing Ventilation and Blood Flow with Capnography Capnography
More informationOB Well Baby Nursery Admission (Term) [ ] For specialty focused order sets for your patient, refer to: General
OB Well Baby Nursery Admission (Term) [3040000234] For specialty focused order sets for your patient, refer to: 3040000424 Neonatal Circumcision Order Set 3040000522 Neonatal Herpes Viral Order Set 3040000524
More information