This document discusses indications for parenteral nutrition, which is intravenous nutrition delivered when a patient is unable to absorb enough nutrients enterally. Common conditions requiring parenteral nutrition include massive small bowel resection, intractable vomiting, severe diarrhea, bowel obstruction, and gastrointestinal fistulae. The document outlines the composition of parenteral nutrition formulations including macronutrients like amino acids, carbohydrates, and intravenous fat emulsions as well as micronutrients like electrolytes, vitamins, and trace elements. It also discusses assessing a patient's nutritional status and requirements in order to determine the appropriate parenteral nutrition formulation and administration.
Estudio científico de la UV demuestra los beneficios de consumir arándanos an...Emisor Digital
La investigación, realizada por las académicas de la Escuela de Nutrición y Dietética de la Universidad de Valparaíso Ximena Palma y Samanta Thomas, junto al doctor Gonzalo Cruz, del Centro de Neurobiología y Fisiopatología Integrativa (CENFI) y académico del Instituto de Fisiología de la UV, apuntó a evaluar el manejo de la glucosa posprandial (después de las comidas) y la capacidad antioxidante de los arándanos frescos.
Total parenteral nutrition (TPN) involves administering nutrients intravenously to bypass an impaired gastrointestinal tract. TPN can be central, delivered into a central vein, or peripheral, delivered into a smaller vein. TPN formulations provide carbohydrates, lipids, amino acids, electrolytes, vitamins, and fluids to meet the nutritional needs of patients who cannot receive adequate nutrition enterally. TPN solutions must be carefully manufactured, labeled, and administered according to a patient's age, medical condition, and nutritional requirements to safely provide complete nutrition intravenously.
formulation of diet therapy along with diet therapy of peptic ulcerGokulArora
This document provides an introduction to diet therapy and references peptic ulcer. It discusses therapeutic diets, food acceptance in illness, how illness affects nutrition, and nutritional assessment in clinical settings. It describes types of diets including clear liquid, full liquid, soft, and pureed diets. It also discusses types of feeding such as tube feeding, parenteral feeding, and total parenteral nutrition. Finally, it provides a treatment chart for peptic ulcer that involves a milk and banana diet followed by a diet emphasizing fruits, vegetables, and whole grains with milk.
This document provides information on diet therapy and protein energy malnutrition. It discusses the objectives and principles of diet therapy, including using food to treat diseases by changing a patient's normal diet based on their condition. It also covers the classification, causes, risk factors, complications, and treatment of protein energy malnutrition, specifically marasmus and kwashiorkor. The key differences between marasmus and kwashiorkor are outlined. Prevention and management of PEM focuses on proper nutrition, hygiene, breastfeeding, and treating underlying infections.
Diet therapy involves modifying a patient's normal diet in response to disease or injury in order to meet altered nutritional requirements. The objectives of diet therapy include maintaining positive health and nutrition, correcting nutrient deficiencies, and adjusting food intake based on a person's ability to metabolize nutrients. Therapeutic diets are prescribed by doctors and are adaptations of a normal diet tailored to a patient's individual circumstances like economic status, preferences, and medical condition. Diet therapy principles include selecting easily digestible and preferred foods to maximize nutrient utilization and ensure patient cooperation, which is essential for success.
This document discusses nutrition and nutritional support. It begins by outlining nutrient metabolism, including carbohydrate, lipid, and protein metabolism. It then discusses stress metabolism and how the body's metabolic response to stress is similar to starvation. The document covers nutritional assessment, including methods to evaluate a patient's nutritional status. It provides details on enteral and parenteral nutrition administration, including feeding tube types, formulas, and protocols. Complications of both enteral and parenteral nutrition are also summarized.
This document describes a specialized liquid formula called Diamax for people with diabetes. It has a low glycemic rate and provides glycemic control through its balanced ratio of nutrients including a high amount of soluble fiber and monounsaturated fatty acids. Clinical studies show diets with a low glycemic rate can reduce HbA1c and improve lipid profiles. Diamax's formulation aims to improve metabolic outcomes for people with diabetes through its customized nutrients and macronutrient profile.
Estudio científico de la UV demuestra los beneficios de consumir arándanos an...Emisor Digital
La investigación, realizada por las académicas de la Escuela de Nutrición y Dietética de la Universidad de Valparaíso Ximena Palma y Samanta Thomas, junto al doctor Gonzalo Cruz, del Centro de Neurobiología y Fisiopatología Integrativa (CENFI) y académico del Instituto de Fisiología de la UV, apuntó a evaluar el manejo de la glucosa posprandial (después de las comidas) y la capacidad antioxidante de los arándanos frescos.
Total parenteral nutrition (TPN) involves administering nutrients intravenously to bypass an impaired gastrointestinal tract. TPN can be central, delivered into a central vein, or peripheral, delivered into a smaller vein. TPN formulations provide carbohydrates, lipids, amino acids, electrolytes, vitamins, and fluids to meet the nutritional needs of patients who cannot receive adequate nutrition enterally. TPN solutions must be carefully manufactured, labeled, and administered according to a patient's age, medical condition, and nutritional requirements to safely provide complete nutrition intravenously.
formulation of diet therapy along with diet therapy of peptic ulcerGokulArora
This document provides an introduction to diet therapy and references peptic ulcer. It discusses therapeutic diets, food acceptance in illness, how illness affects nutrition, and nutritional assessment in clinical settings. It describes types of diets including clear liquid, full liquid, soft, and pureed diets. It also discusses types of feeding such as tube feeding, parenteral feeding, and total parenteral nutrition. Finally, it provides a treatment chart for peptic ulcer that involves a milk and banana diet followed by a diet emphasizing fruits, vegetables, and whole grains with milk.
This document provides information on diet therapy and protein energy malnutrition. It discusses the objectives and principles of diet therapy, including using food to treat diseases by changing a patient's normal diet based on their condition. It also covers the classification, causes, risk factors, complications, and treatment of protein energy malnutrition, specifically marasmus and kwashiorkor. The key differences between marasmus and kwashiorkor are outlined. Prevention and management of PEM focuses on proper nutrition, hygiene, breastfeeding, and treating underlying infections.
Diet therapy involves modifying a patient's normal diet in response to disease or injury in order to meet altered nutritional requirements. The objectives of diet therapy include maintaining positive health and nutrition, correcting nutrient deficiencies, and adjusting food intake based on a person's ability to metabolize nutrients. Therapeutic diets are prescribed by doctors and are adaptations of a normal diet tailored to a patient's individual circumstances like economic status, preferences, and medical condition. Diet therapy principles include selecting easily digestible and preferred foods to maximize nutrient utilization and ensure patient cooperation, which is essential for success.
This document discusses nutrition and nutritional support. It begins by outlining nutrient metabolism, including carbohydrate, lipid, and protein metabolism. It then discusses stress metabolism and how the body's metabolic response to stress is similar to starvation. The document covers nutritional assessment, including methods to evaluate a patient's nutritional status. It provides details on enteral and parenteral nutrition administration, including feeding tube types, formulas, and protocols. Complications of both enteral and parenteral nutrition are also summarized.
