Parenteral nutrition (PN), also known as total parenteral nutrition, involves administering nutrients directly into the bloodstream through an intravenous catheter. It is used when impaired gastrointestinal function prevents adequate oral or enteral nutrition. PN provides proteins, carbohydrates, fats, vitamins, minerals, and other nutrients. It is designed based on a patient's nutritional needs and can be administered either peripherally or centrally depending on the clinical situation and duration of therapy. Care must be taken to avoid potential complications when using PN such as infections, metabolic abnormalities, and catheter-related issues.
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
This document discusses the metabolic response and nutritional needs of critically ill children. It notes that critical illness leads to increased caloric and protein needs due to catabolism. Early enteral nutrition within 24 hours is recommended where possible to provide nutrients and prevent wasting, though total parenteral nutrition may be needed if enteral is not feasible. The document outlines the administration, types, indications, and complications of both enteral and parenteral nutrition in critical illness. It also discusses using immunonutrition formulas to help modulate the immune response.
Total parenteral nutrition (TPN) involves supplying nutrients intravenously. TPN may be used when the gastrointestinal tract is not functional, such as for patients who cannot meet at least 50% of their metabolic needs for over 7 days or undernourished patients preparing for surgery. The goals of TPN are to decrease catabolism, support metabolism, and improve organ function. TPN solutions provide water, energy from glucose and lipids, amino acids for protein, electrolytes, vitamins, and minerals tailored to individual patient needs. Careful monitoring is required due to risks such as hyperglycemia, hypertriglyceridemia, and infections.
Biochemical aspects of Obesity and its complications.pptRevathy Gunaseelan
Obesity occurs when excess body fat accumulates due to increased caloric intake and decreased energy expenditure. It is commonly measured using body mass index (BMI), which is weight in kilograms divided by the square of height in meters. A BMI over 27.8 for men and 27.3 for women indicates obesity. Obesity increases the risk of numerous health conditions like diabetes, cardiovascular disease, and hypertension. Lifestyle modifications including reduced calorie intake, increased physical activity, and frequent small meals can help treat obesity.
This document discusses diet and nutrition as they relate to oral health and prosthodontic treatment. It defines key terms like diet, nutrition, and balanced diet. It describes the major nutrients - carbohydrates, lipids, proteins, vitamins, minerals, and water. It discusses dietary requirements and recommendations for different age groups, especially the elderly. It emphasizes the importance of adequate protein, vitamin, mineral and calcium intake for dental patients, especially those undergoing prosthodontic treatment. It provides dietary guidelines for new denture wearers.
1. Protein energy wasting (PEW) is a state of nutritional and metabolic derangements in patients with chronic kidney disease characterized by loss of body protein and energy stores leading to loss of muscle and fat mass.
2. PEW is caused by hypercatabolic status, uremic toxins, malnutrition, inflammation, and is highly prevalent in hemodialysis patients where it is associated with adverse outcomes.
3. Mechanisms of PEW include activation of the ubiquitin-proteasome system, caspase-3, lysosomes and myostatin which can be initiated by complications of CKD like metabolic acidosis and inflammation.
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.
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
This document discusses the metabolic response and nutritional needs of critically ill children. It notes that critical illness leads to increased caloric and protein needs due to catabolism. Early enteral nutrition within 24 hours is recommended where possible to provide nutrients and prevent wasting, though total parenteral nutrition may be needed if enteral is not feasible. The document outlines the administration, types, indications, and complications of both enteral and parenteral nutrition in critical illness. It also discusses using immunonutrition formulas to help modulate the immune response.
Total parenteral nutrition (TPN) involves supplying nutrients intravenously. TPN may be used when the gastrointestinal tract is not functional, such as for patients who cannot meet at least 50% of their metabolic needs for over 7 days or undernourished patients preparing for surgery. The goals of TPN are to decrease catabolism, support metabolism, and improve organ function. TPN solutions provide water, energy from glucose and lipids, amino acids for protein, electrolytes, vitamins, and minerals tailored to individual patient needs. Careful monitoring is required due to risks such as hyperglycemia, hypertriglyceridemia, and infections.
Biochemical aspects of Obesity and its complications.pptRevathy Gunaseelan
Obesity occurs when excess body fat accumulates due to increased caloric intake and decreased energy expenditure. It is commonly measured using body mass index (BMI), which is weight in kilograms divided by the square of height in meters. A BMI over 27.8 for men and 27.3 for women indicates obesity. Obesity increases the risk of numerous health conditions like diabetes, cardiovascular disease, and hypertension. Lifestyle modifications including reduced calorie intake, increased physical activity, and frequent small meals can help treat obesity.
This document discusses diet and nutrition as they relate to oral health and prosthodontic treatment. It defines key terms like diet, nutrition, and balanced diet. It describes the major nutrients - carbohydrates, lipids, proteins, vitamins, minerals, and water. It discusses dietary requirements and recommendations for different age groups, especially the elderly. It emphasizes the importance of adequate protein, vitamin, mineral and calcium intake for dental patients, especially those undergoing prosthodontic treatment. It provides dietary guidelines for new denture wearers.
1. Protein energy wasting (PEW) is a state of nutritional and metabolic derangements in patients with chronic kidney disease characterized by loss of body protein and energy stores leading to loss of muscle and fat mass.
2. PEW is caused by hypercatabolic status, uremic toxins, malnutrition, inflammation, and is highly prevalent in hemodialysis patients where it is associated with adverse outcomes.
3. Mechanisms of PEW include activation of the ubiquitin-proteasome system, caspase-3, lysosomes and myostatin which can be initiated by complications of CKD like metabolic acidosis and inflammation.
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.
DIET AND NUTRITION IN COMPLETELY EDENTULOUS PATIENTS.pptxpraveena943549
Definitions
Nutritional objectives
Factors that affect nutritional status
Classification of nutrients
Calcium and bone health
Food groups
Balanced diet and food guide pyramid
Calorific value of common Indian foods
Nutritional guidelines for prosthodontic patient
Nutrition and geriatrics
Dietary management when teeth are extracted
Diet recommended for new denture wearers
Nutrition for maxillofacial prosthetic patients
This document discusses various metabolic diseases and their management. It covers defects in amino acid, carbohydrate, fatty acid, and other metabolisms. For treatment, it recommends reducing precursor substrates, providing alternative substrates, supplementing cofactors, and removing toxic metabolites. Specific diets are described for phenylketonuria (PKU), maple syrup urine disease (MSUD), and other conditions. Both acute and long-term management strategies are outlined.
