_______________ refers to a comprehensive nutritional assessment based on identified client needs upon which therapeutic treatment of disease processes can be based.
Medical Nutrition Therapy (MNT)
purpose of MNT
• Correct & replace nutrient deficiencies
• Provide adequate nutrition for clients with defined health problems
It is important to include ________ as a part of a sound foundation on
which to base identified needs, expected outcomes, and response to
treatments.
nutrition
_________ factors greatly influence disease risk and progression.
Dietary
Clients feel better when they eat better and are in an acceptable weight range pattern (per BMI). True or False?
True
Indications for nutritional support
• Client physical conditions
• Therapeutic bowel rest
• Severe PCM/PEM
Type of Support Methods
1. Oral Supplement
2. Tube Feedings
3. Tube Enterostomy
4. Parenteral Nutrition
(Support Method) In liquid or powdered form & are usually packaged in ready-to-use formulations.
Oral Supplement
(Type of 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)
(Type of 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)
(Type of oral supplement) Provides nutrients in predigested form, making
their transport & absorption easier in the body
Elemental
(predigested/hydrolyzed)
1-1.3 kcal/ml)
(Type of oral supplement) Provides formulation specific to metabolic requirements
Involves placement of tubes through a surgical opening to provide nutrient/fluid intake
Tube enterostomy
Tube enterostomy is for specific malabsorptive problems requiring long-term therapy. True or False?
True
Site selections for Tube enterostomy
• PEG tube – percutaneous endoscopic gastrostomy
• PEJ tube – percutaneous endoscopic jejunostomy
Nutrients/fluids are delivered through the parenteral route to maintain adequate metabolic balance
Parenteral nutrition
Site selections for Parenteral nutrition
• PPN – peripheral parenteral nutrition
• TPN – total parenteral nutrition
Nutritional requirements for clients with supportive methods
Macronutrients
Micronutrients
Water
Members of the healthcare team
Physician
Dietician
Nurse
Client/Family
It refers to a method of feeding clients who have a functioning GI tract but are unable to take a diet orally or whose diet is inadequate.
Enteral Nutrition
For enteral nutrition, if feeding is short term it is via ______________.
nasogastric tubes or oral route
For enteral nutrition, if feeding is long term it is via ______________.
enterostomy place surgically or percutaneously
(Classification of feeding) EN via feeding pump for 24h/day
Continuous
(Classification of feeding) EN via feeding pump for <24h/day
Cyclic
(Classification of feeding) EN over 20-60 min every 4-6h with/without feeding pump
Intermittent
(Classification of feeding) EN over short time period at specified interval via gravity drip or syringe
Bolus
Characteristics of formula include:
• Protein classification
• Nutrient density
• Amounts of residue and fiber
Check placement of tube prior to any feeding, flush, or medications administration. How do we check the placement of the tube?
• Aspiration of gastric contents
• Introduction of air with auscultation
• X-ray
In inserting tube for EN, position client to _____________________.
semi-fowlers to high-fowler’s position
In EN, flush the tube before and after feedings (____ml).
30-50
(EN) Irrigate tubes every ____ hours.
6-8
(EN) Include the amounts of flush or irrigation used in the client’s I & O. True or False?
True
For EN, medications must be in what form?
liquid
(EN) Tablet-form medications must be _________ and flushed with how many mL of water?
crushed, 20cc
(EN) Remember:
• Do not mix together multiple medications
simultaneously unless compatibility is known.
• Do not hang more than the documented amount
of formula.
• Change solution/tubing per hospital protocol.
• Monitor pertinent labs and document daily
weights.
(EN) Parameters to monitor
• Tube placement
• Urine glucose q shift
• Gastric residuals q 4H
• BM and consistency
• Tolerance to feedings
• Record daily weight and I&O
• Record weekly
-Serum e- and blood counts
-Chemistry profile
-Nitrogen balance
EN Mechanical complications
• Clogged tube
• Tube dislodgment
• Defected infusion pump
EN Metabolic complications
• DHN
• E- imbalances
• Altered blood glucose levels
EN Formula-related complications
• Diarrhea
• Cramps
• Abdominal distention
• Constipation
• Nausea
• Vomiting
EN Dermatologic complications
• Skin irritation
• infection
It is the administration of nutrients by a route other than the GI tract, usually intravenously.
Parenteral Nutrition
2 types of Parenteral Nutrition
a. Total Parenteral Nutrition (TPN)
b. Peripheral Parenteral Nutrition (PPN)
IV sites for TPN and PPN
TPN:Superior Vena Cava & Subclavian vein
PPN: Peripheral vein
TPN and PPN Osmolality
TPN: > 10%
PPN: Isotonic solutions
<10% dextrose
<5% amino acids
(Parenteral Nutrition) List of nutrients
• Dextrose (Carbohydrate source)
• Amino acids (protein source)
• Lipids (fat source)
• Water
• Electrolytes
• Micronutrients
• Vitamins
• Additives
• Lipid emulsions are added to dextrose and amino acid mixtures
• Also called as 3-in-1 mixture
• Advantage: allows infusion over 24 hours
TNA: TOTAL NUTRIENT ADMIXTURE
Verify TPN prescription with ___ RNs using ____ Rights of Medication principles.
2, 5/10
Run TPN through a ________ line.
dedicated
Change TPN solutions & tubing per protocol q ___ hours.
24
True or False? Inspect TPN products prior to hanging for “cracking” (lipid separation). Do not hang if it is present. Return it to the pharmacy.
True
DO NO STOP TPN ABRUPTLY – It can cause ____________.
rebound hypoglycemia
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. True or False?