This document describes a specialized liquid formula called Diamax for people with diabetes. It has a low glycemic rate and provides glycemic control through its balanced ratio of nutrients including a high amount of soluble fiber and monounsaturated fatty acids. Clinical studies show diets with a low glycemic rate can reduce HbA1c and improve lipid profiles. Diamax's formulation aims to improve metabolic outcomes for people with diabetes through its customized nutrients and macronutrient profile.
MUMBAI UNIVERSITY SEMINAR on potential anti-diabetic herbal drugsDRx.Yogesh Chaudhari
This document discusses diabetes and herbal treatments for it. It begins by defining diabetes as a metabolic disorder caused by pancreatic beta cell dysfunction leading to insulin deficiency or resistance. It describes the two main types and their characteristics. Several herbal plants traditionally used to treat diabetes are then discussed in more detail, including their parts used, active chemical constituents, mechanisms of action, and other medicinal properties. These include Gymnema sylvestre, Momordica charantia, Allium sativum, Ocimum sanctum, Trigonella foenum-graecum, and Tinospora cordifolia.
2010 effect of pistachio diet on lipid parameters, endothelial functionAgrin Life
This study investigated the effects of consuming a pistachio-enriched Mediterranean diet on cardiovascular risk factors in 32 healthy young men. Compared to a standard Mediterranean diet, the pistachio diet for 4 weeks significantly decreased blood glucose, LDL cholesterol, total cholesterol, and triglycerides. It also significantly improved endothelial function and decreased markers of inflammation and oxidative stress. The findings suggest that pistachios may have beneficial effects beyond lipid lowering and cardiovascular health.
This document provides an overview of total parenteral nutrition (TPN). It discusses that TPN involves intravenous administration of nutrients like proteins, carbohydrates, fats, minerals, electrolytes and vitamins for patients unable to meet nutritional needs enterally. It outlines the types of patients that require TPN, its composition, routes of administration, potential complications, and the role of pharmacists in monitoring patients on TPN. Close monitoring of fluid, electrolytes, glucose and organ function is important to manage risks and optimize outcomes for patients receiving TPN.
Total parenteral nutrition (TPN) involves delivering nutrients directly into the bloodstream. It contains carbohydrates, proteins, lipids, electrolytes, vitamins and minerals. TPN provides water, energy, amino acids and essential fatty acids based on a patient's needs and condition. Common components include dextrose for carbohydrates, crystalline amino acids for protein, Intralipid for lipids, and minerals and trace elements. TPN is indicated for patients unable to eat or absorb enough nutrients enterally due to conditions like short bowel syndrome, GI fistulas or following surgery. It allows for complete nutrient delivery to support patients who cannot meet their needs through oral or tube feeding.
Development of fiber rich powder and effect of supplementation on constipationSukhveerSingh31
Constipation is common health problem of youngsters and their cure is possible through change in food habits. Inclusion of dietary fibers in the diet reduces the constipation and its complications like overweight, cancer etc.
This document discusses parental nutrition, including its definition, indications, administration routes, formulation, and documentation. Parental nutrition involves infusing nutrients directly into the circulatory system to bypass the gastrointestinal tract. It is indicated for patients who cannot receive adequate nutrition enterally due to GI dysfunction. Formulations provide nitrogen, amino acids, energy sources like dextrose and lipids, electrolytes, trace elements, and vitamins. Components are individualized for each patient's needs. Monitoring is important when on parental nutrition.
This document summarizes a review article about saffron and its potential role in regulating metabolic functions related to obesity. Saffron is the dried stigma of Crocus sativus flowers and contains bioactive compounds like crocin, crocetin, and picrocrocin that have strong antioxidant properties. The review examines evidence that saffron may beneficially alter obesity pathophysiology by reducing levels of glucose, triglycerides, and LDL cholesterol; increasing energy expenditure and fat oxidation; and lowering body weight and adiposity. It also discusses saffron's anti-inflammatory, anti-diabetic, hypolipidemic, and hypoglycemic effects. However, more studies are needed to
Medicinal plants and diabetes A series of PresentationByMr. Allah Dad Kha...Mr.Allah Dad Khan
A series of PresentationByMr. Allah Dad Khan Former DG Agriculture Extension KP Province and Visiting Professor the University of Agriculture Peshawar Pakistan allahdad52@gmail.com
The document describes a randomized controlled trial that investigated the impact of consuming apricots, pomegranate juice, fermented sobya, or combinations for 3 weeks on biomarkers related to antioxidant activity and oxidative stress in healthy adults. 35 participants were divided into 5 groups: a control group, an apricot group, a pomegranate juice group, a combination pomegranate juice and fermented sobya group, and a fermented sobya group. Blood and urine samples were collected at baseline and after 3 weeks to analyze markers of antioxidant capacity, oxidative stress, and glutathione transferase enzyme activity. The study found that consuming pomegranate juice increased plasma and urinary antioxidant activities and reduced urinary oxidative stress
diet therapy ,formulation of theurapeutic dietseema bisht
Diet therapy involves specially designed meal plans to aid medical or nutritional recovery from illness or disease. Therapeutic diets modify nutrients like carbohydrates, fats, proteins or fiber based on conditions like diabetes, heart disease, kidney disease or malnutrition. Common therapeutic diets include diabetic, heart healthy, renal, high fiber, lactose free, gluten free, food allergy or intolerance diets, and high calorie diets for malnutrition. Ensuring residents receive tasty, nutritious foods integrated into standard menus helps provide effective nutritional care through therapeutic diets.
This document discusses herbal remedies for diabetes, including anti-diabetic compounds found in various plants and how they work. It describes the types and causes of diabetes and the role of insulin. Various plant families containing anti-diabetic properties are listed, along with their active compounds and mechanisms of action. Examples of scientifically investigated antidiabetic plants and polyherbal formulations used to treat diabetes are provided.
Effect of Piper crocatum Extract Against Weight Loss and Liver Enzyme Levels ...iosrphr_editor
Piper crocatum is one of Indonesian medicinal plant that contain flavonoids, tannins, alkaloids, and saponins. Aims of this study were to evaluate the effect of Piper crocatum aqueous extract against a decrease in body weight (BW) and the activity of enzymes involved in lipid metabolism (AMPK, ACC, FAS) in liver obese rats. This study used four groups of Sprague dawley rat (n = 6), including normal group (N), obese controls (OC), Piper crocatum extract dose 1260 mg/kgBW (PcA), and Piper crocatum extract dose of 1890 mg/kgBW (PcB). Measurement of metabolic liver enzyme levels (AMPK, ACC, FAS) are using ELISA kit (CusabioTM). Results of this study showed that the PcA group produce the highest reduction in body weight (4.52%), and the lowest levels of ACC (9.13 ng/g) and FAS (360.68 ng/g) which was significantly different from obese control group (95% CI). Piper crocatum extract can't activate AMPK. The highest levels in rat liver AMPK is in N group with 8.42 ng/g, but this value is not significantly different from other groups.