This document discusses nutrition and protein-energy wasting in patients undergoing hemodialysis. It outlines that patients on dialysis are often depleted of protein and energy stores due to deficient nutrition or protein/energy wasting. The terminology "protein-energy wasting syndrome" describes the loss of body protein and fuel reserves in patients with end-stage kidney disease. Assessment of nutritional status includes dietary assessment of appetite and weight changes, physical assessment of weight and BMI trends, and laboratory assessment including serum albumin and BUN levels. Causes of protein-energy wasting include decreased intake, hypercatabolism, and factors related to dialysis. Dietary recommendations aim to provide at least 1.2 g/kg of protein and 30-35 k
Nutrition of patients undergoing dialysisManiz Joshi
This document discusses nutritional assessment and dietary recommendations for dialysis patients. It outlines several methods for assessing nutritional status, including physical exams, body composition measurements, functional tests, and biochemical markers like serum albumin and prealbumin. Optimal intake levels are provided for proteins, sodium, fluids, potassium, phosphorus, and various vitamins. Maintaining adequate nutrition through diet and supplements is important for dialysis patients given losses during treatment and high risk of malnutrition.
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 nutritional assessment and management in surgical patients. It outlines causes of malnutrition like impaired intake or absorption. Consequences include impaired wound healing and immune function. Nutritional assessment involves history, exam measuring weight and albumin levels. Enteral nutrition via tubes is preferred over parenteral nutrition when possible, providing benefits like maintaining gut health. Formulas are chosen based on patient needs and tolerance is monitored to prevent complications.
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.
This document provides guidance on calculating nutritional requirements and formulations for enteral and parenteral nutrition. It discusses factors to consider such as a patient's caloric needs, protein and fluid requirements, and osmolality of formulas. Commercial formulas are available for enteral or parenteral use, and can be modified as needed to meet a specific patient's nutritional needs. Proper administration of enteral and parenteral nutrition requires calculating appropriate formula volume, infusion rates, and timing of delivery.
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.
This powerpoint contains general information for public awareness on scope of SBEBA in Type 2 Diabetes mellitus .
The author along with Dr. Rajkumar are the pioneers of Science Based Evidence Based Ayurveda , a novel methodology for Evidence Based Practice in Ayurveda emerged in 2012. Currently hundreds of patients of Type 2 Diabetes are out of drugs/ med and Insulin by this methodology with their HbA1c maintained below 6 .
- Malnutrition is common in 30-60% of hospitalized patients, especially those with prolonged stays or postoperative complications, and increases the risk of further complications and death.
- Nutritional assessment involves clinical evaluation of weight loss, lab tests like albumin and lymphocyte count, and anthropometric measurements like BMI, though these have limitations in critically ill patients.
- Nutritional support aims to meet caloric and protein needs through enteral or parenteral nutrition while avoiding overfeeding, with requirements varying based on patient condition and stress level.
The document discusses how lifestyle factors like diet and nutritional supplements can impact drug therapy. A well-balanced diet may decrease drug needs by preventing chronic illness. Dietary factors like protein status, food intake, and vitamin levels can influence drug absorption and effectiveness. Long-term diuretic use may cause deficiencies in potassium, magnesium, and zinc due to increased excretion. Herbal preparations and nutritional supplements also have the potential for drug interactions and should be discussed with patients.
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.
This document provides an overview of nutrition and key nutrients. It discusses:
- The main classes of nutrients including carbohydrates, proteins, lipids, vitamins, minerals and water.
- How each nutrient is digested and absorbed.
- The nutrient requirements and recommended daily intakes.
- Energy balance and imbalances that can lead to obesity, marasmus or kwashiorkor.
- Key aspects of water, electrolytes, trace elements, calcium and phosphorus including their functions, sources, regulation and imbalance issues.
This document discusses normal nutrient requirements and the nutrient values of common foods. It defines nutrition and the important macro/micronutrients required by the body, including carbohydrates, proteins, fats, vitamins and minerals. It provides recommendations for daily intake of these nutrients based on age, gender and other factors. Nutrient requirements are especially important for growth in children and infants. The document also discusses the roles and dietary sources of specific nutrients.
Enzymes are biological catalysts that speed up chemical reactions in the body. Several therapeutic enzymes are used clinically. Streptokinase, produced by bacteria, treats thromboembolic disorders by activating plasminogen to plasmin. Urokinase, produced in the kidneys, works similarly. Asparaginase is used in leukemia chemotherapy. Recombinant human DNase improves cystic fibrosis by breaking down DNA in thick mucus. Digestive enzymes including pancreatin, amylase, protease, and lipase are formulated to survive stomach acid and aid digestion for deficiencies.
The document discusses various classes of cytokines, including interleukins, interferons, tumor necrosis factors, and hematopoietic growth factors. Cytokines are small secreted proteins that regulate cell-to-cell communication and are involved in immune and inflammatory responses. Examples of approved biological products derived from cytokines given in the document include interferons used to treat hepatitis and cancer, interleukin-2 used to treat kidney cancer, and hematopoietic growth factors like erythropoietin and granulocyte colony-stimulating factor used to treat chemotherapy-induced neutropenia.
DIET AND NUTRITION IN COMPLETELY EDENTULOUS PATIENTS.pptxpraveena943549
Definitions
Nutritional objectives
Factors that affect nutritional status
Classification of nutrients
Calcium and bone health
Food groups
Balanced diet and food guide pyramid
Calorific value of common Indian foods
Nutritional guidelines for prosthodontic patient
Nutrition and geriatrics
Dietary management when teeth are extracted
Diet recommended for new denture wearers
Nutrition for maxillofacial prosthetic patients
This document discusses various metabolic diseases and their management. It covers defects in amino acid, carbohydrate, fatty acid, and other metabolisms. For treatment, it recommends reducing precursor substrates, providing alternative substrates, supplementing cofactors, and removing toxic metabolites. Specific diets are described for phenylketonuria (PKU), maple syrup urine disease (MSUD), and other conditions. Both acute and long-term management strategies are outlined.
