Nutritional support provides nourishment to patients who cannot eat normally. It involves either enteral or parenteral feeding. Enteral feeding delivers nutrients through the gastrointestinal tract using tubes, while parenteral feeding delivers nutrients intravenously. Transitional feeding involves gradually transitioning patients from parenteral to enteral feeding as their gastrointestinal function returns. Dietitians play an important role in assessing patients' nutritional needs, selecting appropriate formulas, educating patients, and managing complications during all stages of nutritional support.

1. SPECIAL
NUTRITIONAL
SUPPORT

2. INTRODUCTION
Special nutritional support-
definition ,types, use
TABLE OF CONTENTS
ENTERAL FEEDING
Definition,use,types,
complication
PARENTERAL FEEDING
Definition, use ,types,
complication
TRANSITIONAL
FEEDING
ENTERAL V/S
PARENTERAL
CONCLUSION
01
02
03
04
05
06

3. Nutritional support is therapy for people who cannot get enough
nourishment by eating or drinking. You may need it if you :
 Can't swallow
 Have problems with your appetite
 Are severely malnourished
 Can't absorb nutrients through your digestive system
 You receive nutritional support through a needle or catheter
placed in your vein or with a feeding tube, which goes into your
stomach.
Special nutritional support

4.  Nutritional support is often needed for critically ill patients
Example:
 Patients with metabolic stress.
 Patients with kidney failure requiring dialysis.
 Patients > 70 years

5. Enteral
Feeding 01

6.  Enteral feeding refers to intake of food via the
gastrointestinal (GI) tract
 Enteral feeding may mean nutrition taken through
the mouth or through a tube that goes directly to the
stomach or small intestine
 Being fed through a tube allows them to receive
nutrition and keep their GI tract working.
What is Enteral Feeding?

7. Types of Enteral feeding
Nasogastric tube
(NGT) starts in the
nose and ends in the
stomach.
Orogastric tube
(OGT) starts in the
mouth and ends in
the stomach.
Nasoenteric tube
starts in the nose
and ends in the
intestines
Oroenteric tube
starts in the mouth
and ends in the
intestines.

8.  a stroke, which may impair ability to swallow
 cancer, which may cause fatigue, nausea, and
vomiting that make it difficult to eat
 critical illness or injury, which reduces energy or
ability to eat
 failure to thrive or inability to eat in young children or
infants
 serious illness, which places the body in a state of
stress, making it difficult to take in enough nutrients
When is Enteral Feeding used?

9.  neurological or movement disorders that increase
caloric requirements while making it more difficult to
eat
 GI dysfunction or disease, although this may require
intravenous (IV) nutrition instead

10. 1. Recommend an appropriate enteral feeding formula
2. Determine the patient's feeding route (e.g., nasogastric, nasoenteric,
gastrostomy)
3. Adjusting the feeding rate, volume, and formula as necessary.
4. Collaborate with other members of the healthcare team
5. Educate the patient and their caregivers on the importance of enteral
feeding
6. Monitor the patient's nutritional status and make appropriate changes to
the feeding regimen as needed.
7. Document the patient's progress and communicate with the healthcare
team
Role of dietician

11. 1. Carbohydrates: Typically in the form of maltodextrin, corn syrup,
or other simple sugars to provide energy for the body.
2. Proteins: Usually in the form of whey protein, soy protein, or
casein to promote tissue growth and repair.
3. Fats: Often in the form of vegetable oils to provide essential fatty
acids and promote absorption of fat-soluble vitamins.
4. Vitamins and minerals: Added to the formula to meet the patient's
daily requirements.
5. Fiber: May be added to promote gut motility and prevent
constipation.
Enteral feeding diet

12.  Aspiration, which is food going into the lungs
 Refeeding syndrome, dangerous electrolyte imbalances that
may occur in people who are very malnourished and start
receiving enteral feeds
 Infection of the tube or insertion site
 Nausea and vomiting that may result from feeds that are too
large or fast, or from slowed emptying of the stomach
 Skin irritation at the tube insertion site
 Diarrhea due to a liquid diet or possibly medications
 Tube dislodgement
 Tube blockage, which may occur if not flushed properly
Complications

13. Parenteral
Feeding 02

14.  Parenteral nutrition is a way for you to receive nutrients by
bypassing your digestive system.
 People who can’t use their digestive systems because of a
condition can temporarily or permanently receive nutrition
intravenously, through an IV catheter.
 Parenteral nutrition can be supplementary (partial) or complete
(total parenteral nutrition).
What is Parenteral feeding

15. Types of Parenteral feeding
Central parenteral
nutrition (CPN) is
delivered through a
central vein — usually,
the superior vena
cava located under your
collarbone, which goes
directly to your heart.
The larger central vein
allows a larger catheter
to deliver higher
concentrations of
nutrition with higher
calories.
Peripheral parenteral
nutrition (PPN) is
delivered through a
smaller, peripheral vein,
perhaps in your neck or
in one of your limbs.
PPN is used to provide
partial parenteral
nutrition temporarily,
using the quicker and
easier access of the
peripheral vein.

