Parentral nutrition
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This document discusses parenteral nutrition, which is a method of providing nutrition intravenously. It can be referred to as total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN) depending on the vein used. The document outlines indications for parenteral nutrition in newborns, children, and adults. It describes the components of parenteral nutrition and potential complications. Nursing actions are provided regarding assessment, administration, and monitoring of parenteral nutrition.
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NUTRITION IN CRITICAL CARE
This document provides national guidelines and protocols for critical care nutrition practice in India. It discusses why adequate nutrition is important for critically ill patients, when to start enteral or parenteral nutrition, how to determine caloric and protein needs based on patient characteristics, appropriate routes of administration, contraindications, complications, and disease-specific nutrition protocols. The key recommendations are to start early enteral nutrition within 48 hours when possible, provide 1.2-2 g/kg protein and 20-35 kcal/kg calories based on weight status, and use enteral over parenteral nutrition when GI function allows.
Arterial line insertion
This document provides information about arterial line insertion and monitoring. It discusses:
1. The radial artery is commonly used for insertion due to its low complication rates and accessibility. The Allen's test is recommended to ensure adequate blood flow if the radial artery is used.
2. Insertion involves locating the artery, prepping the skin, puncturing at a 45-60 degree angle, advancing the catheter, securing it, and dressing the site.
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Nutrition in critically ill patients
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basic airway management
The document provides an overview of airway anatomy and management. It begins with a review of upper and lower airway anatomy, highlighting key structures like the pharynx, larynx, trachea, and bronchi. It also discusses important differences in pediatric airway anatomy compared to adults. The document then covers objectives and contents for a presentation on airway management, including initial airway techniques, advanced airway management with intubation, and management of airways in special situations like head trauma. The goal is to refresh knowledge of airway equipment and techniques to allow providers to manage a patient's airway effectively.
Basic ventilatory modes
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Airway assessment
This document discusses preoperative airway assessment. It begins by defining the airway and why assessing it is important, as respiratory events are a leading cause of anesthesia-related injuries. It then defines what constitutes a difficult airway and lists various individual predictors and scoring systems that can be used for assessment, including measurements of neck and mouth structures. Overall, thorough preoperative airway examination involving multiple predictive tests can help identify patients that may present difficulties during ventilation or intubation.
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NUTRITION IN CRITICAL CARE
This document provides national guidelines and protocols for critical care nutrition practice in India. It discusses why adequate nutrition is important for critically ill patients, when to start enteral or parenteral nutrition, how to determine caloric and protein needs based on patient characteristics, appropriate routes of administration, contraindications, complications, and disease-specific nutrition protocols. The key recommendations are to start early enteral nutrition within 48 hours when possible, provide 1.2-2 g/kg protein and 20-35 kcal/kg calories based on weight status, and use enteral over parenteral nutrition when GI function allows.
Arterial line insertion
This document provides information about arterial line insertion and monitoring. It discusses:
1. The radial artery is commonly used for insertion due to its low complication rates and accessibility. The Allen's test is recommended to ensure adequate blood flow if the radial artery is used.
2. Insertion involves locating the artery, prepping the skin, puncturing at a 45-60 degree angle, advancing the catheter, securing it, and dressing the site.
3. The arterial monitoring system works by transmitting pressure changes via saline from the arterial line to a transducer, which converts it to an electrical signal displayed as a waveform on the monitor. Problems can cause dampened or resonant traces.
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Artificial airways
It is the fastest and most commonly practiced approach and allows visual inspection of the supraglottic areas for foreign bodies (e.g., false or loose teeth, aspirated objects) and other obstructions (e.g., tumors). The most important consideration in oral intubation is appropriate head position.
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basic airway management
The document provides an overview of airway anatomy and management. It begins with a review of upper and lower airway anatomy, highlighting key structures like the pharynx, larynx, trachea, and bronchi. It also discusses important differences in pediatric airway anatomy compared to adults. The document then covers objectives and contents for a presentation on airway management, including initial airway techniques, advanced airway management with intubation, and management of airways in special situations like head trauma. The goal is to refresh knowledge of airway equipment and techniques to allow providers to manage a patient's airway effectively.