This document discusses nutrition and protein-energy wasting in patients undergoing hemodialysis. It outlines that patients on dialysis are often depleted of protein and energy stores due to deficient nutrition or protein/energy wasting. The terminology "protein-energy wasting syndrome" describes the loss of body protein and fuel reserves in patients with end-stage kidney disease. Assessment of nutritional status includes dietary assessment of appetite and weight changes, physical assessment of weight and BMI trends, and laboratory assessment including serum albumin and BUN levels. Causes of protein-energy wasting include decreased intake, hypercatabolism, and factors related to dialysis. Dietary recommendations aim to provide at least 1.2 g/kg of protein and 30-35 k
Nutrition of patients undergoing dialysisManiz Joshi
This document discusses nutritional assessment and dietary recommendations for dialysis patients. It outlines several methods for assessing nutritional status, including physical exams, body composition measurements, functional tests, and biochemical markers like serum albumin and prealbumin. Optimal intake levels are provided for proteins, sodium, fluids, potassium, phosphorus, and various vitamins. Maintaining adequate nutrition through diet and supplements is important for dialysis patients given losses during treatment and high risk of malnutrition.
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 nutritional assessment and management in surgical patients. It outlines causes of malnutrition like impaired intake or absorption. Consequences include impaired wound healing and immune function. Nutritional assessment involves history, exam measuring weight and albumin levels. Enteral nutrition via tubes is preferred over parenteral nutrition when possible, providing benefits like maintaining gut health. Formulas are chosen based on patient needs and tolerance is monitored to prevent complications.
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.
This document provides guidance on calculating nutritional requirements and formulations for enteral and parenteral nutrition. It discusses factors to consider such as a patient's caloric needs, protein and fluid requirements, and osmolality of formulas. Commercial formulas are available for enteral or parenteral use, and can be modified as needed to meet a specific patient's nutritional needs. Proper administration of enteral and parenteral nutrition requires calculating appropriate formula volume, infusion rates, and timing of delivery.
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.
This powerpoint contains general information for public awareness on scope of SBEBA in Type 2 Diabetes mellitus .
The author along with Dr. Rajkumar are the pioneers of Science Based Evidence Based Ayurveda , a novel methodology for Evidence Based Practice in Ayurveda emerged in 2012. Currently hundreds of patients of Type 2 Diabetes are out of drugs/ med and Insulin by this methodology with their HbA1c maintained below 6 .
- Malnutrition is common in 30-60% of hospitalized patients, especially those with prolonged stays or postoperative complications, and increases the risk of further complications and death.
- Nutritional assessment involves clinical evaluation of weight loss, lab tests like albumin and lymphocyte count, and anthropometric measurements like BMI, though these have limitations in critically ill patients.
- Nutritional support aims to meet caloric and protein needs through enteral or parenteral nutrition while avoiding overfeeding, with requirements varying based on patient condition and stress level.
The document discusses how lifestyle factors like diet and nutritional supplements can impact drug therapy. A well-balanced diet may decrease drug needs by preventing chronic illness. Dietary factors like protein status, food intake, and vitamin levels can influence drug absorption and effectiveness. Long-term diuretic use may cause deficiencies in potassium, magnesium, and zinc due to increased excretion. Herbal preparations and nutritional supplements also have the potential for drug interactions and should be discussed with patients.
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.
This document provides an overview of nutrition and key nutrients. It discusses:
- The main classes of nutrients including carbohydrates, proteins, lipids, vitamins, minerals and water.
- How each nutrient is digested and absorbed.
- The nutrient requirements and recommended daily intakes.
- Energy balance and imbalances that can lead to obesity, marasmus or kwashiorkor.
- Key aspects of water, electrolytes, trace elements, calcium and phosphorus including their functions, sources, regulation and imbalance issues.
This document discusses normal nutrient requirements and the nutrient values of common foods. It defines nutrition and the important macro/micronutrients required by the body, including carbohydrates, proteins, fats, vitamins and minerals. It provides recommendations for daily intake of these nutrients based on age, gender and other factors. Nutrient requirements are especially important for growth in children and infants. The document also discusses the roles and dietary sources of specific nutrients.
Enzymes are biological catalysts that speed up chemical reactions in the body. Several therapeutic enzymes are used clinically. Streptokinase, produced by bacteria, treats thromboembolic disorders by activating plasminogen to plasmin. Urokinase, produced in the kidneys, works similarly. Asparaginase is used in leukemia chemotherapy. Recombinant human DNase improves cystic fibrosis by breaking down DNA in thick mucus. Digestive enzymes including pancreatin, amylase, protease, and lipase are formulated to survive stomach acid and aid digestion for deficiencies.
The document discusses various classes of cytokines, including interleukins, interferons, tumor necrosis factors, and hematopoietic growth factors. Cytokines are small secreted proteins that regulate cell-to-cell communication and are involved in immune and inflammatory responses. Examples of approved biological products derived from cytokines given in the document include interferons used to treat hepatitis and cancer, interleukin-2 used to treat kidney cancer, and hematopoietic growth factors like erythropoietin and granulocyte colony-stimulating factor used to treat chemotherapy-induced neutropenia.
1. The document discusses the history and evolution of Ethiopia's healthcare system from the introduction of modern medicine in the 16th century to the current three-tier system.
2. It outlines the different approaches used over time, including the Basic Health Service Approach of the 1950s-60s, the Primary Health Care approach of 1974-1991, and the Health Sector Development Programs from 1991-2015.
3. The current system consists of a three-tier structure with primary hospitals and health centers at the first level, general hospitals at the second level, and specialized hospitals at the third level.
This document discusses drug supply management and the Ethiopian healthcare system. It provides definitions of key terms like drugs, supply management, and the pharmaceutical supply chain. It describes Ethiopia's three-tier healthcare system including primary, secondary, and tertiary levels of care. Primary health care is rooted in principles of universal access, community involvement, appropriate technology, intersectoral collaboration, and health promotion. The goal of drug supply management is to ensure high quality essential medicines are available, affordable, and used rationally throughout the healthcare system.