There are several ways that medications can cause nutrient depletion including decreasing nutrient absorption, interfering with metabolism and production, and increasing excretion. Key at-risk groups are the elderly, children, pregnant women, and those with serious health conditions. Healthcare professionals have an obligation to counsel patients about nutrient-drug interactions and recommend prevention strategies like a nutrient-rich diet, supplementation, and increased fiber intake to minimize health risks and improve outcomes.
This document provides an overview of parenteral nutrition. It defines parenteral nutrition as intravenous infusion of nutrients that bypasses digestion. Indications for parenteral nutrition include inadequate oral/enteral intake for over a week, GI dysfunction, severe malnutrition, and medical conditions like burns or surgery. Total parenteral nutrition provides complete nutrition support through a central line and includes carbohydrates, proteins, lipids, fluids, electrolytes, and trace metals. The document discusses monitoring, complications, and gradual discontinuation of parenteral nutrition.
A comprehensive presentation on Total parenteral nutrition(TPN) to facilitate easy -learning for medical , dental , pharmacology and biotechnology students.
Consuming cruciferous vegetables even by people with thyroid problems could potentially provide certain health benefits, such as antioxidant and ant inflammatory effects to the gland, without a negative impact to its functioning.
This document discusses nutrition in critical care patients. It recommends that critically ill patients who are at high nutritional risk based on a NUTRIC or NRS 2002 score of 5 or higher should receive specialized nutrition support, preferably through enteral feeding. Enteral feeding is preferred over parenteral nutrition when possible. The goals of nutrition support are to provide 1.2-2.0 g/kg/day of protein and aim for 25 kcal/kg/day of calories. Achieving adequate protein provision may improve outcomes over providing only trophic or permissive underfeeding. Monitoring of nutrition support is important to help meet goals and avoid overfeeding complications.
MUMBAI UNIVERSITY SEMINAR on potential anti-diabetic herbal drugsDRx.Yogesh Chaudhari
This document discusses diabetes and herbal treatments for it. It begins by defining diabetes as a metabolic disorder caused by pancreatic beta cell dysfunction leading to insulin deficiency or resistance. It describes the two main types and their characteristics. Several herbal plants traditionally used to treat diabetes are then discussed in more detail, including their parts used, active chemical constituents, mechanisms of action, and other medicinal properties. These include Gymnema sylvestre, Momordica charantia, Allium sativum, Ocimum sanctum, Trigonella foenum-graecum, and Tinospora cordifolia.
2010 effect of pistachio diet on lipid parameters, endothelial functionAgrin Life
This study investigated the effects of consuming a pistachio-enriched Mediterranean diet on cardiovascular risk factors in 32 healthy young men. Compared to a standard Mediterranean diet, the pistachio diet for 4 weeks significantly decreased blood glucose, LDL cholesterol, total cholesterol, and triglycerides. It also significantly improved endothelial function and decreased markers of inflammation and oxidative stress. The findings suggest that pistachios may have beneficial effects beyond lipid lowering and cardiovascular health.
This document provides an overview of total parenteral nutrition (TPN). It discusses that TPN involves intravenous administration of nutrients like proteins, carbohydrates, fats, minerals, electrolytes and vitamins for patients unable to meet nutritional needs enterally. It outlines the types of patients that require TPN, its composition, routes of administration, potential complications, and the role of pharmacists in monitoring patients on TPN. Close monitoring of fluid, electrolytes, glucose and organ function is important to manage risks and optimize outcomes for patients receiving TPN.
Total parenteral nutrition (TPN) involves delivering nutrients directly into the bloodstream. It contains carbohydrates, proteins, lipids, electrolytes, vitamins and minerals. TPN provides water, energy, amino acids and essential fatty acids based on a patient's needs and condition. Common components include dextrose for carbohydrates, crystalline amino acids for protein, Intralipid for lipids, and minerals and trace elements. TPN is indicated for patients unable to eat or absorb enough nutrients enterally due to conditions like short bowel syndrome, GI fistulas or following surgery. It allows for complete nutrient delivery to support patients who cannot meet their needs through oral or tube feeding.
Development of fiber rich powder and effect of supplementation on constipationSukhveerSingh31
Constipation is common health problem of youngsters and their cure is possible through change in food habits. Inclusion of dietary fibers in the diet reduces the constipation and its complications like overweight, cancer etc.
This document discusses parental nutrition, including its definition, indications, administration routes, formulation, and documentation. Parental nutrition involves infusing nutrients directly into the circulatory system to bypass the gastrointestinal tract. It is indicated for patients who cannot receive adequate nutrition enterally due to GI dysfunction. Formulations provide nitrogen, amino acids, energy sources like dextrose and lipids, electrolytes, trace elements, and vitamins. Components are individualized for each patient's needs. Monitoring is important when on parental nutrition.
This document summarizes a review article about saffron and its potential role in regulating metabolic functions related to obesity. Saffron is the dried stigma of Crocus sativus flowers and contains bioactive compounds like crocin, crocetin, and picrocrocin that have strong antioxidant properties. The review examines evidence that saffron may beneficially alter obesity pathophysiology by reducing levels of glucose, triglycerides, and LDL cholesterol; increasing energy expenditure and fat oxidation; and lowering body weight and adiposity. It also discusses saffron's anti-inflammatory, anti-diabetic, hypolipidemic, and hypoglycemic effects. However, more studies are needed to
Medicinal plants and diabetes A series of PresentationByMr. Allah Dad Kha...Mr.Allah Dad Khan
A series of PresentationByMr. Allah Dad Khan Former DG Agriculture Extension KP Province and Visiting Professor the University of Agriculture Peshawar Pakistan allahdad52@gmail.com
The document describes a randomized controlled trial that investigated the impact of consuming apricots, pomegranate juice, fermented sobya, or combinations for 3 weeks on biomarkers related to antioxidant activity and oxidative stress in healthy adults. 35 participants were divided into 5 groups: a control group, an apricot group, a pomegranate juice group, a combination pomegranate juice and fermented sobya group, and a fermented sobya group. Blood and urine samples were collected at baseline and after 3 weeks to analyze markers of antioxidant capacity, oxidative stress, and glutathione transferase enzyme activity. The study found that consuming pomegranate juice increased plasma and urinary antioxidant activities and reduced urinary oxidative stress
diet therapy ,formulation of theurapeutic dietseema bisht
Diet therapy involves specially designed meal plans to aid medical or nutritional recovery from illness or disease. Therapeutic diets modify nutrients like carbohydrates, fats, proteins or fiber based on conditions like diabetes, heart disease, kidney disease or malnutrition. Common therapeutic diets include diabetic, heart healthy, renal, high fiber, lactose free, gluten free, food allergy or intolerance diets, and high calorie diets for malnutrition. Ensuring residents receive tasty, nutritious foods integrated into standard menus helps provide effective nutritional care through therapeutic diets.
This document discusses herbal remedies for diabetes, including anti-diabetic compounds found in various plants and how they work. It describes the types and causes of diabetes and the role of insulin. Various plant families containing anti-diabetic properties are listed, along with their active compounds and mechanisms of action. Examples of scientifically investigated antidiabetic plants and polyherbal formulations used to treat diabetes are provided.