Basic ventilatory modes
This document discusses various modes of mechanical ventilation. It begins by covering advanced basics related to flow, time, pressure and volume control. It then describes the main categories of ventilation modes: mandatory modes like controlled mandatory ventilation which are time-triggered and time-cycled; triggered modes like CPAP and PSV which are patient-triggered; and hybrid modes like assist-control and SIMV which combine mandatory and spontaneous breaths. For each mode, it provides details on controls, targets, feedback and cycling. The document provides examples of pressure and volume graphs to illustrate different mode functions and interactions. It concludes with tables summarizing the key characteristics of different mandatory, triggered and hybrid ventilation modes.
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This document discusses preoperative airway assessment. It begins by defining the airway and why assessing it is important, as respiratory events are a leading cause of anesthesia-related injuries. It then defines what constitutes a difficult airway and lists various individual predictors and scoring systems that can be used for assessment, including measurements of neck and mouth structures. Overall, thorough preoperative airway examination involving multiple predictive tests can help identify patients that may present difficulties during ventilation or intubation.
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This document provides an overview of neonatal ventilation fundamentals, including respiratory physiology, ventilator basics, and pulmonary graphics. Some key points:
- Neonates have higher respiratory rates and are more prone to respiratory failure due to anatomical differences in their chest walls and lungs.
- Ventilation eliminates carbon dioxide from the blood and is correlated with minute ventilation and alveolar ventilation. Lung volumes, mechanics, and gas exchange are also discussed.
- Common ventilator terminologies like PIP, PEEP, rate, and modes of ventilation like pressure and volume control are introduced.
- Pulmonary graphics provide pressure, volume, and flow signals over the respiratory cycle to assess ventilation.
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The document discusses various artificial airways used in respiratory therapy, including oropharyngeal airways, nasopharyngeal airways, endotracheal tubes, and tracheostomy tubes. Oropharyngeal airways are used to maintain the airway in unconscious patients and protect endotracheal tubes from being bitten. Nasopharyngeal airways are used for airway maintenance when oral airway placement is difficult. Endotracheal tubes are inserted into the trachea to provide a clear airway and facilitate mechanical ventilation. Tracheostomy tubes are inserted through an opening in the neck to provide a direct airway to the trachea.
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Nutrition in critically ill patients
- 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.
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Malnutrition is common in critically ill ICU patients and can lead to organ dysfunction and poor outcomes. Enteral nutrition is preferred over parenteral nutrition due to lower risks of infection and other complications. Early initiation of enteral feeding within 48 hours for stable patients is recommended. Formulas are tailored to patient needs and disease states. Monitoring for complications like hyperglycemia, liver issues, and electrolyte imbalances is important during nutrition support. Overall goals are to prevent further malnutrition while avoiding overfeeding and its risks.
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Total Parenteral Nutrition
This document provides an overview of total parenteral nutrition (TPN). It defines parenteral nutrition as nutrition delivered through a non-oral/nasal route, often through central or peripheral veins. The document outlines the indications for TPN including failure of enteral nutrition or conditions affecting the GI tract. It describes the components of TPN including carbohydrates, amino acids, lipids, electrolytes and vitamins. It also discusses how to calculate nutrient needs, initiate TPN, and common infusion schedules and potential complications.
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The document discusses ventilation and different modes of noninvasive ventilation. It provides details on:
1) How ventilation works through pressure differences that cause air to flow into and out of the lungs. Different factors like resistance and Boyle's law impact this process.
2) The history and development of noninvasive ventilation, from early negative pressure devices to current use of positive pressure ventilation delivered noninvasively through masks.
3) Modes of noninvasive positive pressure ventilation including volume ventilation, pressure ventilation, bilevel PAP, and CPAP. The benefits and limitations of noninvasive ventilation are also summarized.
Ventilatory support
The document discusses various topics related to mechanical ventilation including:
1. Ventilation strategies for acute respiratory distress syndrome (ARDS) including low tidal volumes, optimal positive end-expiratory pressure, and prone positioning.
2. Ventilation modes and settings should be tailored to the individual patient's condition and aim to prevent ventilator-induced lung injury.
3. Non-invasive ventilation can be considered for certain patients with COPD or asthma to avoid intubation if criteria are met.
