It refers to a comprehensive nutritional assessment based on identified client needs upon which therapeutic treatment of disease processes can be based. It is provided by a dietician in conjunction with collaborative management by health care providers.
Medical Nutrition Therapy (MNT)
It is used to correct & replace nutrient deficiencies and provide adequate nutrition for clients with defined health problems.
Medical Nutritional Therapy
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.
First-Line Treatment
Dietary factors greatly influence disease risk and progression.
True or False?
True
A stable _____ within range of IBW is associated with a decreased risk
of disease progression
weight pattern
Indications for Nutritional Support
• Client 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 & are usually packaged in ready-to-use formulations; Is categorized into 4 types according to formula types.
Oral Supplement
One nutrient source; Not nutritionally complete by themselves; Considered to be nutrient dense without increasing volume
Selection:
CHO – Moducal, Nutrisource CHO, Polycosem Sumacal
Lipids – MCT – Microlipid
Protein – ProMod, Propac, Pro-MT, Casec
Modular supplements
(3.8-4.0 kcal/ml)
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
Selection: Ensure, Sustacal, Resource, Meritene
(Diabetic clients can have intact formulas that address specific glucose requirements.)
Polymeric (intact protein)
(1-2 kcal/ml)
Provides nutrients in predigested form, making their transport & absorption easier in the body
Selection: Flexical, Vital, Vivonex
(Lactose-free, non palatable, & hyperosmolar – best given by enteral administration.)
Elemental (predigested/hydrolyzed)
(1-1.3 kcal/ml)
Provides formulation specific to metabolic requirements
Involves placement of tubes through a surgical opening to provide nutrient/fluid intake and is indicated to specific malabsorptive problems requiring long-term
therapy
Tube Enterostomy
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
Enteral feedings can be delivered either ___ or via a ___ placement.
orally; tube
Indications for short-term
via nasogastric tubes or oral route
Indications for long-term
via enterostomy place surgically or percutaneously
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)
Osmolality: > 10% GIT: Non-functional IV sites: Superior Vena Cava, Subclavian vein Access: Central line /PICC Indications for use: Long-term
Total Parenteral Nutrition (TPN)
Osmolality: Isotonic solutions - <10% dextrose, <5% amino acids GIT: Functional IV sites: Peripheral vein Access: Peripheral line Indications for use: Short-term
Peripheral Parenteral Nutrition (PPN)
PN: List of Nutrients
• Dextrose (Carbohydrate source)
• Amino acids (protein source)
• Lipids (fat source)
• Water
• Electrolytes
• Micronutrients
• Vitamins
• Additives
Nutrient needs are calculated by ___.
RND
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)
PN: All nutrients are mixed in the same IV bag, except for lipids.
2 in 1
PN: All nutrients are mixed in the same IV bag to form a lipid emulsion.
3 in 1
Run TPN through a ____.
dedicated line
Inspect TPN products prior to hanging for “_____” (lipid separation). Do not hang if it is present. Return it to the pharmacy.
cracking
Infuse TPN using an _____ per protocol
infusion pump
When client is progressing and TPN therapy is to be stopped, follow protocol for discontinuing therapy. DO NO STOP TPN ABRUPTLY – It can cause _______.
rebound hypoglycemia
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?
True
May cause permanent damage to the soft tissue around the IV site; thus, immediate intervention should be done.
IV Infiltration
TPN: Parameters to Monitor (q8h, daily, weekly)
• Every 8h - VS, Urine fractionals
• Daily - Wt, I&O, Serum e-, glucose, crea, BUN
until stable; then twice weekly
• Weekly - Serum Mg, Ca, Ph, Albumin, Liver function Tests, CBC, Review of actual, oral, enteral, and TPN intake
TPN: Complications
• Catheter-related - Occlusion due to thrombosis, Development of air embolism, and Incorrect placement
- OF (Osteorized Feeding) OF 760N KCAL 4 FEEDINGS POTASSIUM RICH FOODS 1 BANANA PER MEAL DAT EXCEPT DARK COLORED FOODS 1500 KCAL/ DAY DIVIDED INTO 4 FEEDINGS 1 BANANA/ MEAL
