Nutrition support

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OBM247 (CHAPTER 3): MANAGING CURRENT RECORD

por Khairul Anwar Bin Khairuddin 3R

triathlon

por dana witheft

DISADVANTAGES of not having time management

por Giorgia Russo

Production Planning

por Gert Struyven

Nutrition support

Diet

See requirements for "nutrition prescription" under PN

USE UBW if WNR BMI

Parenteral Nutrition (PN) bypass the gut

Only gradual increase for re-feeding otherwise DON"T delay

MONITORING

See back page for monitoring guidelines doc

GGT &ALP raised = Cholestasis- cyclic feed to give liver a break

ALT & AST increased= overfeeding

CHECK GLUCOSE INFUSION

Nutrition prescription

Fluid: 30-35ml/Kg/day

Fat: 1-1.5g/kg/day

CHO: 5-10g/Kg/day bw

Protein: 1.0-1.5g/Kg/day OR 1.5-2.0g critically ill

Energy: 100-125kJ/Kg/day

WHEN?

Severe NIS

Enteral has been tried but unsuccessful

Period of oral nutrition inadequate >1 week

Gut is not functioning

Type

Peripherally (PPN)

In a lumen ONLY for nutrition purposes

blood flow 150mL/min

<2 weeks

Centrally (TPN)

Can't use if there is already a picc line for something else

>2 weeks

PICC line

Client hx

NIS/NFPF

Ileus (damaged gut therefore need to bypass-PN)

Vomiting/diarrhoea

Medications past and current:

Esomeprazole (reduces stomach acid)

Aperients (relieve constipation)

ondansetron (anti-nausea)

Medical: past and present; surgery? Chemo?

Monitoring and evaluation

once risk of RFS resolved- trial soft diet HEHP & continue ONS

Monitor and replace electrolytes

If PN remains to reach nutritional adequace, increase TPN to lower range of goal

Re-feeding syndrome (RFS)

Multivitamin daily 10/7 UNLESS on TPN

Thiamine (B1)

In RFS = decrease thiamine which is integral to CHO metabolism

200-300mg IV or 100mg TDS PO 3/7 THEN 100mg PO 7/7

300mg IV 30 min before feeding

BGL's

Albumin and pre-albumin

Liver function tests ALT and AST

RISK of RFS

TWO or more of: BMI<18.5, excessive EtOH, unintentional wt loss >10% 3-6/12

ONE or more: BMI <16, unintentional wt loss >15% <3-6/12, <500kj/24hr or NO intake >10/7

abnormal glucose metabolism

72/24hr

Severe electrolyte disturbance

When pt is severely starved or malnourished

Specialised feeds

Polymeric: intact, not broken down (full necklace)

Semi-elemental: in pairs (partially pre-digested)

Elemental: broken into smallest forms

PERT (pancreatic enzyme replacement therapy)

- trophic feed; small vol of enteral feeding to stimulate the gut

Biochem

K+, Mg, PO4 - nausea and vomiting may cause a decline in these

Anthro:

SGA- check BMI and wt loss % within 3-6/12