This document outlines four methods for quantifying drug needs: consumption, morbidity, proxy/adjusted consumption, and service-level projection of budget requirements.
The consumption method uses past consumption records to estimate future needs. The morbidity method estimates needs based on expected cases and standard treatment guidelines. The proxy/adjusted consumption method uses data from one system to estimate needs in another similar system. Finally, the service-level projection method estimates financial requirements based on average drug costs per patient contact in different facility types.
This document discusses infrared (IR) spectroscopy. It explains that IR spectroscopy involves the interaction of IR radiation with molecules, causing their bonds to vibrate. The document outlines the principles of IR spectroscopy, including which types of molecular vibrations absorb IR radiation. It also describes how to interpret IR spectra and differentiate instrument types. The key learning objectives are to understand the principles and applications of IR spectroscopy for molecular structure identification and analysis.
1. Fluorescence spectrophotometry measures the intensity of light emitted by a substance that has absorbed ultraviolet or visible light.
2. After light absorption, molecules can deactivate through radiationless processes like internal conversion or intersystem crossing, or through emission of a photon during fluorescence or phosphorescence.
3. Factors like a molecule's structure, solvent, temperature, and pH can affect its fluorescence quantum yield by changing rates of radiationless relaxation versus light emission.
Electromagnetic radiation consists of oscillating electric and magnetic fields that propagate through space with the speed of light. It is classified based on its wavelength or frequency into different spectral regions including gamma rays, x-rays, ultraviolet, visible light, infrared, microwaves and radio waves.
The electromagnetic spectrum is the range of all possible electromagnetic radiation. It spans from gamma rays to radio waves and arranges the different types of electromagnetic radiation in order of decreasing energy and increasing wavelength. Each spectral region is associated with different types of atomic and molecular transitions.
Chromatography is a separation technique that distributes components of a mixture between two phases, a stationary phase and a mobile phase. In gas chromatography, the stationary phase is a solid or liquid coated on a support and the mobile phase is a gas. Separation occurs as components partition differently between the stationary and mobile phases due to differences in volatility and interactions with the stationary phase. Common stationary phases include polymers, fluorocarbons, and bonded phases covalently attached to a solid support. Gas chromatography is used to separate volatile components and provides high resolution separations and detection of components in small samples.
Hospital practice Attachment portfolio (2).pptxShikurYasin
The document provides an overview of the attachment period of several students at Zewditu Memorial Hospital pharmacy from November 14th to 25th. It summarizes the key pharmacy units observed including the outpatient, inpatient, emergency, ART and dialysis pharmacies. For each pharmacy, it describes the location, staffing, typical medications dispensed, and notes strengths and weaknesses observed. Overall, the attachment period provided learning experiences in dispensing medications, prescription checking, patient counseling and pharmacy operations.
This document provides an overview of vitamin A for 4th year pharmacy students. It describes the objectives of the lesson which are to describe the different types of vitamins and their functions, food sources, deficiency manifestations, and recommended daily allowances. Key points include vitamin A's roles in vision, immune function, cell differentiation and reproduction. Food sources include green leafy vegetables, yellow and orange fruits and vegetables, and animal liver. Deficiency can cause eye disease and increased infection risk while excess intake risks toxicity.
The document discusses Essential Nutrition Actions (ENA), an approach by the WHO and Federal Ministry of Health to improve nutrition through a package of essential interventions. It focuses on the first 1000 days of life to reduce infant mortality, improve growth and development, and increase productivity. The seven key ENA actions areas are controlling anemia, optimal breastfeeding, controlling vitamin A and iodine deficiencies, women's nutrition, complementary feeding, and feeding sick children. The document provides detailed guidance on optimal breastfeeding and complementary feeding practices after 6 months to ensure children's nutritional needs are met. It emphasizes exclusive breastfeeding for the first 6 months and continued breastfeeding up to 2 years alongside age-appropriate complementary foods.
The document summarizes the pharmacy services at Tikur Anbessa Specialized Hospital (TASH) in Ethiopia. It describes the various inpatient and outpatient pharmacies including the main OPD pharmacy, endocrine pharmacy, ART pharmacy, drug information center, A5 pharmacy, oncology pharmacies, and gynecology pharmacy. It provides details on the services offered, most commonly dispensed medications, limitations, and lessons learned during the pharmacy attachment. Recommendations are provided to improve pharmacy services like increasing pharmacist staffing and ensuring adequate medication availability.
- Community pharmacy provides convenient access to medications and health advice for the public. Gishen pharmacy has been serving the community for over 20 years by dispensing medications, providing counseling, and measuring health indicators. It follows pharmaceutical standards but could improve availability and expand services. Atorvastatin is a statin that lowers cholesterol by inhibiting its synthesis. It is indicated for cardiovascular risk reduction and requires counseling on adherence, side effects like myopathy, and special populations.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. INTRODUCTION
• Parenteral nutrition (PN) also known as Total
Parenteral Nutrition.
• Is “intravenous” administration of nutrients.
• Sends nutrients straight into the bloodstream.
• Used when Impaired GI prevents adequate Oral or
Enteral Nutrition.
• For patients who cannot eat or absorb enough food
through tube feeding formula or by mouth to
maintain good nutrition status.
12/13/2022 ADDIS ABABA UNIVERSITY 2
3. INTRO cont…
• Is a sterile liquid chemical formula, given directly
into the bloodstream through an intravenous
catheter (needle in the vein).
• Include administration of protein,
carbohydrate, fat, minerals and electrolytes,
vitamins and other trace elements.
12/13/2022 ADDIS ABABA UNIVERSITY 3
4. INDICATION OF PN
• When GI dysfunction prevents Oral/Enteral
nutrition.
• For variety of diseases or conditions that impair
food intake, nutrient digestion or absorption.
• Must primarily assess and evaluate the patient’s
nutrition status, clinical status, age, and potential
risks of initiating therapy (infection and other
metabolic abnormalities)
12/13/2022 ADDIS ABABA UNIVERSITY 4
5. INDICATION OF PN cont.
1. Impaired absorption or loss of nutrients via the Gl
tract because of one or more of for eg. Massive
small bowel resection or mucosal disease:
Radiation- or Chemotherapy-related enteritis.
