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Nutritional Supplements

Enteral Nutrition Feeding tubes are used for those with: Abnormal esophageal or stomach peristalsis Altered anatomy secondary to surgery Depressed consciousness Impaired digestive capacity
Enteral Formulation Group: Polymeric Ensure, Ensure-Plus, Isocal, Osmolite, Sustacal, Jevity, others Preferred over elemental formulations for patients with fully functional GI tracts and few specialized nutrient requirements; cause fewer GI problems
Enteral Formulation Group: Polymeric Most closely resemble normal dietary intake
Enteral Formulation Group:Impaired Glucose Tolerance Glucerna Contains proteins, carbohydrates, fat, sodium, potassium Used in patients with impaired glucose tolerance (e.g., diabetic patients)
Parenteral Nutrition Also known as total parenteral nutrition (TPN) or hyperalimentation; can give R insulin through TPN port IVP only, no other medications
Parenteral Nutrition Formulations vary according to individual patient nutritional needs Amino acids Carbohydrates Lipids Trace elements
Peripheral total parenteral nutrition Temporary, short term (less than 2 weeks) Dextrose concentration generally less than 10%
Central total parenteral nutrition Long-term use (over 2 weeks) Dextrose concentrations may be 10% to 50%, but are commonly 25% to 35%
Peripheral TPN:Adverse Effects Phlebitis is the most devastating adverse effect Can lead to loss of a limb Fluid overload
Central TPN Delivered through a large central vein Subclavian Internal jugular Long-term use (more than 2 weeks)
Central TPN Disadvantages are the risks associated with central line insertion, use, and maintenance Higher risk for infection, catheter-induced trauma, metabolic alterations
Implications Ensure that a complete nutritional assessment is taken, including a dietary history, weekly and daily food intakes, and weight and height measurements
Implications Monitor for signs of lactose intolerance – for tube feedings Cramping Diarrhea Abdominal bloating Flatulence
Implications Monitor blood glucose levels with a glucometer Monitor for hyperglycemia Headache, dehydration, weakness Monitor for hypoglycemia Cold, clammy skin, dizziness, tachycardia, tingling of the extremities
Implications Monitor for fluid overload while on TPN Weak pulse Hypertension Tachycardia Confusion Decreased urine output Pitting edema
Implications If TPN is discontinued abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels If TPN must be discontinued abruptly, then infuse 5% to 10% glucose to prevent hypoglycemia
Implementation If the volume aspirated is more than the volume delivered over the previous 2 hours (of continuous feeding), the nurse should return the aspirate, hold the feeding, and contact the prescriber while keeping the head of the patient's bed elevated.
Implementation For intermittent bolus feedings, if the residual amount is more than 50% of the volume previously infused, the nurse should return the aspirate, withhold the feeding, and contact the prescriber.
Implementation Average tube feeding is 75 ml/hour
Implementation Usually the initial rate is 50 mL/hr at one-half strength, but this may be increased per patient tolerance to a rate ordered by the physician or appropriate health care provider.
Created by: codzep