Transcript NURP 113 THERAPEUTIC NUTRITION ANDERSON

Ch. 21: Parenteral Nutrition
 Parenteral Nutrition: Delivery of
nutrient solutions directly into a vein,
bypassing the intestinal tract
 IV Nutrition can be tailored to
individual needs
 Can provide water, amino acids,
carbohydrate, fat and micronutrients
Rationale for Determining Feeding
Route
Parenteral Nutrition
 Advantages
 Can provide total nutritional support for
longer period of time
 Disadvantages of Parenteral Nutrition
 Costly
 Complications
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Sepsis
Liver
Kidneys
Bone disorders
Deficiencies
Parenteral Solutions, cntd.
 Intravenous nutrients
 Amino acids: essential and nonessential
(branch-chained and aromatic)
 Carbohydrate: dextrose 3.4 kcal/gm
 Lipids: LCT or MCT, EFAs
 Micronutrients: prevention of
deficiencies
Types of Intravenous Formulataions
 Types Intravenous Solutions
 Simple
 simple IV solutions typically contain 5 percent dextrose
and/or normal saline (Normal saline is a solution of
sodium and chloride in water)
 other electrolytes or salts may be added
 Types Intravenous Solutions
 Complete
 complete nutrient solutions provide amino acids,
dextrose, fatty acids, vitamins, minerals, and trace
elements
 can be delivered into peripheral veins (the smalldiameter veins that carry blood from the arms and legs)
or central veins (the large-diameter veins located close
to the heart)
 Simple Intravenous Infusions
 used in medical conditions that disrupt
acid base balance or fluid and electrolyte
balance
 are delivered via a IV catheter through a
peripheral forearm vein
 An IV catheter is a thin tube inserted
into a peripheral or central vein.
Additional tubing connects the IV
solution to the catheter
Peripheral vs Total Parenteral
Nutrition
 Compare the composition and uses of PPN
andTPN
 Peripheral Parenteral
 Nutrition (PPN)
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Isotonic formula
Contains all essential nutrients
Requires renal functioning
Short-term: 7-14 days
Additional support for enteral feedings
Used when TPN not possible
PPN and TPN, cntd.
 Total Parenteral Nutrition (TPN)
Central Vein
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IV catheter in large central vein
Highly concentrated solutions
Long-term use
High nutritional needs
Client is severely malnourished
Higher risk of infection
IV Nutrition
 What risks are associated with IV
Nutrition?
 IV Nutrition Risks
 TPN requires surgical placement
 Peripheral veins—inflammation &
infection
 TPN: Disease causing microorganisms
introduced
 Complications on p. 526
IV Nutrition
 Proper way to administer PPN and TPN
solutions
 PPN: Peripheral veins can collapse if
concentration too high
 TPN: Feeding started slowly because of
high glucose content and high osmolality of
solutions
 Infusion pump required
 Hypoglycemia & hyperglycemia risks
 Electrolytes monitored vigilantly
Transition from Parenteral to
Enteral Nutrition
 Appropriate transition from parenteral
to enteral nutrition
 Villi will shrink and lose ability to
function as a result of nonuse
 Slow reintroduction of enteral
nutrition
 Transitional Feedings
 TPN tapered off gradually
 PPN doesn’t require tapering off
Transitioning, cntd.
 Rule of Thumb 1:
 If clients can’t eat enough food to meet
at least 50% of daily nutritional needs
tube feedings should be considered.
 Rule of Thumb 2:
 Parenteral nutrition can be discontinued
when at least 70-75% of energy needs
are being met by oral intake, tube
feedings or both
Home Nutrition Support
 Identify the benefits of and the
criteria used to select candidates for
home nutrition support
 Medical considerations
 Rational, stable personality
 Learning techniques, handling
complications
 Compliant with recommendations
 Adequate financial resources & support
Practice Questions
 Types of formulas that contain
complete proteins are called:
A.
B.
C.
D.
Intact
Hydrolyzed
Modular
Blenderized
 Hydrolyzed formulas are given to
clients who are able to digest and
absorb nutrients without difficulty.
 True
 False
 The primary purpose of a simple IV
solution is to support all of the
following EXCEPT:
a. Help maintain fluid and electrolyte
balance
b. Help maintain adequate nutrient
intake
c. Help restore acid-base balance
 Ideally a person should reach a
severely-depleted state before TPN by
central vein is initiated.
 True
 False