2. Mechanical bowel obstruction.
3. Restricted oral intake or EN necessary for bowel
rest.
4. Motility disorders
5. Inability to achieve or maintain EN instability
12/13/2022 ADDIS ABABA UNIVERSITY 5
6. INDICATION OF PN cont.
• PN is not an emergent intervention;
• should not be initiated until the patient is
hemodynamically and metabolically stable.
• Can be used as long as needed.
• But many times, parenteral nutrition is used for a
short time.
• Lessened or discontinued when the person begins
to switch to tube feeding or eat enough by mouth.
• Taken lifelong at home or for a short period of time.
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7. DESIRED OUTCOME
• Correction patient’s: Caloric, Nitrogen, Fluid,
Electrolyte, Vitamin, and/ or Trace element
abnormalities.
• Lessen the metabolic response to injury by
minimizing oxidant stress and favorably modulating
immune response.
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8. COMPONENTS
• Should provide the optimal combination of macro- and
micronutrients to provide a patient’s specific
nutritional requirements.
• PN formulations include IV sources of protein, dextrose,
fat, water, electrolytes, vitamins, trace elements, and
other additives.
• Macronutrients include water, protein (as structural
substrates), dextrose, and fat or lipid (used for energy).
• Micronutrients include vitamins, trace elements, and
electrolytes. (for cellular homeostasis such as
enzymatic reactions, fluid balance, and regulation of
electrophysiological processes.)
• Both are necessary for maintenance of normal
metabolism
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9. COMPONENTS cont.
1. Proteins (Amino Acids)
2. Carbohydrate (Dextrose)
3. IV lipid emulsion (IVLE)
4. Vitamins
5. Trace Elements
6. Electrolytes
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10. Proteins (Amino Acids)
• In the form of crystalline amino acids (CAAs).
• When oxidized for energy yield 4cal (approx 17
kJ/g)
• Differ in protein concentration, total nitrogen, and
electrolyte content.
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11. Amino Acids cont.
Standard amino acid solutions:
• for patients with
“normal” organ
function and nutritional
requirements.
• contain a balanced
profile of essential,
semi-essential, and
nonessential L-amino
acids.
Modified amino acid solutions:
• disease-specific PN regimens:
• for patients with altered protein
requirements, i.e. hepatic
encephalopathy, kidney disease,
metabolic stress or trauma, for
neonates and pediatric patients.
• highly concentrated products
(15%-20% amino acids) for
critically ill patients who
typically require fluid restriction
but have large protein needs.
• More expensive and
controversial
12/13/2022 ADDIS ABABA UNIVERSITY 11
12. Amino Acids cont.
• Cysteine
• a conditionally essential amino acid for preterm and
term infants because of their enzymatic immaturity of
the trans-sulfuration pathway.
• enhances Ca and P solubility by decreasing soln pH.
• Showed: positive effects on nutritional markers,
including improved fatty acid oxidation, weight gain, and
nitrogen balance, have been documented.
• reserved for neonates expected to receive PN support
for 7 days or longer.
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13. Amino Acids cont.
• Carnitine
• quaternary amine.
• required for long-chain fatty acid transport into the
mitochondria for β-oxidation and energy production.
• Glutamine
• most abundant free amino acid in the body.
• important intermediate for many metabolic processes.
• maintain intestinal integrity, immune function, and
protein synthesis when there is metabolic stress.
• Showed:
• positive effects on nutritional markers,
• decreased length of hospitalization,
• low incidence ofinfections,
• lower GI toxicities associated with chemotherapy or radiation.
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14. Amino Acids cont.
• Dextrose
• in the form of dextrose monohydrate.
• available in concentrations ranging from 5% to 70%.
• each gram of dextrose provides 3.4 kcal (14.2 kJ) when
oxidized
• IV dextrose dose depends on the patient’s age,
estimated caloric requirements, and clinical condition
• Neonates: 6 to 8 mg/kg/min
• Infants: 14 to 18mg/kg/min
• Adults: 4 to 7 mg/kg/min
• Excessive dextrose infusion rates - may contribute to the
development of hyperglycemia and fatty infiltration of
the liver.
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15. Amino Acids cont.
• Dextrose cont.
• If dextrose infusion rate exceeds > glucose oxidation rate;
glycogen repletion and lipid synthesis are favored = increased
energy expenditure = increased oxygen consumption =
increased carbon dioxide production.
• Glycerol
• an alternate Carbohydrate sources to Dextrose
• not insulin-dependent to improve glycemic control for
patients with impaired insulin secretion or activity.
• Disadvantage; dilute amino acid and carbohydrate
concentrations.
• require up to 3 to 4 L/day together with IV lipid emulsion as a
caloric source to meet minimum energy requirements.
• Safe in Adult but no data available for infants and children.
12/13/2022 ADDIS ABABA UNIVERSITY 15
16. IV lipid emulsion (IVLE)
• Used as a concentrated source of calories and
essential fatty acids.
• Prepared as: combinations of
• SO and olive oil;
• SO, olive oil, medium chain triglyceride oil (MCT), and fish oil
(FO)…SMOF, or
• 100% FO
• Used as a caloric source,
• minimize complications of nutrition therapy such as
hyperglycemia, hepatotoxicity, or increased carbon
dioxide production.
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17. IV lipid emulsion (IVLE) cont.
• SO Based:
• higher linoleic and linolenic FA composition.
• important for cellular integrity, platelet function,
postnatal brain development, and wound healing.
• for treatment or prevention of essential fatty acid
deficiency
(EFAD) in both adult and pediatric patients.
• may have negative effects on immune function and
hepatic function (cholestasis: PN-associated liver disease
(PNALD))
• Adult: 100 g SO IVLE weekly… for EFAD prevention
• Neonates and infants: min 0.5 - 1 g/kg SO IVLE daily.
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18. IV lipid emulsion (IVLE) cont.
• SO-Olive oil and SMOF products:
• lower linoleic and linolenic acid content.
• inadequate provision of essential fatty acids to prevent
or treat EFAD.