Effect of Piper crocatum Extract Against Weight Loss and Liver Enzyme Levels ...iosrphr_editor
Piper crocatum is one of Indonesian medicinal plant that contain flavonoids, tannins, alkaloids, and saponins. Aims of this study were to evaluate the effect of Piper crocatum aqueous extract against a decrease in body weight (BW) and the activity of enzymes involved in lipid metabolism (AMPK, ACC, FAS) in liver obese rats. This study used four groups of Sprague dawley rat (n = 6), including normal group (N), obese controls (OC), Piper crocatum extract dose 1260 mg/kgBW (PcA), and Piper crocatum extract dose of 1890 mg/kgBW (PcB). Measurement of metabolic liver enzyme levels (AMPK, ACC, FAS) are using ELISA kit (CusabioTM). Results of this study showed that the PcA group produce the highest reduction in body weight (4.52%), and the lowest levels of ACC (9.13 ng/g) and FAS (360.68 ng/g) which was significantly different from obese control group (95% CI). Piper crocatum extract can't activate AMPK. The highest levels in rat liver AMPK is in N group with 8.42 ng/g, but this value is not significantly different from other groups.
There are several ways that medications can cause nutrient depletion including decreasing nutrient absorption, interfering with metabolism and production, and increasing excretion. Key at-risk groups are the elderly, children, pregnant women, and those with serious health conditions. Healthcare professionals have an obligation to counsel patients about nutrient-drug interactions and recommend prevention strategies like a nutrient-rich diet, supplementation, and increased fiber intake to minimize health risks and improve outcomes.
This document provides an overview of parenteral nutrition. It defines parenteral nutrition as intravenous infusion of nutrients that bypasses digestion. Indications for parenteral nutrition include inadequate oral/enteral intake for over a week, GI dysfunction, severe malnutrition, and medical conditions like burns or surgery. Total parenteral nutrition provides complete nutrition support through a central line and includes carbohydrates, proteins, lipids, fluids, electrolytes, and trace metals. The document discusses monitoring, complications, and gradual discontinuation of parenteral nutrition.
A comprehensive presentation on Total parenteral nutrition(TPN) to facilitate easy -learning for medical , dental , pharmacology and biotechnology students.
Consuming cruciferous vegetables even by people with thyroid problems could potentially provide certain health benefits, such as antioxidant and ant inflammatory effects to the gland, without a negative impact to its functioning.
This document discusses nutrition in critical care patients. It recommends that critically ill patients who are at high nutritional risk based on a NUTRIC or NRS 2002 score of 5 or higher should receive specialized nutrition support, preferably through enteral feeding. Enteral feeding is preferred over parenteral nutrition when possible. The goals of nutrition support are to provide 1.2-2.0 g/kg/day of protein and aim for 25 kcal/kg/day of calories. Achieving adequate protein provision may improve outcomes over providing only trophic or permissive underfeeding. Monitoring of nutrition support is important to help meet goals and avoid overfeeding complications.
Nutrition is important for surgical patients. Malnutrition can compound complications, while well-nourished patients tolerate surgery better. Several factors are used to assess a patient's nutritional status prior to surgery, including weight loss, serum albumin levels, and medical history. For patients who cannot eat adequately after surgery, enteral or parenteral nutrition may be needed to meet nutrient demands and support healing. Enteral nutrition involves feeding through a stomach or intestinal tube, while parenteral nutrition is administered intravenously.
In the changing scenario of pharmacy practice in India, for successful practice of
Hospital Pharmacy, the students are required to learn various skills like drug distribution,
drug dispensing, manufacturing of parenteral preparations, drug information, patient
counselling, and therapeutic drug monitoring for improved patient care
Multiple factors can contribute to malnutrition, including inadequate food intake, increased nutritional demands from illness, impaired digestion or absorption, and metabolic issues. Malnutrition can develop gradually or suddenly and result in impaired immune function, reduced muscle strength, respiratory issues, impaired wound healing, infections, delayed recovery from illness, and reduced quality of life. Parenteral nutrition is used when oral or enteral nutrition is not possible or sufficient and involves the intravenous administration of balanced nutrients including amino acids, glucose, lipids, vitamins, minerals, and electrolytes to meet nutritional needs. Close monitoring is needed to ensure nutritional support meets the patient's requirements.
Total parenteral nutrition (TPN) involves administering nutrients intravenously to bypass an impaired gastrointestinal tract. TPN can be central, delivered into a central vein, or peripheral, delivered into a smaller vein. TPN formulations provide carbohydrates, lipids, amino acids, electrolytes, vitamins, and fluids to meet the body's nutritional needs. Manufacturing involves compounding sterile nutrient solutions according to a patient's requirements. TPN must be administered, stored, and labeled properly to ensure safety and effectiveness.
- Critically ill patients are at high risk of malnutrition due to poor nutrient intake and increased metabolic demands.
- Early enteral nutrition within 48 hours is recommended to improve outcomes when possible. Parenteral nutrition may be considered after 1 week if enteral nutrition is not feasible.
- Nutrition support aims to meet caloric and protein goals to reduce catabolism and support anabolism while avoiding overfeeding. Standard enteral formulas are preferred over specialty formulas.
- Careful monitoring is needed to optimize delivery of nutrition and minimize risks like aspiration while the patient's condition and ability to tolerate feeds is changing.
This document provides guidelines on nutrition in the intensive care unit (ICU). It defines patients at risk of malnutrition in the ICU, how to assess nutritional status, determine energy needs, choose feeding routes, and adapt nutrition based on clinical conditions. It discusses initiating and progressing nutrition administration, determining macronutrient needs, and paying special attention to glutamine and omega-3 fatty acids. The guidelines also address nutrition for patients with conditions like dysphagia, trauma, surgery, sepsis, and obesity that are common in the ICU.
Parenteralandenteralfeeding or Total parentral nutritionjinsigeorge
Parenteral nutrition, also known as intravenous feeding or TPN, provides nutrients directly into the bloodstream. It is used for patients who cannot receive adequate nutrition from food due to conditions like Crohn's disease or cancer. Enteral tube feeding delivers nutrients directly into the digestive tract via a tube placed in the nose, mouth or abdomen. TPN solutions provide water, energy, amino acids, essential fatty acids, vitamins and minerals. Strict sterile technique is required for TPN administration due to the central venous catheter. Patients on TPN require monitoring of blood work and glucose levels to watch for potential complications like infection, glucose abnormalities or liver dysfunction.
This document discusses nutrition for critically ill patients. It outlines nutritional risk assessment tools, energy and protein needs, and enteral feeding protocols. For the case, it recommends starting enteral nutrition as soon as hemodynamically stable, with a calorie target of 25-30 kcal/kg ideal body weight per day, or 1250-1500 kcal for a 50kg man. Locally available formulas like Plumpy'Nut and Mumbai formula are options for enteral feeding in the ICU.
