6 - Nutritional Support

Proverbs 16:3

a. Malnutrition

A deficiency, excess, or imbalance of energy, protein, and other nutrients that causes measurable adverse effects on body tissue, size, shape, composition, function and clinical outcome

a. Malnutrition
b. Overnutrition
c. Undernutrition
d. Cachexia

TRUE

TRUE OR FALSE

• Nutrients can be introduced in the body in different routes

Kwashiorkor

Identify:

a. Marasmus

b. Kwashiorkor

Marasmus

Identify:

a. Marasmus

b. Kwashiorkor

Kwashiorkor

It develops in children whose diets are deficient of protein

a. Marasmus

b. Kwashiorkor

Marasmus

It is due to deficiency of proteins and calories.

a. Marasmus

b. Kwashiorkor

Kwashiorkor

It occurs in children between 6 months and 3 years of age.

a. Marasmus

b. Kwashiorkor

Marasmus

It is common in infants under 1 year of age.

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Subcutaneous fat is preserved.
a. Marasmus

b. Kwashiorkor

Marasmus

Subcutaneous fat is not preserved.

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Oedema is present

a. Marasmus

b. Kwashiorkor

Marasmus

Oedema is absent

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Enlarged fatty liver.

a. Marasmus

b. Kwashiorkor

Marasmus

No fatty liver.

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Ribs are not very prominent.

a. Marasmus

b. Kwashiorkor

Marasmus

Ribs become very prominent.

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Lethargic

a. Marasmus

b. Kwashiorkor

Marasmus

Alert and irritable.

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Muscle wasting mild or absent.

a. Marasmus

b. Kwashiorkor

Marasmus

Severe muscle wasting

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Poor appetite.

a. Marasmus

b. Kwashiorkor

Marasmus

Voracious feeder.

a. Marasmus

b. Kwashiorkor

Kwashiorkor

The person suffering from this needs adequate amounts of proteins.

a. Marasmus

b. Kwashiorkor

Marasmus

The person suffering from this needs adequate amount of protein, fats and carbohydrates.

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Protuberant belly

a. Marasmus

b. Kwashiorkor

Marasmus

Prominent bones

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Xerosis

a. Marasmus

b. Kwashiorkor

Marasmus

Loose skin

a. Marasmus

b. Kwashiorkor

Kwashiorkor

Poor wound healing

a. Marasmus

b. Kwashiorkor

[MALNUTIRTION]

Steps in clinical approach to nutritional screening and support:

a. True

Nutrients can be introduced in the body by different routes such as enteral and parenteral routes.

a. True

b. False

a. True

Combinations of oral diet, enteral feeding and parenteral nutrition, either peripherally or centrally, may be appropriate

a. True

b. False

a. Enteral Nutrition

A method of providing nutritional support via tubes inserted into the stomach or small intestine
a. Enteral Nutrition
b. Parenteral Nutrition
c. Oral Nutrition
d. Specialized Nutritional Support

b. Parenteral Nutrition

A nutritionally balanced aseptically prepared or sterile physiochemically stable solution or emulsion for IV administration

a. Enteral Nutrition
b. Parenteral Nutrition
c. Oral Nutrition
d. Specialized Nutritional Support

b. Parenteral Nutrition

Indicated whenever the GI tract is inaccessible or nonfunctional or when enteral nutrition is inadequate or unsafe

a. Enteral Nutrition
b. Parenteral Nutrition
c. Oral Nutrition
d. Specialized Nutritional Support

• Solution should be compounded in a pharmacy using a laminar flow

• Solution must be infused or discarded within 24hours after hanging

• Vitamins are only stable at room temperature for 24hours so they are added to the PN solution at the time of infusion

[NUTRITION]

Key practice points for parenteral nutrition [3]

a. Laminar flow hood

[Key Practice Points for Parenteral Nutrition]

