Refers to a comprehensive nutritional assessment based on identified client needs upon which therapeutic treatment of disease processes can be based
Medical Nutrition Therapy
It is provided by a dietitian in conjunction with collaborative management by healthcare providers
Medical Nutrition Therapy
Medical Nutrition Therapy is used to:
1. Correct and replace nutrient deficiencies
2. Provide adequate nutrition for clients with defined health problems
It is important to include nutrition as a part of a sound foundation on which to base identified needs, expected outcomes, and response to treatments.
True
________ greatly influence disease risk and progression.
Dietary factors
A stable weight pattern within range of IBW is associated with?
A decreased risk of disease progression
Clients feel better when they eat better and are in an acceptable weight range pattern (per BMI).
True
Indications for Nutritional Support
• Client's physical conditions
• Therapeutic bowel rest
• Severe PCM/PEM
Types of Support Methods
1. Oral Supplement
2. Tube Feedings
3. Tube Enterostomy
4. Parenteral Nutrition
- Provides calories & nutrients
- In liquid or powdered form; Usually packaged in ready-to-use formulations
Oral Supplement
4 Types of Oral Supplements
1. Modular
2. Polymeric (Intact protein)
3. Elemental (Predigested/Hydrolyzed)
4. Disease-specific
Oral Supplement:
- One Nutrient source
- Not nutritionally complete by themselves
- Considered to be nutrient-dense without increasing volume
Modular supplements (3.8-4.0 kcal/mL)
Oral Supplement:
- Essential nutrient in a specific volume based on a specified formulation
- Contains intact proteins of high biologic value, complex CHOs, fats, vitamins, minerals, & trace elements
Polymeric (Intact protein) (1-2 kcal/mL)
Oral Supplement:
Provides nutrients in predigested form, making their transport & absorption easier in the body
EN over 20-60 minutes q4-6h with/without feeding pump
Intermittent (Discontinuous Feeding)
EN over short time period at specified interval via gravity drip or syringe
Bolus (Discontinuous Feeding)
Characteristics of Formula
1. Protein classification
2. Nutrient Density
3. Amounts of residue and fiber
Equipments (Formula Selections)
1. Asepto Syringe
2. NGT Tubes
Nursing Interventions (NGT)
1. Inspect the formula to be used
2. Check placement of tube prior to any feeding, flush, or medication administration
3. Position client to semi- or high fowler's position
4. Flush the tube before and after feedings (30-50 mL)
5. Irrigate tubes every 6-8 hours
6. Include the amounts of flush or irrigation used in the client's I & O.
7. Medications must be liquid form. Crush tablet-form medications. Flush with 20cc of water
8. Do not mix together multiple medications simultaneously unless compatibility is known
9. Do not hang more than the documented amount of formula
10. Change solution/tubing per hospital protocol
11. Monitor pertinent labs and document daily weights
12. Work with the healthcare team members in order to maintain nutritional balance and skin integrity
13. Incorporate concepts of altered nutritional status & body image in developing a plan of care
14. Be aware that the placement of feeding tubes may be long-term in nature given the client's underlying medical condition
Parameters to monitor (NGT)
1. Tube placement
2. Urine glucose q every shift
3. Gastric residuals q4h
4. BM and consistency
5. Tolerance to feedings
6. Record daily weight and I&O
Record weekly
1. Serum e- and blood counts
2. Chemistry profile
3. Nitrogen balance
Mechanical Complications
1. Clogged tube
2. Tube dislodgement
3. Defected infusion pump
Metabolic complication
1. DHN
2. E-imbalances
3. Altered blood glucose levels
Formula-related complications
1. Diarrhea
2. Cramps
3. Abdominal distention
4. Constipation
5. Nausea
6. Vomiting
Dermatologic complications
1. Skin irritation
2. Infection
It is the administration of nutrients by a route other than the GI tract, usually intravenously (e.g. Feeding through the peripheral veins and central veins)
Parenteral Nutrition
2 Types of Parenteral Nutrition
1. Peripheral Parenteral Nutrition (PPN)
2. Total Parenteral Nutrition (TPN)
Total Parenteral Nutrition (TPN)
Osmolality:
GIT:
IV sites:
Access:
Indications for use:
Osmolality: >10%
GIT: Non-functional
IV sites: Superior Vena Cava and subclavian vein
Access: Central line (PICC)
Indications for use: Long-term
Peripheral Parenteral Nutrition (PPN)
Osmolality:
GIT:
IV sites:
Access:
Indications for use:
• Lipid emulsions are added to dextrose and amino acid mixtures
• Also called as 3-in-1 mixture
• Advantage: allows infusion over 24 hours
Total Nutrient Admixture (TNA)
All nutrients are mixed in the same IV bag, except for lipids
2 in 1
Nursing Interventions (TPN)
1. Verify TPN prescription with 2 RNs using 5/10 Rights of Medication principles
2. Run TPN through a dedicated line
3. Change TPN solutions & tubing per protocol q24h
4. Ensure that a pharmacist mixes all TPN solutions.
5. Inspect TPN products prior to hanging for “cracking” (lipid separation). Do not hang if it is present. Return it to the pharmacy.
6. Infuse TPN using an infusion pump per protocol.
7. Continuously assess for complications.
8. When client is progressing and TPN therapy is to be stopped, follow protocol for discontinuing therapy. DO NOT STOP TPN ABRUPTLY – It can cause rebound hypoglycemia.
9. As TPN is stopped, enteral feeding routes are increased to a greater percentage of the total intake. When enteral feedings are being tolerated by the patient (60% of caloric intake), the client is ready to be taken off from TPN.
10. Collaborate with RND & AP in the assessment and evaluation of client response.
11. Provide education and support to patient and SOs.
12. Document pertinent findings relative to TPN therapy.
Nursing Interventions (PPN)
1. Inspect IV site for S/Sxs of potential irritation &
infection.
2. Use a dedicated line for infusion. Always use an
infusion pump with filter.
3. Change solutions bag q24h per agency protocol - decrease risk of infection.
4. 2 RNs must verify solution prior to hanging:
• Prescription of Tx
• Contents of bag with original order
5. Communicate with the entire health care team.
6. Continuously assess for complications.
Catheter-related Complications
• Occlusion due to thrombosis
• Development of air embolism
• Incorrect placement
Metabolic-related Complications
• Acid-base imbalances
• E- imbalances
• Nutrient deficiencies
• DHN
• Fluid retention
Common Hospital Diets (GTLMH)
1. 1600 KCl in 6 divided feedings (Diabetic Diet)
2. Soft diet
3. DAT NDCF (Diet as Tolerated - No Dark Colored Foods)
4. Low salt, Low fat
5. Diabetes Mellitus (DM) Diet
6. DAT with SAP (Diet as Tolerated with Strict Aspiration Precaution)
7. No Dark Colored Foods
8. Low Purine Diet
9. LSLF, DM Diet
10. NPO (Nothing by mouth)
11. Soft diet with sap, npo if dyspneic
12. LSLF No fruits diet
13. Renal Diet
14. LSLF Diabetic diet
15. DAT (Diet as Tolerated)
16. BF (Breastfeeding)
17. Diet for Age with ap
18. DFA (Diet for Age)
19. OF (Osteorized Feeding) - 760N KCal 4 feedings potassium-rich foods, 1 banana per meal DAT except dark colored foods
20. 1500 kcal/day divided into 4 feedings 1 banana/meal
