Mosby items and derived items © 2005, 2002 by Mosby, Inc. CHAPTER 53 Nutritional Supplements.

Mosby items and derived items © 2005, 2002 by Mosby, Inc.

CHAPTER 53

Nutritional Supplements


What to Know About


Nutritional Supplements

• Dietary products used to provide nutritional support

• Can be given in a variety of ways

• Vary in amounts and complexity of carbohydrates, protein, and fat content

• Electrolytes, vitamins, minerals, and osmolality may also vary


Nutritional Supplements (cont'd)

• Malnutrition: the body’s nutritional needs are not met by nutrient intake

• Enteral nutrition– Provision of food or nutrients through the GI tract

• Parenteral nutrition– Nutrients are delivered directly into the circulation

by means of an intravenous solution


Enteral Nutrition

• Provision of food or nutrients through the GI tract

• Oral consumption is the most common and least invasive route

• Feeding tubes through various routes can be used for enteral nutrition


Enteral Nutrition (cont'd)

• Feeding tubes are used for those with:– Abnormal esophageal or stomach

peristalsis– Altered anatomy secondary to surgery– Depressed consciousness– Impaired digestive capacity


Four Enteral Formulation Groups

• Provide the basic building blocks for anabolism

• Supply complete dietary needs through the GI tract by oral route for by feeding tube– Elemental– Polymeric– Modular– Altered amino acid


Enteral Formulation Group:Elemental

• Vivonex Plus, Peptamen, Vital HN

• Minimum digestion needed; residual is minimal

• Used for partial bowel obstruction, irritable bowel disease, other conditions

• Hyperosmolarity of formulas may cause GI problems


Enteral Formulation Group:Polymeric

• Complete, Ensure, Ensure-Plus, Isocal, Osmolite, Sustacal

• Preferred over elemental formulations for patients with fully functional GI tracts and few specialized nutrient requirements; causes fewer GI problems


Enteral Formulation Group:Modular

• Three types– Carbohydrate: Moducal, Polycose– Fat: MICT oil, Microlipid– Protein: Casec, ProMod, Stresstein

• Single nutrient formulas

• Can be added to other formulas if needed


Enteral Formulation Group:Altered Amino Acid

• Amin-Aid, Hepatic-Aid, Lonalac, Stresstein, Travasorb Renal

• Contain varying amounts of specific amino acids

• Used for patients with genetically altered metabolism problems


Enteral NutritionInteractions

• Various nutrients can interact with drugs to produce significant food-drug interactions

• Enteral nutrition can delay absorption of some medications

• Enteral nutrition may inactivate some medications (i.e., tetracycline and nutrient formulations that contain calcium)


Parenteral Nutrition

• Totally digested nutrients are given intravenously, directly into the circulatory system

• The entire GI system is bypassed, eliminating the need for absorption, metabolism, or bowel elimination


Parenteral Nutrition (cont'd)

• Amino acids– Nonessential amino acids– Essential amino acids– Semiessential amino acids

• Trace elements– Chromium – Copper– Iodine – Manganese



• Also known as total parenteral nutrition (TPN) or hyperalimentation

• Formulations will vary according to individual patient nutritional needs– Amino acids– Carbohydrates– Lipids– Trace elements


Figure 53-2 One gram of dextrose, fat, or protein will provide varying amounts of energy as calories.



• Peripheral administration– Temporary, short term (less than 2 weeks)– Dextrose concentration generally less than

10%

• Central administration– Long-term use (7 to 10 days)– Dextrose concentrations may be 10% to

50%


Peripheral TPN

• Used to provide nutrients to patients who need more nutrients than present oral intake can provide– Procedures that restrict oral feedings– Anorexia caused by chemotherapy or radiation

treatments– GI illnesses that prevent oral food intake– After surgery– When nutritional deficits are minimal, but oral

nutrition will not be started for more than 5 days


Peripheral TPN:Side/Adverse Effects

• PHLEBITIS is the most devastating adverse effect– Can lead to loss of a limb

• Fluid overload


Central TPN

• Delivered through a large central vein– Subclavian– Internal jugular

• Long-term use (more than 7 to 10 days)


Central TPN (cont'd)

• Disadvantages are the risks associated with central line insertion, use, and maintenance

• Higher risk for infection, catheter-induced trauma, metabolic alterations


Central TPN (cont'd)

• Delivers total dietary nutrients to patients who require nutritional supplementation– Patients with large nutritional requirements

(metabolic stress or hypermetabolism)– Patients who need nutritional support for

more than 7 to 10 days– Patients who are unable to tolerate large

fluid loads


Central TPN:Side/Adverse Effects

• Most common are those surrounding the use of the central line for the delivery of TPN– Infection– Catheter-induced trauma

• Greater chance for hyperglycemia due to the larger and more concentrated volumes given


Nursing Implications

• Ensure that a complete nutritional assessment is taken, including a dietary history, weekly and daily food intakes, and weight and height measurements

• Consult with a registered dietitian



• Assess baseline laboratory studies, such as total protein, albumin, BUN, RBC, WBC, cholesterol, etc.

• Collect anthropometric data• Assess for allergies to components of

enteral nutritional supplements (such as whey, egg whites)

• Assess for lactose intolerance



• If administering enteral nutrition by tube feedings, follow facility policy for ensuring proper tube placement and for checking residual before giving a feeding

• Follow procedures for flushing tubing to prevent clogging the feeding tube with formula



• Monitor how the patient is tolerating enteral feedings carefully

• Most enteral feedings are started slowly and the rate is increased gradually

• Monitor for signs of lactose intolerance– Cramping, diarrhea, abdominal bloating,

flatulence



• Follow facility policies and procedures for care and maintenance of TPN IV lines, including tubing changes

• Monitor patient’s temperature; report any increase immediately



• Monitor blood glucose levels with a glucometer

• Monitor for hyperglycemia– Headache, dehydration, weakness

• Monitor for hypoglycemia– Cold, clammy skin, dizziness, tachycardia,

tingling of the extremities



• While on TPN, the pancreas is providing increased amounts of insulin to cover the increased glucose levels

• If TPN is discontinued abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels

• If TPN must be discontinued abruptly, then infuse 5% to 10% glucose to prevent hypoglycemia



• Monitor for fluid overload while on TPN– Weak pulse, hypertension, tachycardia,

confusion, decreased urine output, pitting edema

• Monitor daily weights and intake and output volumes



• Monitor for therapeutic responses to nutritional supplementation– Improved well-being, energy, strength, and

performance of activities of daily living– Increased weight– Laboratory studies that reflect a more

positive nutritional status

Mosby items and derived items © 2005, 2002 by Mosby, Inc. CHAPTER 53 Nutritional Supplements.

Documents

mosby items

derived items

enteral nutrition slide

medications enteral

enteral nutrition contd

calcium slide

enteral formulation

intravenous solution