Nutrition (espen & aspen guidelines)
This document discusses nutrition in the ICU, including nutritional assessment and requirements for critically ill patients. It recommends initiating enteral nutrition within 24-48 hours for patients unable to maintain oral intake. Parenteral nutrition should only be used if enteral nutrition is not feasible or possible after 7 days of hospitalization. The goals of nutrition support are to provide adequate calories, protein, vitamins and minerals to meet metabolic demands and support organ function while avoiding complications.
Basic Of Mechanical Ventilation
This document provides an overview of ventilator basics and parameters including:
1) It describes the basic components and parameters of ventilators such as modes, controls, triggers and adjunct therapies.
2) It explains some common ventilator modes like pressure control ventilation, BiPAP, and APRV and notes some safety considerations.
3) It outlines potential complications from mechanical ventilation and stresses the importance of monitoring patients and equipment.
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Parentral nutrition
This document provides information on parenteral nutrition including:
- Parenteral nutrition involves infusing complete nutrient solutions directly into the bloodstream via a central or peripheral vein to meet nutritional needs.
- It can be delivered through either total parenteral nutrition (TPN) using a central line, or peripheral parenteral nutrition (PPN) using a peripheral vein or peripherally inserted central catheter (PICC) line.
- PPN has limitations as the peripheral sites are more prone to inflammation/infection and the catheter may need repeated insertion, while TPN is preferred for long-term nutrition support.
- Indications for parenteral nutrition include when the gastrointestinal tract is non-functioning or unable to meet
Basics of mechanical ventilation
Mechanical ventilation is the use of a ventilator to move air into and out of the lungs to maintain proper oxygen and carbon dioxide levels. There are two main types: invasive ventilation which requires intubation, and non-invasive ventilation without intubation. The goals are to improve gas exchange, relieve respiratory distress, and improve pulmonary mechanics. Common modes include volume-controlled, pressure-controlled, and non-invasive BiPAP. Nurses monitor various parameters and alarms to assess patient-ventilator synchrony and make appropriate adjustments.
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This document discusses nutritional support for surgical patients. It begins by outlining the learning objectives which are to describe the pathophysiology and importance of nutritional support, the aims of support measures, and indications and complications of different forms of support. It then defines nutritional support and discusses the principles of support including indications for pre-operative and post-operative support via enteral or parenteral means. Specific patient factors that affect nutritional status and requirements are also outlined.
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This document provides an overview of neonatal ventilation fundamentals, including respiratory physiology, ventilator basics, and pulmonary graphics. Some key points:
- Neonates have higher respiratory rates and are more prone to respiratory failure due to anatomical differences in their chest walls and lungs.
- Ventilation eliminates carbon dioxide from the blood and is correlated with minute ventilation and alveolar ventilation. Lung volumes, mechanics, and gas exchange are also discussed.
- Common ventilator terminologies like PIP, PEEP, rate, and modes of ventilation like pressure and volume control are introduced.
- Pulmonary graphics provide pressure, volume, and flow signals over the respiratory cycle to assess ventilation.
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The document discusses various artificial airways used in respiratory therapy, including oropharyngeal airways, nasopharyngeal airways, endotracheal tubes, and tracheostomy tubes. Oropharyngeal airways are used to maintain the airway in unconscious patients and protect endotracheal tubes from being bitten. Nasopharyngeal airways are used for airway maintenance when oral airway placement is difficult. Endotracheal tubes are inserted into the trachea to provide a clear airway and facilitate mechanical ventilation. Tracheostomy tubes are inserted through an opening in the neck to provide a direct airway to the trachea.
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Nutrition in critically ill patients
- 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.
Nutrition in icu
Malnutrition is common in critically ill ICU patients and can lead to organ dysfunction and poor outcomes. Enteral nutrition is preferred over parenteral nutrition due to lower risks of infection and other complications. Early initiation of enteral feeding within 48 hours for stable patients is recommended. Formulas are tailored to patient needs and disease states. Monitoring for complications like hyperglycemia, liver issues, and electrolyte imbalances is important during nutrition support. Overall goals are to prevent further malnutrition while avoiding overfeeding and its risks.
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This document provides information on central venous catheterization, including indications, contraindications, complications, techniques, and tips. It discusses the Seldinger technique for placement and locations for catheter insertion, including the internal jugular, subclavian, and femoral veins. Precautions are outlined for each approach. Ultrasound guidance is becoming standard to visualize the vein and compress it during insertion.