Total Parenteral Nutrition (TPN), also known as hyperalimentation, is the intravenous infusion of a nutritionally complete formula including amino acids, dextrose, fat emulsions, vitamins, electrolytes, minerals, and trace elements. TPN provides nutrition when the gastrointestinal tract cannot be used due to conditions such as severe burns, sepsis, liver failure, or gastrointestinal diseases impairing absorption. Candidates for TPN are patients unable to take in nutrition orally or enterally who are at risk of malnutrition due to an inability to ingest, digest, or absorb nutrients. TPN must be carefully monitored to ensure patients maintain ideal body weight, fluid and electrolyte balance, normal blood glucose levels, and remain free
Daily minimum nutritional requirements of the critically illRalekeOkoye
The document discusses the daily minimum nutritional needs of critically ill patients. It defines key terms like critically ill patient and malnutrition. It describes the nutritional changes, assessment of nutritional state, and predictors of outcome during critical illness. It provides guidelines for calculating nutritional requirements including carbohydrates, proteins, fats, vitamins, and minerals. It discusses enteral nutrition as the preferred route of administration when possible, and provides guidelines for safe enteral feeding including early initiation and proper tube positioning.
Total parenteral nutrition (TPN) involves delivering a complete nutritional regimen directly into the bloodstream without using the gastrointestinal tract. It includes crystalline amino acids, dextrose, triglyceride emulsions, minerals, electrolytes, and micronutrients. TPN is indicated when enteral nutrition is inadequate or contraindicated, and the goals are to maintain or improve nutritional status while minimizing catabolism and supporting immune function. Careful planning is required to calculate nutritional needs, select appropriate routes and formulations, administer TPN, and monitor for complications.
Appropriate and safe assessment and administration of fuid therapy and nutritional support is of key importance in good surgical practice. It is imperative that the preoperative nutritional state of the patient and the impact of any surgical intervention are taken into account when considering nutritional requirements and the mode of nutrient delivery.
This document provides an overview of parenteral nutrition. It defines parenteral nutrition as nutrition given through a route other than the gastrointestinal tract, such as through central or peripheral intravenous lines. The document outlines the indications for parenteral nutrition, including when the gastrointestinal tract is non-functional, as well as contraindications. It describes the components of parenteral nutrition including carbohydrates, amino acids, lipids, electrolytes, vitamins and minerals. The document also discusses guidelines for calculating nutrient requirements and infusion schedules for parenteral nutrition. Potential complications are also summarized.
This document discusses the role of medical nutrition therapy in wound healing, specifically for pressure ulcers. It identifies key nutrients needed to support wound repair like protein, calories, vitamins, and minerals. The goals of nutrition intervention for wound healing are to provide adequate nutrients and prevent or promote healing of pressure ulcers. Medical nutrition therapy for wound healing should include increasing energy and protein intake and fluid intake. It also discusses the role of registered dietitian nutritionists in assessing nutritional status, identifying risks, developing nutrition care plans, and monitoring progress.
This document discusses nutrition in surgical patients. It begins by outlining the goals of nutritional support, which include identifying patients at risk of malnutrition, preventing or reversing catabolism, and meeting energy requirements. It then covers topics like malnutrition, nutritional assessment tools, estimating energy needs, and administration of enteral and parenteral nutrition. The key points are that nutritional support should begin preoperatively for high-risk patients or if oral intake won't resume within 7 days post-op, and the enteral route is preferred over parenteral nutrition when possible.
This document discusses nutrition support for surgical patients, including enteral and parenteral nutrition. It outlines the goals of nutritional support as preventing catabolism, meeting energy requirements, and aiding tissue repair. Methods for estimating caloric and protein requirements are provided. The advantages of enteral over parenteral nutrition are described. Complications and their management for both enteral and parenteral nutrition are covered. Specific nutrients important for immune function, such as arginine, glutamine, and omega-3 fatty acids, are also discussed.
This document discusses diabetes mellitus and its management. It defines diabetes as a metabolic disorder characterized by hyperglycemia due to impaired insulin secretion or action. It describes the different types of diabetes and discusses strategies for glycemic control including lifestyle modifications, oral medications, and insulin therapy. It also covers monitoring targets and the treatment of diabetes complications.
1. Metabolic acidosis results from an increase in acids other than carbonic acid, which causes a decrease in plasma bicarbonate (HCO3-) concentration. Causes include losses of HCO3- through the GI tract or kidneys, or gains of acid through ingestion or endogenous production.
2. Metabolic alkalosis occurs when there is an increase in plasma HCO3- concentration due to a loss of hydrogen ions or gain of HCO3-. Causes include vomiting, use of diuretics, or renal failure.
3. Respiratory acidosis is defined as hypercapnia (PCO2 > 40 mm Hg) and usually results from airway impairment that causes CO
Fluid and electrolyte management in parenteral nutrition newRaniya Khalid
1) The document discusses fluid and electrolyte management in parenteral nutrition, including standard intravenous solutions and their uses, as well as management of various electrolyte abnormalities.
2) Key electrolytes discussed include sodium, potassium, magnesium, phosphorus, and calcium. Normal ranges, causes of imbalances, signs and symptoms, and treatment approaches are covered for each electrolyte.
3) The importance of carefully considering electrolyte needs based on a patient's fluid status, organ function, and other factors is emphasized when designing parenteral nutrition regimens.
Pneumonia is an inflammation of the lungs that is often caused by an infection. Common symptoms include fever, cough, chest pain, and shortness of breath. Chest x-rays are used to confirm pneumonia. There are several types including community-acquired pneumonia (CAP), which occurs outside of hospitals, and hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which occur in hospital patients. Initial treatment depends on severity and risk factors, and may involve antibiotics alone or in combination to treat common causative organisms like streptococcus pneumoniae, staphylococcus aureus, and pseudomonas aeruginosa. Guidelines provide scoring systems and recommendations for empiric antibiotic therapy based on the type and severity
Acute coronary syndrome (ACS) refers to conditions caused by reduced blood flow in the coronary arteries. This can be due to plaque buildup narrowing the arteries or plaque rupture leading to clot formation. ACS includes ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). Patients present with chest pain and may have ECG changes or elevated cardiac biomarkers. Treatment involves oxygen, nitroglycerin, aspirin, and morphine (MONA) along with long-term therapies like antiplatelets, beta-blockers, statins, and ACE inhibitors to prevent future events.
This document defines hypertension and describes its diagnosis and treatment. Hypertension is defined as a systolic blood pressure of 140 mm Hg or greater, a diastolic blood pressure of 90 mm Hg or greater, or currently taking blood pressure medication. The majority of cases are essential hypertension with no identifiable cause. Treatment involves lifestyle modifications and pharmacologic therapy using thiazide diuretics, calcium channel blockers, or ACE inhibitors/ARBs initially. Goals of treatment depend on patient risk factors and comorbidities. Resistant hypertension may require multiple medications, including diuretics, mineralocorticoid receptor antagonists, and other classes.
