Enteral and Parenteral Nutrition Flashcards
Canadian Malnutrition Task Force has adopted the following definition:
“Malnutrition includes both the deficiency or excess or imbalance of energy, protein and other nutrients”
what are the 3 broad types of malnutrition?
- Undernutrition (includes wasting)
- micronutrient-related malnutrition (includes micronutrient deficiencies)
- overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers)
malnutrition is associated with increased risk of:
- morbidity in acute and chronic diseases
- infections
- post-op complications
- mortality
- pressure wound ulcers
- Poor wound healing
- Delayed functional - improvement
- Increased length of stay
- Increased readmission rates
- Delay in the initiation of adjunctive treatment
what percentage of patients admitted to acute care (medical and surgical wards) have moderately or severely malnourished upon admission?
42%
what percentage of people admitted to acute care have “disease-related malnutrition”?
76%
what are the 4 basic “Nursing Admission” questions that are integral to the early identification of nutritional risk patients?
(In order of importance)
- Have you lost weight?
- If Yes, How much weight have you lost and over what time frame?
- What is your current weight?
- What is your height?
what is the highest predictor of malnutrition?
weight loss of 10% in the preceding 6 months of hospital admission
In developed countries, what is the main cause of malnutrition?
disease NOT starvation
what factors of disease have the potential to result in or worsen malnutrition?
Response to trauma, infection or inflammation may alter metabolism, appetite, absorption or assimilation of nutrients
what factors are associated with poor intake in the hospital?
Organizational factors
Patient factors
what are organizational factors of poor intake in the hospital?
- Lack of nutrition awareness by healthcare providers and patients
- Inappropriate NPO status
- Multiple medical tests requiring fasted states
- Unprotected meal times (diagnostics, visitors, transfers) – staff may forget to give food to patient when meal is missed
- Adverse hospital smells and noises
- Lack of assistance at meals
- Food services issues, i.e. unpalatable food, cold food, selective options, dry and chewy food
- Lack of nutritious food options outside of meal times
what are examples of illness effects?
Poor appetite
Too sick
Tired
Pain
what are examples of eating difficulties?
- Difficulty opening packages/unwrapping food
- Uncomfortable position to eat
- Difficulty reaching food
- Difficulty chewing and swallowing food
what are the Goals of Clinical Nutrition Intervention?
- To improve clinical status and outcome
- To restore/improve nutritional status in the face of disease and injury
- To possibly modulate/attenuate the disease process
- To minimize the catastrophic effects of injury, sepsis and inflammation
- Minimize the rate of lean body mass catabolism and weight loss and work towards anabolism
- Provide essential nutrients (macro and micronutrients)
- Decrease infectious and non-infectious complications
- Reduce length of stay, costs
- Improve quality of life
what are the Clinical Nutrition Interventions to malnutrition?
- oral
- enteral nutriton (tube feeds)
- parenteral nutrition (IV, TPN)
Indications: Oral Nutrition
- Consistent with medical and patient’s goals
- Inadequate oral intake to meet nutrient needs
- Functional gastrointestinal tract (digestion and absorption)
- Safe functional swallow
what are the Indications for Enteral Nutrition?
- Consistent with medical and patient goals
- Oral intake is deemed unsafe, inadequate, or impossible to meet nutrient needs
- Functional gastrointestinal tract (digestion and absorption)
- Accessible gastrointestinal tract
what are contraindications of enteral nutrition?
- Non-operative mechanical GI obstruction
- Intractable vomiting/diarrhea
- Paralytic ileus
- Severe GI bleed
- Perforation of the GI tract
- Inability to gain access to the GI tract
- Aggressive intervention not warranted or not desired
what conditions are associated with impaired ingestion?
Intubation, facial or esophageal trauma, CVA (stroke)
what conditions are associated with inability to consume adequate nutrition?
- A condition (hyperemesis of pregnancy, anorexia associated with CHF)
- A hyper-catabolic state (Bone Marrow Transplant, severe burns, sepsis)
what conditions are associated with impaired digestion and absorption?
Pancreatic cancer, short bowel, pancreatitis, gastroparesis
what conditions are associated with severe wasting/malnutrition?
end stage liver disease awaiting transplant, severe Crohn’s disease
what are the benefits of enteral nutrition?
- Preserves GI tract integrity and function
- Reduce infectious and non-infectious complications associated with disease and injury
- Less expensive than parenteral nutrition
- Generally safer than parenteral nutrition
what are the three types of Nasoenteric feeding routes?
Nasogastric (NG), nasoduodenal (ND), nasojejunal (NJ)
are Nasogastric (NG), nasoduodenal (ND) and nasojejunal (NJ) short or long term?
short term (<3-4 weeks)
what are the 2 types of Percutaneous enterostomy?
Gastrostomy (PEG) or jejunostomy (PEJ)
