Nutrition - ch.21 - Parental Nutrition

intravenous

through veins

Why would you do intravenous route?

intestinal obstruction or openings

paralytic or paralyzed intestinal

vomiting / diarrhea

bone marrow transplant

severe malabsorption

feeding intolerance

peripheral vein

7-10 days

phlebitis

central vein

tolerated more

longer period

Constituents of IV feeding solutions

amino acids instead of whole protein

dextrose is more soluble form of glucose

• only offers 3.4 cal/grams

fatty acids and all vitamins and minerals - except Vit K

Simple IV solutions

water, dextrose, electrolytes

NS

normal saline - 0.9% NaCl

no nutrients - salt+water

D5W

% of dextrose in water

5% of dextrose

TPN

total parental nutrition

provides 2,500 cal/day

suited for 2wks or less

respiratory acidosis

low blood pH due to improper lung function

• worsen by glucose oxidation so these patients should have more fat containing formulas

phlebitis

inflammation of vein

cyclic infusion

periodic administration of IV feeding

• allows insulin to rise and fall like normal

• continuous drip → insulin has to stay high which slows fatty acid use + causes fatty acid to build up in liver

Cruzan Case

supreme court decision that families do not have a right to remove feeding tube from incapacitated person unless convincing evidence from patient

disclosure

revealing important information

informed consent

patients agreement for treatment after disclosure

distributive justice

determining equity of care for all

advanced directive

written or oral instructions concerning medical treatment when incapacitated

living will

documentation stated whether or not a person wished to have heroic life saving measures

durable power of attorney

legal document that authorize another person to make decision for someone

DNR

do not resuscitate