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This document provides an overview of total parenteral nutrition (TPN). It defines parenteral nutrition as nutrition delivered through a non-oral/nasal route, often through central or peripheral veins. The document outlines the indications for TPN including failure of enteral nutrition or conditions affecting the GI tract. It describes the components of TPN including carbohydrates, amino acids, lipids, electrolytes and vitamins. It also discusses how to calculate nutrient needs, initiate TPN, and common infusion schedules and potential complications.
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The document discusses ventilation and different modes of noninvasive ventilation. It provides details on:
1) How ventilation works through pressure differences that cause air to flow into and out of the lungs. Different factors like resistance and Boyle's law impact this process.
2) The history and development of noninvasive ventilation, from early negative pressure devices to current use of positive pressure ventilation delivered noninvasively through masks.
3) Modes of noninvasive positive pressure ventilation including volume ventilation, pressure ventilation, bilevel PAP, and CPAP. The benefits and limitations of noninvasive ventilation are also summarized.
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The document discusses various topics related to mechanical ventilation including:
1. Ventilation strategies for acute respiratory distress syndrome (ARDS) including low tidal volumes, optimal positive end-expiratory pressure, and prone positioning.
2. Ventilation modes and settings should be tailored to the individual patient's condition and aim to prevent ventilator-induced lung injury.
3. Non-invasive ventilation can be considered for certain patients with COPD or asthma to avoid intubation if criteria are met.
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This document discusses nutrition in the ICU, including nutritional assessment and requirements for critically ill patients. It recommends initiating enteral nutrition within 24-48 hours for patients unable to maintain oral intake. Parenteral nutrition should only be used if enteral nutrition is not feasible or possible after 7 days of hospitalization. The goals of nutrition support are to provide adequate calories, protein, vitamins and minerals to meet metabolic demands and support organ function while avoiding complications.
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This document provides an overview of ventilator basics and parameters including:
1) It describes the basic components and parameters of ventilators such as modes, controls, triggers and adjunct therapies.
2) It explains some common ventilator modes like pressure control ventilation, BiPAP, and APRV and notes some safety considerations.
3) It outlines potential complications from mechanical ventilation and stresses the importance of monitoring patients and equipment.
Fluid responsiveness in critically ill patients
This document discusses fluid responsiveness in critically ill patients. It begins by defining fluid responsiveness as an increase in cardiac index after fluid infusion. It then describes three scenarios involving fluid resuscitation: patients with acute blood or fluid loss requiring immediate resuscitation, patients with suspected septic shock where early goal-directed therapy with fluids is important, and ICU patients who have already received fluids and their fluid responsiveness needs to be assessed. The document discusses various methods of assessing preload and preload dependence, including filling pressures, volumes, respiratory variations in inferior vena cava diameter, inspiratory drops in right atrial pressure, and predicting responsiveness through respiratory variations in parameters related to cardiac index. It emphasizes that preload alone
Parentral nutrition
This document provides information on parenteral nutrition including:
- Parenteral nutrition involves infusing complete nutrient solutions directly into the bloodstream via a central or peripheral vein to meet nutritional needs.
- It can be delivered through either total parenteral nutrition (TPN) using a central line, or peripheral parenteral nutrition (PPN) using a peripheral vein or peripherally inserted central catheter (PICC) line.
- PPN has limitations as the peripheral sites are more prone to inflammation/infection and the catheter may need repeated insertion, while TPN is preferred for long-term nutrition support.
- Indications for parenteral nutrition include when the gastrointestinal tract is non-functioning or unable to meet
Basics of mechanical ventilation
Mechanical ventilation is the use of a ventilator to move air into and out of the lungs to maintain proper oxygen and carbon dioxide levels. There are two main types: invasive ventilation which requires intubation, and non-invasive ventilation without intubation. The goals are to improve gas exchange, relieve respiratory distress, and improve pulmonary mechanics. Common modes include volume-controlled, pressure-controlled, and non-invasive BiPAP. Nurses monitor various parameters and alarms to assess patient-ventilator synchrony and make appropriate adjustments.
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4. nutrition support to critically ill in icu
This document discusses nutrition support for critically ill patients. It defines malnutrition as a deficiency or excess of energy, protein or nutrients that causes adverse health effects. The normal diet and essential nutrients are described. Malnutrition is common in hospitals, with 40-43% of ICU patients affected. Consequences include weight loss, weakness and impaired healing. Nutritional assessment methods are outlined. Enteral nutrition via tube feeding is preferred over parenteral nutrition when possible, with protocols described for administration and maintenance.