Arrhythmias are abnormalities in the formation and conduction of electrical impulses in the heart that can cause the heart rate to be too fast (tachyarrhythmias) or too slow (bradyarrhythmias). They are commonly caused by conditions that damage the heart like ischemia, infarction, or heart failure. Non-cardiac conditions like electrolyte imbalances, hyperthyroidism, or drugs can also trigger arrhythmias. Arrhythmias are diagnosed using an electrocardiogram and treated with drugs that block sodium, potassium, or calcium channels in the heart or slow the heart rate. Antiarrhythmic drugs have different side effects and dosing based on their mechanism of action and a patient's kidney
Ischemic heart disease, also known as stable ischemic heart disease, is caused by reduced blood flow to the heart muscle due to plaque buildup in the coronary arteries. It typically causes chest pain called angina that feels squeezing, heavy, or suffocating. Stable angina is predictable chest pain brought on by exertion and relieved by rest, while unstable angina is a medical emergency with increasing chest pain not relieved by rest. Treatment involves antiplatelet agents like aspirin, antianginal drugs like beta blockers and calcium channel blockers to reduce symptoms, and statins to reduce risk of future cardiovascular events.
Chronic heart failure occurs when the heart cannot supply sufficient blood to the body due to impaired ability to fill or eject blood from the ventricles. It is commonly classified as ischemic, due to decreased blood supply such as from a myocardial infarction, or non-ischemic such as from long-standing uncontrolled hypertension. Treatment focuses on blocking neurohormonal activation through ACE inhibitors, ARBs, beta blockers, and aldosterone receptor antagonists to reduce symptoms and improve cardiac function, with diuretics used to reduce fluid retention. Inotropic drugs may be used for acute decompensated heart failure to increase cardiac output.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
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Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Adult parenteral nutrition
1. Indication for prarnteral nutrition
Adult Parenteral Nutrition
Done by :
Raniya.Khalid
@Rania1997301
Reference:
Murdaugh, L. (2015). Competence assessment tools for health-system
pharmacies (5th ed., p. Chapter 37). Jack Bruggeman.
2. Indications for Parenteral Nutrition
nutrition may need to be delivered intravenously, which is referred to as parenteral nutrition (PN).
Patients who are unable to absorb enough nutrients from the GIT to meet nutrition requirements with enteral nutrition
(EN)—These patients are malnourished, or have the potential of becoming malnourished, and generally will not resume
adequate EN within 7 days. Common conditions requiring PN include the following:ͷ Massive small bowel resectionͷ
Intractable vomitingͷ Severe diarrheaͷ Bowel obstructionͷ GIT fistulae
Cancer therapy (e.g., radiation, antineoplastic medications, or bone marrow
transplantation)
Pancreatitis
Critical care
Hyperemesis during pregnancy
Eating disorder
Failure when patient attempted a trial of EN
Preoperatively in moderately-to-severely malnourished patients
undergoing major GIT surgery when the surgery can be postponed for 7 to
14 days
Raniya.Khaled
@Rania1997301
3. One gram of protein yields 4 kilocalories (kcal).
There are two basic types of solutions:
1.Standard solutions:
These solutions are for patients with normal
organ function and nutritional requirements
2. Specialized solutions:
These solutions are for patients with altered
protein requirements due to conditions such as
hepatic encephalopathy, renal failure, and
metabolic stress from disease, trauma, injury, or
surgery.
Formulations containing increased amounts of
branched-chain amino acids (BCAA) and
decreased amounts of aromatic amino acids (AAA)
and methionine :
can be used in patients with hepatic
encephalopathy. Preparations containing
increased amounts of BCAA and proportional
amounts of AAA can be used in patients under
metabolic stress (e.g., sepsis or multiple trauma).
Amino Acids
Macronutrients
Composition of Parenteral nutrition formulations
Carbohydrates
Intravenous Fat Emulsion
Fat emulsions provide a
concentrated source of
calories and essential fatty
acids.
Essential fatty acids are
needed by the body for many
important functions, such as
platelet function and wound
healing. Fat emulsions can be
especially useful as a daily
source of calories in patients
with diabetes, metabolic stress,
and certain respiratory
conditions.
The major source of
energy in PN formulations
is carbo- hydrate, usually
in the form of dextrose.
One gram of dextrose
yields 3.4 kcal.
Raniya.Khaled
@Rania1997301
4. Composition of Parenteral nutrition formulations
Electrolytes
Micronutrients
Support metabolic activities such as enzymatic reactions, fluid balance, and nerve conduction processes
Vitamins
The principal electrolytes in
PN formulations are sodium,
potassium, calcium, magnesium,
phosphorus, chloride, and
acetate.
Electrolytes are essential for
many cellular functions, such as
acid–base balance and nerve
conduction.
Trace Elements
Vitamins are needed to
preserve metabolism and
cellular functions.
They are also needed to
properly utilize the
macronutrients in PN
formulations.
Trace elements are minerals
needed in small amounts for
certain body functions, including
enzyme function and other
metabolic pathways.
Multiple-mineral preparations
include zinc, copper, chromium,
manganese, and selenium. Some
preparations also contain iodide
or molybdenum.
Raniya.Khaled
@Rania1997301
5. Assessment of Nutritional Status
To determine a patient’s nutritional needs and monitor the effectiveness of nutrition support,
the patient’s nutritional status must be assessed.
Nutrition assessment includes evaluation of several parameters:
1-Medical/dietary history—Useful in the initial assessment of the patient’s nutritional status.
2-Physical examination
3-Anthropometric measurements
4-Immune function
5-Biochemical assessment :
Three common proteins monitored are albumin, prealbumin, and transferrin
Raniya.Khaled
@Rania1997301
6. Assessment of Nutritional Status cont..
5-Biochemical assessment :
Three common proteins monitored are albumin, prealbumin, and transferrin
Albumin Prealbumin Transferrin
Albumin is useful in the initial
assessment of a patient’s
nutritional status. Normal
serum concentrations are 3.5
to 5.4 g/dL. Because it has a
long half-life (18 to 21 days),
use of albumin is limited in
evaluating the short-term
improvements from PN
Prealbumin (transthyretin
protein) is a more sensitive
indicator of the adequacy of
nutrition support. The short
half-life (2 to 3 days) makes
prealbumin useful as an early
indicator of nutritional
repletion. Normal serum
concentrations are 15 to 40
mg/dL.
Transferrin is another clinically
useful indicator of nutritional
status, but it is not as sensitive
or specific as prealbumin. It has
an intermediate half-life (7 to
10 days), allowing weekly
monitoring. Normal serum
concentrations are 200 to
400 mg/dL
Raniya.Khaled
@Rania1997301
7. Assessment of Nutrition Requirements
CALORIE REQUIREMENTS PROTEIN REQUIREMENTS FLUID REQUIREMENTS
The RMR
(Resting metabolic rate )
is calculated as follows
Females
RMR (kcal/day) = [10 × Wt (kg)] + [6.25 ×
Ht (cm)] – [5 × Age (yr)] – 161
Males:
RMR (kcal/day) = [10 × Wt (kg)] + [6.25 ×
Ht (cm)] – [5 × Age (yr)] + 5
Calorie requirements increase with physical
activity and the presence of stress (e.g.,
fever, sepsis, major surgery, trauma, burns,
chronic disease). Calorie requirements may
decrease in obesity.
For the
healthy adult patient with normal organ function,
the
protein requirement is decreased for patients
with organ dysfunction, such as liver and kidney
disease that alter protein breakdown and
elimination from the body. Protein requirements
may be increased in surgical patients or those
with critical illness.
