Please enable JavaScript.
Coggle requires JavaScript to display documents.
Complex Nutrition Support - Coggle Diagram
Complex Nutrition Support
Specialised feeds
PERT (pancreatic enzyme replacement therapy)
important in GI conditions
Indications: partial or entirely removed pancreas, enzymes and/or pancreas not working properly, GI conditions
RTH (ready to hang)
Semi-elemental: broken into pairs, partially pre-digested
Polymeric: intact, not yet broken down or pre-digested
Elemental: broken down into smallest/simplest form, easy to digest (pre-digested)
Parenteral
nutrition
Type
Central (TPN)
PICC line, can't use if already for something else
2wks consider TPN
Peripheral
(PPN)
Short-term - 10-14/7 OR < 2 wks
Inserted into lumen ONLY for nutrition purposes
bllod flow 150ml/min
When?
Oral nutrition inadequate 5/7
Enteral tried but unsuccessful
Gut is not functioning
Severe NIS
Nutrition Prescription
CHO: 5-10g/kg/day
Fat: 1-1.5g/kg/day
Protein: 1.0-1.5g/kg/d OR
1.5-2.0g/kg/day in CRITICALLY ILL
Fluid: 30-35mL/kg/day
Energy: 100-125kJ/kg/day
Monitoring
ALT & AST increased = overfeeding
GGT & ALP raised = cholestatsis - cyclic feed to give liver a break
Check glucose infusion
Contraindications
Duration of PN is <5/7 **Consider PPN
Functioning gut; can be fed enterally (consider jejunal feeding)
Awaiting a surgical procedure to improve gut function
Palliative or end of life care
Re-feeding syndrome (RFS)
Occurs
Pt is severely starved or malnourished
Severe electrolyte disturbance (PO4-, K+, Mg & Na+) & fluid shifts
abnormal glucose metabolism
Micronutrient deficiencies (especially thiamane)
After first 72hrs following period of starvation
Pts at Risk of RF
Extremely high risk
Pt has
ONE or more
: BMI<14, negligible intake (<500kJ/24hr) for >15/7 OR no nutrient intake
High risk
PT has
ONE or more
: BMI <16, unintentional wt loss >15% <3-6/12, <500kJ/24hr OR no nutrient intake for 10>7 & electrolyte derangement
Pt has
TWO or more
: BMI <18.5, unintentional wt loss >10% <3/12, <500kJ/24hr for >5/7 OR evidence of stress/ nutrition depletion & excessive EtOH
Biochem
Albumin & pre-albumin
BGL's
Liver function tests (ALT & AST)
Thiamine (B1) **
200-300mg IV or 100mg TDS PO 3/7
THEN 100mg PO 7/7
300mg IV 30 min before feeding
Interventions
Thiamine **
100mg PO 7/7, until nutritionally restored
multivitamin daily 10/7
replace electrolytes accordingly
6000kJ/d OR 100% requirements (whichever is less)
Monitoring & Evaluation
Monitor & replace electrolytes
If PN remains unable to reach nutritional
adequacy, increase TPN to lower range
of goal
Once RF risk resolved, trial soft
HPHE diet & continue ONS
Pg. 169 in handbook
Assessment
Biochem
K+, Mg & PO4-
N& V may cause decrease in these
Client hx
Medical
past & present, surgery, chemo?
Medications
Aperients (relieve constipation)
Esomeprazole (reduces stomach acid)
Ondansetron (anti-nausea)
Anthro
BMI
Wt loss % within 3-6/12
SGA
NIS
N & V
Ileus (damaged gut = need to bypass-PN)
Subtopic
DDR Structure
Recommended intervention (Approach to addressing problem)
Progress to goals & strategies
Consequences if no action taken
Problem (PES that you have diagnosed)
Condition/disease state (Brief pathophysiology of condition and how relates to nutrient/s of interest)
Nutrient/s of interest (what it is, what foods found in, role in the body)
Enteral Nutrition
Types
ONS
tube feeding
Indicators
individual not safe for oral intake (dysphagia, impaired consciousness)
oral intake is not adequate to meet requirements
Guidelines, DAA 2016