Parenteral Nutrition should be compounded using a ______
a. Laminar flow hood
b. Biological safety cabinet
c. Fume hood
d. Clean bench

b. Vitamins

[Key Practice Points for Parenteral Nutrition]

______ in parenteral nutrition are only stable at room temperature for 24 hours. Therefore, they are added to the PN solution at the time of infusion
a. Electrolytes
b. Vitamins
c. Trace elements
d. Amino acids

b. Room temperature

[Key Practice Points for Parenteral Nutrition]

Vitamins in parenteral nutrition are only stable at ____ temperature for 24 hours. Therefore, they are added to the PN solution at the time of infusion
a. Refrigerated
b. Room temperature
c. Body temperature
d. Freezing

Peripheral / Partial Parenteral Nutrition (PPN)

[PPN or TPN]

_______-

• A nutritional support that supplies only part of daily nutritional requirement

• Oral intake in a peripheral vein for short term nutritional support (<14 days)

Total Parenteral Nutrition (TPN)

[PPN or TPN]

_______-

• Supplies all daily nutritional requirements

• Indicated for long term use (>30 days)

• May be administered continuously over a 24-hour period

Peripheral / Partial Parenteral Nutrition (PPN)

[PPN or TPN]

Contains <10% final concentration of dextrose

Total Parenteral Nutrition (TPN)

[PPN or TPN]

Used for patients who cannot get their nutrition through eating

Total Parenteral Nutrition (TPN)

[PPN or TPN]

10% of dextrose and 5% protein

Peripheral / Partial Parenteral Nutrition (PPN)

[PPN or TPN]

Solution tonicity: <500 mOsm/L

Total Parenteral Nutrition (TPN)

[PPN or TPN]

Solution tonicity: 500 mOsm/L

Peripheral / Partial Parenteral Nutrition (PPN)

[PPN or TPN]

May be administered through a larger peripheral vein

Total Parenteral Nutrition (TPN)

[PPN or TPN]

Central line

Total Parenteral Nutrition (TPN)

[PPN or TPN]

Designed to totally replace enteral intake

1. When specialized nutritional support is required, enteral nutrition should be used in preference to parenteral nutrition.

2. Parenteral nutrition should be used when GI tract is not functional or cannot be adequately nourished by oral diet or enteral nutrition.

3. Specialized nutrition support should be initiated in patients with inadequate oral intake for 7 to 10 days or in those patients in whom inadequate oral intake is expected over a 7- to 14-day period.

ASPEN Guidelines [3]

TRUE

[NUTRITIONAL SUPPORT]

TRUE OR FALSE:

When specialized nutritional support is required, enteral nutrition should be used in preference to parenteral nutrition.

TRUE

[NUTRITIONAL SUPPORT]

TRUE OR FALSE:

Parenteral nutrition should be used when GI tract is not functional or cannot be adequately nourished by oral diet or enteral nutrition.

b. 7 to 10 days

[NUTRITIONAL SUPPORT]

Specialized nutrition support should be initiated in patients with inadequate oral intake for _____ days or in those patients in whom inadequate oral intake is expected over a 7- to 14-day period.

a. 5 to 7 days
b. 7 to 10 days
c. 3 to 5 days
d. 10 to 14 days

b. 7- to 14-day

[NUTRITIONAL SUPPORT]

Specialized nutrition support should be initiated in patients with inadequate oral intake for 7 to 10 days or in those patients in whom inadequate oral intake is expected over a ______ period.
a. 5- to 10-day
b. 7- to 14-day
c. 10- to 15-day
d. 14- to 21-day

Components of Parenteral Nutrition

Oral diet vs. Parenteral nutrition

1. Glucose to amino acids: Press the upper left chamber (glucose) to mix with the lower chamber (amino acids).

2. Add electrolytes and trace elements in port.

3. Lipid emulsions: Press the upper right chamber (liquid) to mix with lower chamber.

4. Add vitamins.

5. Mix thoroughly then hang it on the drip stand for 24 hrs

Steps in mixing TPN components [5]