Another method used to determine protein
requirements is to calculate the nitrogen balance
The goal is to provide enough protein to the
patient to equal or exceed losses
Nitrogen balance (NB) can be calculated using
the following formula9:
NB (g/day) = [protein intake (g/day)/6.25] –
[UUN(g/day) + 4]
A simple method for estimating a
patient’s fluid needs is to use 20 to
40 mL/kg/day. A more accurate
method is to use 1,500 mL for the
first 20 kg of body weight plus 20
mL/kg for actual weight above the
first 20 kg. Fluid requirements are
dependent on many variables,
including renal and hepatic function,
presence of fever, or gastrointestinal
loss (e.g., vomiting, diarrhea, or
gastrointestinal suction),
concomitant diseases, and nutritional
status. All non-nutrition fluid
sources must also be taken into
account (e.g., fluid volume of IV
medications).
Raniya.Khaled
@Rania1997301
8. Selection of Parenteral Nutrition Formulations
Selection of Parenteral Nutrition Formulations
Nutritional status
Organ function
Disease states
Medication therapy
Patient-specific factors to consider when selecting the ingredients of a PN nutrition
formulation include the following:
Miscellaneous factors such as
nasogastric suction, fistulas, diarrhea,
and vomiting
Metabolic stress from sepsis, burns,
surgery, and other trauma
Fluid and electrolyte balance
Raniya.Khaled
@Rania1997301
9. Preparation and Storage of Parenteral Nutrition
Formulations
There are
two types of
PN bases
Amino acid/dextrose admixtures
Amino acids and dextrose are
prepared in the same container.
Micronutrients are added as
required by the patient’s
nutritional needs.
The admixture is administered
with or without IV fat emulsion
piggybacked into the PN line.
Total nutrient admixture (TNA)
Amino acids, dextrose, and IV
fat emulsion are prepared in the
same container.
This type of preparation is also
known as a 3-in-1 admixture.
Micronutrients are added as
required by the patient’s
nutritional needs.
Raniya.Khaled
@Rania1997301
10. Preparation and Storage of Parenteral Nutrition
Formulations
TNA
Preparation
Advantages of TNA
preparations:
Disadvantages of TNA
preparations:
•Increased clearance and utilization of IV
fat emulsion
•Decreased compounding and
administration time
•Decreased amount of administration
supplies such as tubing
•Potential decrease in the risk of
catheter contamination due to
manipulation of the infusion line
•Easy delivery and storage for patients
receiving PN at home
•Difficulty in visually inspecting the
preparation for precipitates and
other particulate matter due to
opaque appearance
•Inability to be filtered with a
bacteria-retentive filter
•Concerns regarding stability of the
preparation, compatibility of the
ingredients, and the risk of bacterial
and fungal contamination and growth
Raniya.Khaled
@Rania1997301
11. Testing of formulations during and after the compounding process to ensure
correct concentrations of ingredients, including
Gravimetric analysis Chemical analysis
Refractometric analysis
Indirect assessment of the
accuracy of amounts of
ingredients by measuring
their weight
Direct measurement of the
final concentrations of the
ingredients
Indirect determination of
the final concentrations of
the ingredients by
measuring refractive index
(this method cannot be used
with formulations containing
IV fat emulsion)
Preparation and Storage of Parenteral Nutrition
Formulations
It is recommended that PN admixtures be refrigerated if not administered immediately
after compounding. Refrigerated admixtures should be used within 24 to 48 hours.
Raniya.Khaled
@Rania1997301
12. Stability and Compatibility
PN admixtures are prone to problems with stability and
compatibility of components. Factors influencing stability
and compatibility include temperature, pH,
concentrations of ingredients, order of admixture of
ingredients, and the length of time between compounding
and administration.
The most common compatibility problem is the precipitation of
calcium and phosphorus, which can be life-threatening.
The risk of this interaction is increased by the following factors:
• High concentrations of calcium and phosphorus salts
• Decreased amino acid concentrations (amino acids act as a
buffer to retard precipitation)
• Increased temperature of the admixture
• Use of the chloride salt of calcium
• Increased pH of the admixture
• Improper mixing sequence of calcium and phosphorus salts
• Presence of other additives
To prevent precipitate formation, calcium and
phosphorus salts should be added separately to the
admixture. In general, phosphate should be added first,
and calcium should be added near the end of the
compounding procedure.
Sodium bicarbonate can also cause compatibility problems.
The addition of bicarbonate to acidic admixtures may cause
formation of carbon dioxide gas and precipitation of calcium and
magnesium salts.
The use of acetate salts (which convert to bicarbonate in the
body) is a safer alternative.
The stability of vitamins may be adversely affected by pH
changes, storage time, temperature, light, and other additives. It
is recommended that vitamins be added to the PN admixture
close to the administration time, if possible, and not remain in the
admixture more than 24 hours.
Raniya.Khaled
@Rania1997301
13. Administration of Parenteral Nutrition Formulations
PN may be administered through central or
peripheral venous access.
Patients considered candidates for peripheral
administration must meet two criteria:
They must have good peripheral venous
access.
They must be able to tolerate large volumes of
fluid (2.5 to 3 L).
They also should require at least 5 days but
not
more than 14 days of therapy.
Contraindications to peripheral PN include
the following:
Significant malnutrition
Severe metabolic stress
Large electrolyte needs
Large nutrient needs
Fluid restriction
Greater than 2 weeks of PN required
Renal dysfunction
Liver compromise
It is recommended that a 0.22-micron filter
be used when infusing amino acid–dextrose
formulations to remove air, particulate
matter, and microorganisms that may be
present.
TNA formulations and IV fat emulsions
administered separately should be infused
through a 1.2-micron filter because the fat
droplets are too large to pass through a
0.22-micron filter.
A filter clog during administration of PN
should be investigated by a healthcare
practitioner.