• Not approved for use in pediatric patients.
• 100% FO
• relatively lower essential FA content
• not indicated for treating EFAD
• Indicated for use in pediatric patients with PN-
associated cholestasis.
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19. IV lipid emulsion (IVLE) cont.
• Caloric content:
• 10% IVLE = 1.1 kcal/mL (4.6 kJ/mL)
• 20% IVLE = 2 kcal/mL (8.4 kJ/mL) and
• 30% emulsion = 3 kcal/mL (12.6 kJ/mL)
• patients receiving their first IVLE dose should be
monitored for dyspnea, chest tightness, palpitations,
and chills. Headache, nausea, and fever also have been
reported and might be associated with a rapid infusion
rate.
• contraindicated for patients with an impaired ability to
clear fat emulsion, such as patients with pathologic
hyperlipidemia, lipoid nephrosis, and
hypertriglyceridemia associated with pancreatitis.
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20. Vitamins
• Vitamin requirements may be altered in
malnutrition and other specific
disease states or with certain drug therapies.
• Individual and combination products (as Multi-
vitamins) are available.
• Vitamin K was not included in early multivitamin
formulations due to the potential for drug-nutrient
interactions in patients receiving anticoagulants.
150 mcg/day
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21. Trace Elements
• important part of metalloenzymes and function as
cofactors in a variety of regulatory metabolic
pathways.
• deficiency syndromes in humans have been
described only for cobalt (as vitamin B12), copper,
iodine, iron, and zinc.
• available as single-trace element solutions and as
multiple-trace element combinations.
12/13/2022 ADDIS ABABA UNIVERSITY 21
22. Trace Elements cont.
• Single-entity injectable :
• allows for individualization of trace mineral supplementation of
chromium, copper, iodine, manganese, selenium, and zinc.
• Combination products:
• provide the daily requirements for the trace elements considered
essential by the NAG-AMA (ie, chromium, copper, manganese,
selenium, and zinc).
• higher doses of supplemental zinc likely are necessary
for patients with high-output ostomies or diarrhea because
the GI tract is the predominant excretion route for zinc
• manganese and copper are excreted through the biliary
tract, chromium, molybdenum, and selenium are excreted
renally. Hence, these trace elements should be restricted or
withheld from PN solutions for patients with cholestatic
liver disease and kidney disease, respectively.
12/13/2022 ADDIS ABABA UNIVERSITY 22
23. Electrolytes
• Sodium, potassium, calcium, magnesium,
phosphorus, chloride, and acetate
• Necessary PN components for the maintenance of
many cellular functions.
• Given to maintain normal serum concentrations or
to correct deficits.
• Pt with “normal” organ function and relatively
normal serum concentrations of any electrolyte =
receive “normal” maintenance electrolyte doses
when PN is initiated and daily thereafter.
12/13/2022 ADDIS ABABA UNIVERSITY 23
24. Electrolytes cont.
• Requirements vary according to the patient’s age,
disease state, organ function, previous and current
drug therapy, nutrition status, and extrarenal
losses.
• Available commercially as single- and multiple-
nutrient solutions
• Multiple-nutrient solutions : useful for stable
patients with normal organ function who are
receiving PN
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26. • Several factors including the patient’s venous
access, fluid status, and macronutrient and
micronutrient requirements, are important
considerations when designing the PN regimen.
• PN solutions may be administered by central or
peripheral venous acess.
12/13/2022 ADDIS ABABA UNIVERSITY 26
27. • Parenteral nutrition formulations may be provided
as:
• a two-in-one admixture that contains dextrose, CAA, and
other necessary micronutrients or as,
• three-in one admixture or TNA that contains dextrose,
CAA, and IVLE, as well as other necessary micronutrients
12/13/2022 ADDIS ABABA UNIVERSITY 27
28. • Advantage of Using TNA,
• reduced inventory (infusion pumps, tubing, and other related
supplies),
• decreased time for compounding and administration,
• a potential decrease in manipulations of the infusion line
(which should correspond with a decreased risk of catheter
contamination),
• ease of delivery and storage for patients receiving home PN.
• Potential disadvantages,
• increased risk of infections and
• stability and compatibility concerns. For example, the stability
of TNA admixtures is less predictable than that of two-inone
admixtures, which makes their use less desirable in some
patient populations such as neonates and infants.
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30. Peripheral venous acess
• An option for mild-to-moderately stressed patients in
whom adequate GI tract function is expected to return
within 10 to 14 days.
• May be used as a temporary source of PN, or as a
bridge therapy during transition periods.
• Potential PPN candidates should not be fluid-restricted
or require large nutrient amounts.
• Low concentration of CAA (3-5%), Dextrose (5-10%)
and micronutrients. (usually require high volume and
IVLE)
• Primary advantages of PPN include a potentially lower
risk of infectious and technical complications associated
with CVC access.
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31. • Who is more likely to be a poor candidate for PPN?
• poor venous access as the result of multiple courses of
chemotherapy
• malnutrition
• illness of long duration that has required multiple
venous accesses for fluid and medication administration
• premature infants
• elderly
• Thrombophlebitis is a commonly reported
complication for patients receiving PPN (for
solutions greater than 600 to 900 mOsm/L)
12/13/2022 ADDIS ABABA UNIVERSITY 31
32. Central Parenteral Nutrition
• CPN solutions are highly concentrated hypertonic
solutions that must be administered through a
large central vein. (because the high blood flow)
• CPN is the preferred route for patients requiring PN
for more than 7 to 14 days.
• Candidates for CPN
• large nutrient requirements
• poor peripheral venous access
• fluctuating fluid requirements
12/13/2022 ADDIS ABABA UNIVERSITY 32
33. • Disadvantage of CPN
• risks associated with catheter insertion,
• routine catheter use, and
• Care of the access site.
• Relative to peripheral venous access, CVC access is
associated
• with a greater potential for infection
• risk of more serious catheter induced trauma and
related sequelae
12/13/2022 ADDIS ABABA UNIVERSITY 33
34. • Choice of central venous access site depends on;
• Age and anatomy.
• CVS for short-term use for adults are commonly
inserted percutaneously into the subclavian vein and
advanced so that the tip is at the superior vena cava.