Total Parenteral Nutrition (TPN)
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1. Nutritional Support In The Surgical Patient
The document discusses nutritional support in surgical patients. It covers 5 key issues: indications for nutritional support, determining nutritional status, the effectiveness of support for well-nourished vs malnourished patients, the route of nutrition (enteral vs parenteral), and appropriate composition of diets. Severely malnourished patients, those with short bowel syndrome, and those not expected to feed for 7+ days are good candidates. Markers like weight loss, transport proteins, and nutritional indices help determine status. Enteral nutrition is preferred but parenteral may be needed in some cases.
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Parentral nutrition
- 1. PARENTRAL NUTRITION ANCY T F MSC NURSING GOVT COLLEGE OF NURSING THIRUVANANTHAPURAM
- 2. MEANING Parenteral nutrition, or intravenous feeding, is a method of getting nutrition into patient’s body through veins. Depending on which vein is used, this procedure is often referred to as either total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN).
- 3. TYPES Total parenteral nutrition Peripheral parenteral nutrition
- 5. INDICATIONS Newborns with gastrointestinal anomalies such as tracheoesophageal fistula, massive intestinal atresia, complicated meconium ileus, massive diaphragmatic hernia, gastroschisis, omphalocele and neglected pyloric stenosis. Failure to thrive in infants with short bowel syndrome, malabsorption, inflammatory bowel disease, enzyme deficiencies and chronic idiopathic diarrhea Other pediatric indications include necrotizing enterocolitis, intestinal fistulae, severe trauma, burns, postoperative infections and malignancies
- 6. CONT.. Adults with short bowel syndrome secondary to massive small-bowel resection or internal or external enteric fistulae. Malnutrition secondary to high intestinal obstruction for example achalasia, esophageal strictures and neoplasms, pyloric obstruction and gastric neoplasms. Prolonged ileus due to medical or surgical causes (for example post-operative, following abdominal trauma or polytrauma). Malabsorption secondary to sprue, enzyme & pancreatic deficiencies, regional enteritis, ulcerative colitis, granulomatous colitis, and tuberculosis enteritis.
- 7. CONT. Functional gastrointestinal disorders like idiopathic diarrhoea, psychogenic vomiting, anorexia nervosa. Patients with depressed sensorium (for example following head injury or intracranial surgery) in whom tube feeding is not possible. Hyper catabolic states secondary to severe sepsis, extensive full thickness burns, major fractures, polytrauma, major abdominal operations etc.
- 8. Cont.. patients with malignancies in whom malnutrition may jeopardize successful delivery of a therapeutic option (surgery, chemo- or radiotherapy). Paraplegics/quadriplegics with pressure sores in pelvic or perinal regions where fecal soiling is a problem.
- 9. Components of parenteral Nutrition Carbohydrate: Amino acids ( protein ) Fat emulsion (lipid) Vitamins Minerals and trace elements Water ,insulin and heparin
- 11. COMPLICATIONS Air embolism Hyperglycemia Hypervolemia Hypoglycemia Infection Pneumothorax
- 12. NURSING ACTION Before the PN administration Assess the need for parenteral nutrition by performing nutritional assessment Check the physician’s order Explain the procedure in detail to the patient and relatives. Remove the bag of parenteral nutrition from refrigerator at least 1 hr before administration Inspect the fluid for presence of creamy or any changes in constitution Check the vitals
- 13. During the procedure: Wash hands, put mask and gloves Using strict aseptic technique, attach tubing with bag and purge out air Close all clamps on new tubing and insert tubing into volume control infuser. Place the patient in a supine position ,connect the tubing in to hub of catheter ,make sure that the connection is secured Open all clamps and regulate the flow Monitor the vitals hourly ,assessing the patient tolerance. Record the procedure.
- 14. After care Monitor the vital signs Monitor the allergic reactions such as vomiting , headache chest pain, back pain and fever Monitor blood glucose frequently Monitor intake and output, daily weight , CVP , breath sounds, and peripheral edema Maintain strict aseptic technique when changing the dressing and tubing . monitor any complications