Methods of Nutrition Support

KNH 411

Oral diets  “House” or regular diet  Therapeutic diets  Maintain or restore health & nutritional status   Accommodate changes in digestion, absorption, or organ function Provide nutrition therapy through nutrient content changes

Oral diets  Changes from the house diet  Caloric level  Consistency  Single nutrient manipulation  Preparation  Food restriction  Number, size, frequency of meals  Addition of supplements

Oral diets  Texture modifications  Soft diets  Liquid diets   Clear liquid Full liquid   Consider osmolality Preparation for a specific medical test

Oral Supplements  Goal: Increase nutrient density without increasing volume     Snacks Liquid meal replacement formulas Modular products Commercial supplements

Appetite Stimulants  Drugs that stimulate appetite  Prednisone  Megestrol acetate  Dronabinol

Specialized Nutrition Support (SNS)  Administration of nutrients with therapeutic intent  Enteral  Parenteral  Ethical considerations

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Enteral Nutrition  Feeding through the GI tract via tube, catheter or stoma delivering nutrients distal to oral cavity  “Tube feeding”  Indicated for patients with functioning GI but unable to self-feed  Contraindications  Advantages / Disadvantages?

Enteral Nutrition   Decisions for the nutrition prescription GI access  Formula  Feeding technique  Equipment needed

Enteral Nutrition  • GI Access Access route described by where it enters the body and where the tip is located      Nasogastric Orogastric Nasointestinal Typically used for short term Disadvantages?

Enteral Nutrition  • GI Access – “Ostomy” •   Gastrostomy Jejunostomy  PEG More permanent

© 2007 Thomson - Wadsworth

Enteral Nutrition   Formulas Based on substrates, nutrient density, osmolality, viscosity     Protein Soy or casein 10-25% kcal Elemental or chemically defined Specialized amino acid profiles

Enteral Nutrition   Formulas Lipid   Corn or soy oil Long- and medium-chain TG   Omega-3 fatty acids Structured lipids

Enteral Nutrition   Formulas Vitamins and minerals   Meet DRI Supplemental amounts      Fluid and nutrient density 1.0-2.0 kcal per mL Difference depends on water content Ensure adequate fluid - 80% water for 1 kcal per mL Osmolality and osmolarity

Enteral Nutrition   Formulas Other considerations   Considered medical food – not drug  No test for efficacy or benefit Cost

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Enteral Nutrition  Feeding techniques/ delivery methods    Bolus feedings Intermittent feedings Continuous feedings © 2007 Thomson - Wadsworth

Enteral Nutrition  Equipment  Feeding tubes - french size  Cans or sealed containers  Pumps

Enteral Nutrition  Determining the nutrition prescription - clinical application

Enteral Nutrition  Complications  Mechanical complications   Clogged or misplaced tubes GI complications  Diarrhea  Aspiration

Enteral Nutrition  Monitoring for complications  Dehydration   Tube Feeding Syndrome Electrolyte Imbalances    Underfeeding or Overfeeding Hyperglycemia Refeeding Syndrome  Monitor serum phosphorus, mg, potassium

Parenteral Nutrition  Administration by “vein”  a.k.a. – PN, TPN, CVN, IVH  TPN vs. PPN  Indicated if unable to use oral diet or enteral nutrition  Certification of medical necessity

Parenteral Nutrition  Venous access  Short-term access   CVC inserted percutaneously Using subclavian, jugular, femoral veins   PICC Long-term access   Tunneled catheters Implantable ports

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Parenteral Nutrition  Solutions   Compounded by pharmacist using “clean room” Two-in-one    Dextrose & amino acids Lipids added separately Clear - easier to identify precipitates  Three-in-one   Dextrose, amino acids & lipids Single administration

Parenteral Nutrition  Solutions  Protein     Individual amino acids Modified products for renal, hepatic and stress Commercial amino acids 3.5-20% .8- 1.8 g/kg depending on condition

Parenteral Nutrition  Solutions  Carbohydrates     Energy source – dextrose monohydrate 3.4 kcal/g 1 mg/kg/min minimum 5%, 10%, 50%, 70% concentrations

Parenteral Nutrition  Solutions  Lipids     Emulsion of soybean or safflower oil Essential fatty acids Source of energy Minimum of 10% kcal

Parenteral Nutrition  Solutions  Electrolytes  DRI standards used  Vitamins/Minerals  Trace minerals  Medications

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Parenteral Nutrition  Determining the nutrition prescription – clinical application - sample form

Parenteral Nutrition  Administration techniques  Initiate 1 L first day; increase to goal volume on day 2  Patient monitoring  Intake vs. output  Laboratory monitoring

Parenteral Nutrition  Complications  GI complications  Infections