• short-term for critically ill neonates via a catheter
placed in the umbilical vein.
• When therapy is expected to last longer than 4 weeks,
the catheter usually is tunneled subcutaneously before
entering the central vessel, secured initially with
retaining sutures, and anchored in place with a felt cuff
that promotes subcutaneous fibrotic tissue growth
around the catheter.
12/13/2022 ADDIS ABABA UNIVERSITY 34
36. Constructing
a Parenteral
Nutrition
Regimen
After the route of delivery is chosen, the
components of the PN regimen are
determined based on the patient’s
nutritional assessment.
12/13/2022 ADDIS ABABA UNIVERSITY 36
37. Adult Parenteral Nutrition
Solutions
• There are two methods for ordering adult PN.
• The “standard formula approach” offers a variety of
admixtures with a fixed non-protein calorie-to-
nitrogen ratio.
• Because the nonprotein-calorie-to-nitrogen ratio is
fixed, the daily amount of nutrient delivered
depends solely on the volume infused.
• However, efficiencies associated with use of the
standard formula approach may be hindered if
there is a frequent need to modify the PN
formulation.
12/13/2022 ADDIS ABABA UNIVERSITY 37
38. • The “individualized formula approach” permits
compounding of patient specific admixtures.
• Compounding of the PN admixture is limited only by
the concentrations of stock solutions and stability of
the additives.
• Traditionally, adult PN formulations have been ordered
by expressing the final concentrations of each
component in the solution. For example, CAA and
dextrose are ordered commonly in final percentage,
electrolytes in milliequivalents (or millimoles) per liter,
and other additives in amount (milliliters or units) per
day.
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39. Calculation of an Adult PN Regimen
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40. Calculation of an Adult PN Regimen
12/13/2022 ADDIS ABABA UNIVERSITY 40
41. Calculation of an Adult PN Regimen
12/13/2022 ADDIS ABABA UNIVERSITY 41
42. Pediatric Parenteral Nutrition
Solutions
• Pediatric PN admixtures are typically ordered using
an individualized approach because current safe
clinical practice guidelines recommend nutrient
intakes based on the patient’s weight.
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43. Calculation of an Pediatric PN Regimen
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44. Calculation of an Pediatric PN Regimen
12/13/2022 ADDIS ABABA UNIVERSITY 44
45. Calculation of an Pediatric PN Regimen
12/13/2022 ADDIS ABABA UNIVERSITY 45
46. Administration Techniques
• PN admixtures should be administered with an
infusion pump.
• The IV administration line for CAA-dextrose
solutions should include a 0.22-micron inline filter
to remove particulate matter, air, and any
microorganisms that may be present in the
solution.
12/13/2022 ADDIS ABABA UNIVERSITY 46
47. Initiating and Advancing the
regimen
• For Adults
• Stable patients … okay to abruptly start and stop
• receiving intermittent subcutaneous regular insulin;
patients with severe kidney or liver disease; and patients
with other disease states that have an increased risk for
development of hyperglycemia or hypoglycemia, such as
severe diabetes or pancreatic malignancy
• Gradually increase infusion rate in 12-24hrs and decrease to ½
an hour before discontinuation OR
• Start at desired rate with hypocaloric dextrose dose
12/13/2022 ADDIS ABABA UNIVERSITY 47
48. • For Pediatrics;
• Pediatric PN solutions typically … maintenance fluid
requirements on the first day of therapy. Individual
nutrient substrates … generally being achieved by
day 3 of therapy.
• Protein dose should be pushed on day one.
• IV electrolytes, vitamins, and trace elements should
be initiated on the first day of therapy and
continued as a daily component of the PN solution.
12/13/2022 ADDIS ABABA UNIVERSITY 48
49. • The PN infusion rate should be reduced for 1 to 2
hours before stopping the infusion for neonates
and infants because of their immature counter-
regulatory mechanisms that contribute to an
increased risk for developing rebound
hypoglycemia.
• Blood glucose concentrations should be measured
within 15 to 60 minutes after the PN infusion ends
12/13/2022 ADDIS ABABA UNIVERSITY 49
50. EVALUATION OF THERAPEUTIC
OUTCOMES
• Ensure nutritional outcomes
• Prevent the occurrence of adverse effects or
complications.
• Routine evaluation should include the assessment
of the patient’s clinical condition with a focus on
nutritional and metabolic effects of the PN
regimen.
12/13/2022 ADDIS ABABA UNIVERSITY 50
51. • Serum concentrations of electrolytes, hematologic
indices, and biochemical markers for kidney and
liver function, and nutrition status.
• The frequency of blood laboratory measurements
for neonates and infants tends to be more
conservative because of their smaller blood
volumes and, in some cases, lack of central vascular
access
12/13/2022 ADDIS ABABA UNIVERSITY 51
53. COMPLICATIONS OF PARENTERAL
NUTRITION
• Mechanical and Technical Complications
• malfunctions in the system used for IV delivery of the solution
• CVC-related complications are potentially life-threatening.
• Pneumothorax, catheter misdirection or migration into the
wrong vein or improper positioning within the cardiac
chambers, arterial puncture, bleeding, and hematoma
formation may occur during surgical placement of the
catheter.
• CVCs occasionally occlude or break during use and if these
problems cannot be rectified easily, the catheter may need to
be surgically replaced.
12/13/2022 ADDIS ABABA UNIVERSITY 53
54. • Infectious Complications
• Infectious complications can be a major hazard for
patients receiving CPN because of the increased risk
associated with the presence of an indwelling CVC.
• The source of a CVC infection may be skin organisms
from the catheter insertion site, contamination of the
catheter hub, or hematogenous seeding of the catheter
from a distant site.
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55. • The risk of catheter infection is increased for those who
require multiple manipulations of the line used for PN
administration as well as those who experience failure
of in-line bacterial filter, poor catheter placement
technique, and poor CVC and insertion site care.
• Catheter-related bloodstream infections (CRBSIs),
defined as the presence of clinical manifestations of
infection (eg, fever, chills, hypotension) associated with
bacteremia or fungemia resulting from no apparent
source other than the catheter, are common sources of
systemic infection.