16. 1) Partial parenteral nutrition –
 given temporarily to people who need an immediate boost of
calories before transitioning to a longer-term solution — either
enteral feeding or gradually resuming mouth feeding
 given to long-term hospital patients who tend to have general
malnutrition for a variety of reasons
When is Parenteral feeding used

17. 2) Total parenteral nutrition – if your digestive system isn’t functioning
or if you have a gastrointestinal disease that requires you to give it complete
rest
1. Specific conditions that may require TPN include:
2. Abdominal surgery
3. Chemotherapy
4. Intestinal ischemia
5. Small or large intestinal obstructions
6. Gastrointestinal bleeding
7. Radiation enteritis
8. Extremely premature birth
9. Prolonged diarrhea
10. Inflammatory bowel diseases

18. 1. Assess the patient's nutritional needs and determine if parenteral
nutrition (PN) is appropriate and necessary
2. Select the appropriate PN formula and make adjustments
3. Calculate and adjust the PN solution based on the patient's weight,
metabolic requirements, and lab values
4. Monitor the patient's blood glucose levels, electrolyte levels
5. Evaluate the patient's response to the PN and make recommendations
for any necessary changes
6. Educate the patient and their caregivers on the importance of PN
7. Monitor the patient's nutritional status and make appropriate changes to
the PN regimen as needed
Role of dietician

19. Components of a parenteral feeding solution:
1. Amino Acids: added to the parenteral feeding solution in the form of a
crystalline amino acid solution
2. Carbohydrates: Glucose is the most common carbohydrate added to
parenteral feeding solutions
3. Lipids: Fat emulsions are often added to parenteral feeding solutions to
provide essential fatty acids
4. Vitamins and Minerals: These may be added as individual components or
as a multivitamin solution
5. Electrolytes: Electrolytes such as sodium, potassium, and chloride are
added
6. Trace Elements: Trace elements such as zinc, copper, and selenium
Parental feeding diet

20. 1. Infection
2. Blood clots
3. GI atrophy
4. Glucose imbalances
5. Transient liver reactions
6. Parenteral nutrition-associated liver disease (PNALD)
7. Gallbladder problems
8. Bone demineralization (osteoporosis or osteomalacia)
Complications

21. Transitional
Feeding 03

22. TRANSITIONAL FEEDING

23. Steps

26. 1. Assessment of Nutritional Needs: involve calculating energy and protein
requirements based on the patient's weight, medical condition, and level of
activity.
2. Selection of Enteral Feeding Formula: The dietitian will work with the healthcare
team to select an enteral feeding formula that meets the patient's nutritional
needs and medical condition.
3. Feeding Tube Placement: If the patient requires a feeding tube, the dietitian may
assist with determining the most appropriate type of tube and placement.
4. Monitoring and Adjustment of Feeding: involve adjusting the feeding rate, volume,
or formula to meet the patient's changing nutritional needs.
5. Management of Complications: management of complications related to enteral
feeding, such as diarrhea, constipation, or feeding tube dislodgement.
6. Education and Support: The dietitian may also provide guidance on food choices
and meal planning for when the patient is able to resume oral feeding.
Role of dietician

27.  The transition from parenteral to enteral feedings can only be
made when the gastrointestinal function has returned.
 Presence of bowel sounds
 The passage of flatus and stools
 Return of appetite
 Should not be vomiting
 When the patient is ready for the transition to enteral feeding, an
oral diet or tube-feeding is initiated
 When the patient is able to eat, an oral diet is preferred
Conditions

29. ● https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-
S026156140280022X/first-page-pdf
● https://www.chi.sg/Documents/369KTPHNHIP%202021%20Transitional%20
Feeding%20Guide%20%20Wean%20the%20Feeding%20Tube%20OffCOMBI
NED.pdf
● https://my.clevelandclinic.org/health/treatments/22802-parenteral-
nutrition#:~:text=Parenteral%20nutrition%20means%20feeding%20intraven
ously,system%2C%20from%20mouth%20to%20anus.
● https://www.mayoclinic.org/tests-procedures/home-enteral-
nutrition/about/pac-20384955
RESOURCES

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