Chapter 21-Parenteral Nutrition Support

StudyBlue printing of Chapter 21-Parenteral Nutrition Support html, body, div, span, applet, object, iframe, h1, h2, h3, h4, h5, h6, p, blockquote, pre, a, abbr, acronym, address, big, cite, code, del, dfn, em, font, img, ins, kbd, q, s, samp, small, strike, strong, sub, sup, tt, var, b, u, i, center, fieldset, form, label, legend, table, caption, tbody, tfoot, thead, tr, th, td { margin: 0; padding: 0; border: 0; outline: 0; font-size: 100%; background: transparent; } body { line-height: 1; } blockquote, q { quotes: none; } blockquote:before, blockquote:after, q:before, q:after { content: ''; content: none; } /* remember to define focus styles! */ :focus { outline: 0; } /* remember to highlight inserts somehow! */ ins { text-decoration: none; } del { text-decoration: line-through; } /* tables still need 'cellspacing="0"' in the markup */ table { border-collapse: collapse; border-spacing: 0; } /* end RESET */ .header { min-width:800px; } .logo { padding:6px 20px 2px 20px; margin:0; font-size:25px; font-weight:bold; color:#808285; position:relative; border-bottom: 1px solid #c5c5c5; } .logo-blue { color:#70adc4; } .logo-desc { font-weight:normal; font-size:19px; color:#cccccc; margin-top:50px; position:absolute; display: none; } .back-button { position:absolute; top:20px; right:20px; font-size:13px; line-height:25px; color:rgb(0,175,225); font-weight:normal; } .back-button a { color:rgb(0,175,225); } .instructions { padding:0; margin:0; width:100%; position:relative; color:rgb(100,100,100); } .step-holder { border-left:1px solid #ededed; margin-left:20px; } .steps { padding:15px 0; float:left; width:24%; border-right:1px solid #ededed; text-align:center; } .steps-01 { } .steps-02 { } .steps-03 { } .steps-04 { } .label { padding:5px 10px; } .print-button { } .print-button a { background-color:rgb(0,175,225); color:white; line-height: 19px; padding:9px 8px 5px 30px; font-size:14px; text-decoration:none; background-image: url(images/printer.png); background-repeat: no-repeat; background-position: 7px 50%; -moz-border-radius: 5px; -webkit-border-radius: 5px; } .print-button a:hover { background-color:black; } .theNote .content { width: 8.0in !important; margin: 5px auto; padding:20px; background-color:white; } .theNote .header { border-bottom: 1px dashed #C8C8C8; font-size: 17px; padding: 0 0 10px; line-height: 19px; color: #00ADE1; min-width:500px; } .theNote .body { font-size: 14px; line-height: 19px; padding: 10px 0; } .theNote{ padding:6px 0; clear:both; background-color: rgb(200,200,200); } .theNote h3{ color: rgb(100,100,100); } .theNote h1, .theNote h3{ background-color:white; padding:2px 20px; width:8.0in !important; margin: 0 auto; font-size: 15px; } .theNote h1{ padding-top: 10px; font-size: 15px; } .theNote h1:first-child{ font-size: 20px; } .theNote h3 { font-size: 14px; font-weight: normal; } #options { border: 3px double #ccc; padding: 5px 12px; margin: 10px 50px 10px 20px; float: left; } #info { border-top: 1px solid #ccc; padding-top: 5px; font-style: italic; } li { margin: 5px 10px 5px 25px; } ul li { list-style: disc; } ol li { list-style: decimal; } img { border: 0; } table { clear: both; width: 100%; border: 1px solid #c5c5c5; border-width: 1px 0; margin: 0; page-break-after: always; } table#page { page-break-after: auto; } td { text-align: center; font-size: 12px; border-bottom: 1px dashed #c5c5c5; height: 1.75in; width: 50%; padding-left: 15px; } .leftside { border-right: 1px solid #cccccc; padding: 0 15px 0 0; } .bottom td { border-bottom: none; } .clearfix { clear:both; line-height:1px; height:1px; } img { max-width:80%; max-height:150px; margin:20px; } @media print {.header { display: none; } .content .header{ display:inherit; } table { border: 1px dashed #bbb; border-width: 1px 0; } .theNote{ background-color:white; } } Chapter 21-Parenteral Nutrition Support Objectives : Discuss parenteral nutrition. What is it? Indicated for patients who are unable to use the GI tract and who are either malnourished or likely to become so. Who is a candidate? Patients with intestinal obstructions or fistulas, paralytic ileus (intestinal paralysis), short bowel syndrome (a substantial portion of the small intestine has been removed), intractable vomiting or diarrhea, bone marrow transplants, severe malnutrition and intolerance to enteral nutrition. How is nutrition provided? Access sites fall into two main categories : the peripheral veins (arms and legs() and the central veins (located near the heart). Compare and contrast PPN and TPN. PPN (Peripheral Parenteral Nutrition are when nutrients are delivered only using the peripheral veins. Is used in patients who require short-term nutrition support (7-10 days) and who do not have high nutrient needs or fluid restrictions. TPN (Total Parenteral Nutrition) Is used in patients with very high nutrient needs or fluid restrictions are able to receive the nutrient-dense solutions they require. Is preferred for patients who require long-term parenteral nutrition. Describe the nutrients found in a parenteral solution. Amino acids (10%) , carbs (glucose), lipids (soybean oil and safflower oil) , fluids and electrolytes (sodium, potassium, chloride, calcium, magnesium, and phosphate), vitamins and trace minerals (Vit K, zinc, copper, chromium, selenium, and maganese) , osmolarity (amino acids, dextrose, and electrolytes), medications (insulin, piggy backing) Explain why fluctuations in blood glucose levels are of concern to those on TPN. What can be done to minimize these fluctuations? Describe transitional feeding. Create the big picture: What factors need to be considered when determining which method of nutrition support (strategies 1-3) to implement? Chapter Outline and Summary : Chapter Outline/Summary I. Indications for parenteral nutrition A. Peripheral parenteral nutrition B. Total parenteral nutrition Parenteral nutrition support delivers nutrients intravenously; it used in patients whose GI tract is not functioning and who may readily become malnourished. Patients receiving parenteral nutrition typically have intestinal disorders or are critically ill. If nutrients are infused directly into peripheral veins (peripheral parenteral nutrition), nutrient concentrations must be limited to avoid inflammation of the veins. The infusion of nutrients into central veins (total parenteral nutrition) can supply nutrient-dense solutions and is used for long-term intravenous feedings. II. Parenteral solutions A. Parenteral nutrients 1. Amino acids 2. Carbohydrate 3. Lipids 4. Fluids & electrolytes 5. Vitamins & trace minerals 6. Osmolarity 7. Medications B. Solution preparation 1. Parenteral formulations 2. Nonprotein kcalorie-to-nitrogen ratio 3. Safety concerns Prescriptions for parenteral solutions are individualized to meet each patient’s needs. The solutions are compounded in hospital pharmacies using commercial nutrient preparations and include amino acids, dextrose, electrolytes, vitamins, and trace minerals. Few medications are added to parenteral solutions due to the potential for drug-nutrient interactions. Parenteral solutions that include lipids are called total nutrient admixtures, 3-in-1 solutions, or all-in-one solutions; solutions that exclude lipids are called 2-in-one solutions. Parenteral solutions are prepared and handled using aseptic techniques to prevent contamination. III. Administering parenteral nutrition A. Insertion & care of intravenous catheters B. Administration of parenteral solutions C. Discontinuing parenteral nutrition D. Managing metabolic complications 1. Hyperglycemia 2. Hypoglycemia 3. Hypertriglyceridemia 4. Refeeding syndrome 5. Abnormal liver function 6. Gallbladder disease 7. Metabolic bone disease A nutrition support team, made up of physicians, nurses, dietitians, and pharmacists, may administer parenteral nutrition support or serve as advisers to other clinicians. Parenteral solutions may be initiated gradually or provided at full volume and full strength in selected patients. Critically ill patients may require continuous infusions, whereas healthier patients and long-term users may prefer cyclic infusions. Catheters are frequently the cause of complications, which include improper placement or dislodgment, infection, clotting, embolism, and phlebitis. Metabolic complications include hyperglycemia and hypoglycemia; hypertriglyceridemia; fluid and electrolyte imbalances; and diseases affecting the liver, gallbladder, and bone. When the need for parenteral nutrition resolves, patients are transitioned to an enteral diet as the volume of parenteral nutrition is gradually reduced. The Case Study can be used to check your understanding of the concepts introduced in this chapter. IV. Nutrition support at home A. Candidates for nutrition support B. Planning home nutrition care 1. Home enteral nutrition 2. Home parenteral nutrition C. Quality-of-life issues Candidates for home enteral nutrition services have disorders that interfere with swallowing ability, GI motility, or nutrient absorption. Candidates for home parenteral nutrition have disorders that severely impair nutrient absorption or cause intestinal motility problems. Patients and caregivers should participate in decisions about access sites, formulas, and nutrient delivery methods. Enteral formulas and parenteral solutions can be purchased or prepared in the home. The use of portable pumps may help individuals lead a normal lifestyle. Nevertheless, lifestyle adjustments to nutrition support may be difficult and stressful. V. Ethical issues in nutrition care A. Ethical considerations B. Ethical dilemmas 1. Legal decisions 2. Religious viewpoints C. Advance planning 1. Advance directives 2. The do-not-resuscitate order 3. Organ & tissue donation 4. Ongoing issues The major ethical considerations for health professionals include: patient autonomy, disclosure, informed consent, decision-making capacity, beneficence vs. maleficence, and distributive justice. Ethical dilemmas arise when nutrition support merely prolongs life without improving its quality for the patient. Individuals can use advance directives and DNR orders to make their medical preferences known in the event they are incapacitated.