12/13/2022 ADDIS ABABA UNIVERSITY 55
56. REFERENCES
1. ASPEN | What Is Parenteral Nutrition. (n.d.).
ASPEN.
http://www.nutritioncare.org/about_clinical_nut
rition/what_is_parenteral_nutrition/
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58. Group Members
1. Natnael Abebe
2. Natnael
3. Nebyu Daniel
4. Niyat Alem
5. Nuhamin Milion
6. Rahel
7. Habiba
HSR/3086/11
12/13/2022 ADDIS ABABA UNIVERSITY 58
Editor's Notes
Bloodstream: Digestive system won’t need to work as hard to break down solid food.
Tube feeding: delivering liquid nutrition directly into the stomach or small intestine
2. Intrinsic or extrinsic blockage of intestinal lumen.
Stenosis or stricture
peritoneal carcinomatosis
3. Ischemic bowel
Mesenteric artery stenosis
Preoperative Status
4. Active GI bleeding
Severe neutropenic fever
short time: In hospital setting and acute cases
Lifelong: when??
(what is PN associated cholestasis)
Phytosterols; not fully metabolized by the human body and must be excreted through the hepatobiliary system. Administration of high doses of intravenous lipids that are high in phytosterols contributes to the development of parenteral nutrition-associated liver disease.
where oral intake or EN is suboptimal or clinical circumstances do not justify placing a central venous catheter (CVC) access.
Because PPN solutions are relatively dilute, larger volumes arevusually necessary to provide nutrient requirements.
Additionally, many patients who receive PPN likely will require IVLE to achieve the desired caloric intake at levels consistent with CPN regimens. The primary advantages of PPN include a potentially lower risk of infectious and technical complications associated with CVC access
Efforts to minimize development of phlebitis or infiltration sequelae for patients receiving PPN include
addition of IVLE as a possible venous lumen protectant,
subtherapeutic heparin doses (0.5-1 unit/mL) to prevent thrombus formation, or
small doses of hydrocortisone (5mg/L) to minimize access site inflammation.
However, the coinfusion of IVLE with PPN (ie, not provided as a TNA) has not been shown to reduce phlebitis. In addition, heparin has not been shown to reduce catheter-related thrombosis and is not compatible for use in TNAs.
fluctuating fluid requirements, such as metabolically stressed patients with extensive surgery, trauma, sepsis, multiple-organ failure, or malignancy
other serious technical or mechanical problems is greater than that with peripheral access.
If this approach is not possible, the internal jugular vein can be used. FOR NEONATES
Implanted CVCs have a larger port or reservoir that is surgically placed beneath the skin surface and anchored in the chest wall muscle. Peripherally inserted central catheters
(PICCs) are venous access devices that are inserted into a peripheral vein (basilic, cephalic, or brachial) and advanced so that the tip is at the superior vena cava. PICCs are increasingly used for both short- and long-term central venous access in acute or home care settings because of ease and economy of bedside placement.
STANDARD METHOD
This method usually includes different formulas for mild-to-moderately stressed patients, and those who have kidney or liver failure or are fluid-restricted.
Finally, standard PN formulations may be difficult to use in complicated patients, such as neonatal or pediatric patients, and those with severe malnutrition, organ failure, glucose intolerance, large GI losses, or critical illness.
The nutrient amount delivered depends on the daily volume of the PN solution infused and the nutrient amounts in the PN solution.
For example, adult patients receiving only PN therapy may need larger volumes of fluid to provide maintenance requirements and replace extrarenal losses. However, patients requiring other IV drug therapy may receive adequate fluid from an additional IV maintenance solution (eg, 0.45% NaCl in 5% dextrose) or co-infused medications (or both).
Calculation of an adult PN regimen. To convert to energy units of kilojoules (kJ) multiply values with kilocalories as the numerator (kcal, kcal/mL, kcal/kg, kcal/g) by 4.18 to give the corresponding value in kilojoules (kJ, kJ/mL, kJ/kg, kJ/g). (CAA, crystalline amino acids; IVLE, intravenous lipid emulsion; PN, parenteral nutrition; TNA, total nutrient admixture
Because infants and children generally receive daily maintenance fluid from the PN regimen, supplemental IV solutions are rarely needed.
However, the TNA system is not recommended for compounding neonatal and infant PN because of IVLE instability with the often-needed higher calcium and phosphorus concentrations
IVLE’s may be administered separately from the CAA-dextrose solution by co-infusion into the PN line. A port beyond the inline filter must be used because the average size of IVLE particles is approximately 0.5 microns.
However, co-infused IVLE should also be filtered with a 1.2- micron filter. The FDA recommends use of a 1.2-micron filter with TNA solutions, which may be effective in preventing catheter occlusion caused by precipitates or lipid aggregates.5,44 This filter size is also reported to remove Candida albicans.
TAPPERED INITIATION AND CESSATION
Continuous versus Cyclic Infusions
The intermittent or cyclic infusion of PN over less than 24 hours, usually for 12 to 18 hours each day, is useful for hospitalized patients with limited venous access in whom administration of multiple other medications requires interruption of the PN infusion.
Cyclic PN should be used with caution for those with severe glucose intolerance, diabetes, or unstable fluid balance.
Serial documentation of a patient’s response to their PN regimen is a helpful guide for determining appropriate adjustments in fluid, electrolyte, and nutrient therapies.
Other important clinical measurements include vital signs, weight, total fluid intake and output, and nutritional intakes.
such as infusion pump failure, problems with administration sets or tubing, or the CVC…..
Many of these complications, in addition to venous thrombosis and air embolism, can occur after insertion
In addition, patients receiving PN therapy are often predisposed to infection because of compromised immunity or concomitant infection
frequent use of broad-spectrum antibiotic therapy and malnutrition are also predisposing factors for development of infection
Infection rarely develops secondary to solution contamination. Strict
adherence to protocols for preparation of PN admixtures should minimize this.
Filling the catheter with antimicrobials such as vancomycin or antiseptics such as 70% alcohol and allowing the solution to dwell for a period of time while the catheter is not in use is referred to as a catheter lock.
Antimicrobial catheter locks have been used to prevent and treat CRBSI in patients with long-term catheters such as those receiving home PN.