Methods of Nutrition Support KNH 406
Malnutrition 30 50% of hospitalized patients 95% of nursing home patients Resulting in reduced quality of life & increased health care costs May be remedied by providing nutrition support Oral diets Supplemental foods Enteral and parenteral nutrition
2007 Thomson - Wadsworth
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 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
2007 Thomson - Wadsworth
Oral Supplements Goal: Increase nutrient density without increasing volume Snacks Liquid meal replacement formulas Modular products Commercial supplements
2007 Thomson - Wadsworth
Appetite Stimulants Drugs that stimulate appetite Prednisone Megestrol acetate Dronabinol
Specialized Nutrition Support (SNS) Administration of nutrients with therapeutic intent Enteral 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 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 Orogastric Nasointestinal Typically used for short term Disadvantages?
Enteral Nutrition GI Access Ostomy Gastrostomy Jejunostomy PEG 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 Specialized amino acid profiles
Enteral Nutrition Formulas Carbohydrate Monosaccharides, oligosaccarides, dextrins, maltodextrins Lactose & sucrose free FOS Fiber?
Enteral Nutrition Formulas Lipid Corn or soy oil Long- and medium-chain TG Omega-3 fatty acids Structured lipids
Enteral Nutrition Formulas Vitamins and minerals Meet DRI Supplemental amounts Fluid and nutrient density 1.0-2.0 kcal per ml Difference depends on water content Ensure adequate fluid - 80% water for 1 kcal per ml Osmolality and osmolarity
Enteral Nutrition 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 2007 Thomson - Wadsworth
Enteral Nutrition Determining the nutrition prescription - clinical application
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
2007 Thomson - Wadsworth
2007 Thomson - Wadsworth
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 Using subclavian, jugular, femoral veins PICC Long-term access Tunneled catheters Implantable ports
2007 Thomson - Wadsworth
Parenteral Nutrition Solutions Compounded by pharmacist using clean room Two-in-one Dextrose & amino acids Lipids added separately Clear - easier to identify precipitates Three-in-one Dextrose, amino acids & lipids Single administration
2007 Thomson - Wadsworth
2007 Thomson - Wadsworth
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
2007 Thomson - Wadsworth
Parenteral Nutrition Determining the nutrition prescription clinical application - sample form
2007 Thomson - Wadsworth
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