Chapter 15 - Enteral AND Parenteral

Chapter 15: Enteral And Parenteral Introduction Nutrient delivery system for pt's unable to consume oral diet Enteral nutrition Via digestive tract (stomach and small intestine) Parenteral nutrition IV infusion, bypasses GI tract Oral Supplements For pt's with poor intake but intact GI tract Augments intake to meet needs, prevent complications, and support healing Enteral Nutrition Candidates for tube feedings Unable or unwilling to meet needs orally Impaired appetite, decreased food intake Malabsorption, intestinal resection, surgical resection Severe anorexia, cancer, burns Short-term Feeding Routes Needed for <4 weeks Nasogastric tube Nasoduodenal tube Nasojejunal tube Long-term Feeding Routes Gastrostomy or jejunostomy Indicated for >4 weeks Impaired swallowing, cancer, aspiration Gastroparesis, intestinal resection, burns Feeding Tubes Small diameter lumens Large diameter lumens (bolus or continuous feeding) Double lumens (balloon or gastric decompression) Types of Enteral Formulas Standard Formulas Complete and balanced nutrition, dietary fiber Lactose-free and gluten-free options Most common formulas used in acute and chronic care settings Elemental Formulas Predigested nutrients for malabsorption or intolerance Lactose-free and gluten-free options Used for specific conditions like Crohn's disease or short bowel syndrome Specialized Formulas Designed for specific medical conditions Renal, pulmonary, hepatic, or metabolic support May contain specific nutrients or restricted components Initiating & Advancing Tube Feedings Formulas provided for strength Intermittent Feedings Initiated at initial feedings, 10-40 ml q1-2h and advance feedings, until reaching goal volume Check tolerance before every meal and increase feeding time Continuous Feedings Steadier delivery rate, better tolerated Gastric Residual Volume Gastric Residual Volume Checking volume of formula and GI secretions remaining in the stomach after feedings Does not hold feedings without other signs of intolerance The stomach produces 50 ml/day in digestive secretions General Nutrition of Enteral Formulas Macronutrients Protein: 10-20% total kcal Carbohydrates: 50-65% total kcal Fats: 20-35% total kcal Osmolality: affects tolerance and absorption Hyperosmolar formulas can cause diarrhea Low osmolar formulas are 300-500 mOsm/kg Safe Handling Facility-specific protocols Formula storage guidelines Administration guidelines Administration of Tube Feedings Preparing for Tube Feedings Discuss procedure with patient and family members Use x-ray to verify tube placement before initiating feedings Elevate patient's body 10-15 degrees during and after feedings to reduce aspiration risk Tube Feedings Delivery Methods Intermittent Feedings 30-40 ml q1-2h, for 30-60 minutes Continuous Feedings Constant delivery rate over 24 hours, usually via infusion pump Enteral Nutrition Fluid needs: 30-40 ml/kg/day (50-65% water) Macronutrients: 10-20% Protein, 50-65% Carbs, 20-35% Fats Vitamins, trace minerals Medications: Most medications can be crushed and mixed in water. Sugar-coated medications may be sprinkled on food. Complications: Aspiration, diarrhea, nausea, vomiting, bloating Transition to oral intake: Depends on medical condition, length of feeding, and patient's tolerance. Parenteral Solutions Fluid needs: Adjusted according to daily fluid losses, hydration assessments Electrolytes: Potassium, calcium, magnesium, and others Vitamins, trace minerals Medications: May be added directly to PN or infused through a separate port in the line. Complications: Infection, metabolic abnormalities, liver problems Parenteral Formulations 3-in-1 solutions: Amino acids, dextrose, lipids 2-in-1 solutions: Amino acids, dextrose Candidates for Parenteral Nutrition Intractable vomiting or diarrhea, severe bleeding, intestinal obstructions, paralytic ileus Short bowel syndrome, post-surgical nutrition, intolerance to enteral nutrition Venous Access 1-Central Parenteral Nutrition: Long-term, requires central venous catheter placement 2-Peripheral Parenteral Nutrition: Short-term, for <2 weeks, limited fluid and electrolyte restrictions Administering Parenteral Nutrition Nutrition support teams Insertion sites of catheters Local anesthesia for insertion Macronutrients in Parenteral Solutions Amino acids: 3-6 g/kg/day Carbohydrates: Dextrose, lipid emulsions supply energy for fat-soluble vitamins Lipids: Source of energy, maintain cell membranes Vitamins: A, D, E, K, B complex, vitamin C Trace minerals: Zinc, copper, manganese, chromium, molybdenum Additional Notes: Administering parenteral nutrition requires specialized training and monitoring. Nutrition support teams collaborate with healthcare providers to optimize patient care. Regular assessment of patient's needs and response to therapy is essential.