An occluded filter should never be removed
to allow a PN formulation to infuse freely as
this increases the risk of infusion of
particulates and microprecipitates
Raniya.Khaled
@Rania1997301
14. Administration of Parenteral Nutrition Formulations
Vascular Access Devices
Catheter Type Placement Advantages Disadvantages
Central access
Percutaneous
nontunneled central
catheter
• Jugular
• Femoral
• Subclavian
Economical
Easily removable
Can be replaced over guidewire
Useful in acute care and short duration
therapies
Catheter breakage not repairable
Patient self-care difficult
Requires sutures to prevent dislodgment
High risk for catheter- related infection
Not recommended for home care
Tunneled cuffed catheters
Percutaneous placement via
subclavian or jugular vessel
Cephalic
Jugular vein cutdown
Long-term usage
Home care
Dressings and sutures can be removed
after 1 mo
Self-care easy
Repair kit available
Operating room or specialized room for placement
Requires small procedure for removal
Peripherally inserted
central catheter (PICC)
nontunneled
• Percutaneous placement via
a peripheral vein
Used in acute and home care for
therapies ranging from several weeks to
months
Low risk of placement complications
Placement occurs anywhere from
radiology suite to patient bedside
Self-care may be difficult with antecubital
placement because dressing changes require both
hands
Extended home care repair kits may not be
available
Implanted ports
• Percutaneous venous
placement via subclavian,
jugular, or peripheral vessels
Used for long-term therapies
Site care only when accessed
Monthly heparin flush
Body image intact
No external segment for breakage
Needle access required
Needle dislodgement can result in infiltration
Placement in operating room or specialized room
Surgical procedure for removal
Raniya.Khaled
@Rania1997301
15. Administration of Parenteral Nutrition Formulations
Vascular Access Devices
Catheter Type Placement Advantages Disadvantages
peripheral access
Peripheral catheters • Percutaneous peripheral
insertion
Least expensive
Least risk for catheter- related infections
No special placement room
Clinicians are easily trained in placement
Requires site rotation q 48–72 hr
Not appropriate to infuse solutions >400–600
mOsm/L, concentrated antibiotics, and vesicants
Midline catheters
• Percutaneous peripheral
insertion
• Used for therapies lasting 2–4 wk
• Not appropriate for infusions requiring central
access including PN with >900 mOsm/L
Midclavicular catheters • Percutaneous peripheral
insertion
• Used for therapies 2–3 mo
• Not appropriate for infusions requiring central
access including PN with >900 mOsm/L
Raniya.Khaled
@Rania1997301
16. Complications of Parenteral Nutrition Therapy
Metabolic Complications
Complications can be divided into three categories: 1. Mechanical 2. Infectious 3. Metabolic
Category Type of Complication Possible Cause Management
Mechanical
• Pneumothorax
• Incorrect position of central venous
catheter
• Radiologic verification of catheter placement
• Catheter occlusion • Precipitation of PN ingredients or
other medications
• Replacement of catheter, identification and correction of
incompatibilities
of formulation ingredients or with other medications infused
through the catheter
• Venous thrombosis • Platelet aggregation around catheter
• Anticoagulant therapy
• Phlebitis
• Admixture too hypertonic for
peripheral infusion
• Decrease dextrose concentration or amino acid concentration,
administer IV fat emulsion, or increase volume
Infectious
• Bacterial or fungal
growth at catheter site
• Poor care of catheter site
• Proper care of catheter site
• Multiple manipulations of catheter
including administration of medications
• Minimize manipulations, strict adherence to aseptic technique
when administering lipids and medications through the catheter
• Sepsis • Contaminated PN admixtures, infected
catheter site
• Strict adherence to aseptic technique when preparing and
administering PN, quality assurance procedures, hang time not to
exceed 24 hr, proper care of catheter site
Raniya.Khaled
@Rania1997301
17. Complications of Parenteral Nutrition Therapy
Metabolic Complications
Complications can be divided into three categories:
1. Mechanical 2. Infectious 3. Metabolic
Metabolic Complications
There are numerous potential metabolic complications
associated with PN :
• Inadequate or excessive intake of nutrients
• Diseases (e.g., diabetes and cancer)
• Major organ dysfunction, especially renal and hepatic
• Nutrient losses from diarrhea, vomiting, GIT suction, dialysis,
fistulae
• Drugs that alter the disposition of nutrients (e.g.,
corticosteroids, diuretics, and insulin)
• Stress (e.g., infection, malnutrition, major surgery, burns, or
trauma)
Refeeding Syndrome
Refeeding syndrome is a potentially life-threatening
condition that occurs from rapid refeeding of malnutrition
patients using high-calorie, high-carbohydrate
formulations.
It causes an intracellular shift of phosphorus resulting in
severe hypophosphatemia (serum phosphorus less than 1
mg/dL).
Hypokalemia, hypomagnesemia, and alterations in serum
glucose also occur.
The patient exhibits progressive symptoms of irritability,
weakness, paresthesias , confusion, seizures, and coma.
Raniya.Khaled
@Rania1997301
18. Complications of Parenteral Nutrition Therapy
Metabolic Complications
Complications can be divided into three categories:
1. Mechanical 2. Infectious 3. Metabolic
Metabolic Complications
There are numerous potential metabolic complications associated with PN :
• Inadequate or excessive intake of nutrients
• Diseases (e.g., diabetes and cancer)
• Major organ dysfunction, especially renal and hepatic
• Nutrient losses from diarrhea, vomiting, GIT suction, dialysis, fistulae
• Drugs that alter the disposition of nutrients (e.g., corticosteroids, diuretics, and insulin)
• Stress (e.g., infection, malnutrition, major surgery, burns, or trauma)
Type of Complication
Management
Type of Complication Management
Hyperglycemia
• Administer insulin
• Decrease infusion rate
• Decrease dextrose concentration
Metabolic acidosis
• Treat underlying causes
• Increase acetate intake
• Decrease chloride and amino acid intake
Hypoglycemia • Increase dextrose intake
• Decrease administration of insulin
Metabolic alkalosis
• Treat underlying causes
• Increase chloride intake
• Decrease acetate intake
Elevated cholesterol or
triglycerides
• Decrease or discontinue IV fat emulsion
Trace element deficiencies
or toxicity
• Adjust trace element intake
Abnormal liver function tests
• Decrease dextrose intake
• Decrease total calories
• Adjust IV fat emulsion or cycle solution with 4 hr off
Vitamin deficiencies or
toxicity
• Adjust vitamin intake
Excess carbon dioxide
production
• Decrease dextrose intake
• Adjust balance of dextrose and IV fat emulsion
Essential fatty acid
deficiency
• Initiate IV fat emulsion
Fluid imbalance
• Adjust fluid intake
• Administer diuretics if excessive fluid load is present
Decreased immune function • Decrease IV fat emulsion intake
Electrolyte imbalance
• Adjust intake of specific electrolytes
• Discontinue phosphate binding antacids in hypophosphatemia
Raniya.Khaled
@Rania1997301
19. Medication Administration in Adults Receiving
Parenteral Nutrition
Patients receiving PN often receive IV medications
as well. These medications are usually given
piggyback
into the PN line
There are several advantages to using PN as a
vehicle for medication delivery
• Decreased compounding and administration time
• Decreased fluid volume infused in fluid-restricted
patients
• Decreased venous catheter manipulations
• Improved therapeutic effectiveness for some
medications (e.g., H2 antagonists)
• However, some disadvantages exist21,22:
• Possible toxicity or therapeutic failure resulting
from changes in the rate of infusion and loss of peak
and trough levels
• Potential for waste with dose changes
• Stability and compatibility concerns
Medications can also affect the disposition of
nutrients in the body.
Possible effects of medications on nutrient utilization
include the following:
Alteration of the patient’s nutrition needs
Alteration of the body’s response to nutrients
Potentiation of medication-related problems that
impede the patient’s nutritional progress
Patients receiving PN should be monitored for drug–
nutrient interactions.
Some examples of common interactions between
medications and PN include the following:
Altered excretion of electrolytes induced by diuretics
Hyperglycemia induced by furosemide,
corticosteroids, or phenytoin
Impaired utilization of nutrients for protein synthesis
induced by antineoplastic agents
• Depletion of vitamin B12 by H2 antagonists and
proton pump inhibitors
• Impaired protein metabolism by corticosteroids
Raniya.Khaled
@Rania1997301