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Ch. 21: Parenteral Nutrition

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.

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Ch. 21: Parenteral Nutrition

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  1. 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

  2. Rationale for Determining Feeding Route

  3. Parenteral Nutrition • Advantages • Can provide total nutritional support for longer period of time • Disadvantages of Parenteral Nutrition • Costly • Complications • Sepsis • Liver • Kidneys • Bone disorders • Deficiencies

  4. 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

  5. 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 small-diameter veins that carry blood from the arms and legs) or central veins (the large-diameter veins located close to the heart)

  6. 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

  7. Peripheral vs Total Parenteral Nutrition • Compare the composition and uses of PPN andTPN • Peripheral Parenteral • Nutrition (PPN) • Isotonic formula • Contains all essential nutrients • Requires renal functioning • Short-term: 7-14 days • Additional support for enteral feedings • Used when TPN not possible

  8. PPN and TPN, cntd. • Total Parenteral Nutrition (TPN) Central Vein • IV catheter in large central vein • Highly concentrated solutions • Long-term use • High nutritional needs • Client is severely malnourished • Higher risk of infection

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. Practice Questions • Types of formulas that contain complete proteins are called: • Intact • Hydrolyzed • Modular • Blenderized

  15. Hydrolyzed formulas are given to clients who are able to digest and absorb nutrients without difficulty. • True • False

  16. 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

  17. Ideally a person should reach a severely-depleted state before TPN by central vein is initiated. • True • False

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