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KEY CONCEPTS

KEY CONCEPTS

  • image Development and implementation of an appropriate, individualized nutrition care plan requires definition of nutrition goals, determination of nutrition requirements and appropriate route of nutrient delivery, and design of a monitoring plan to evaluate suitability of the nutrition regimen as a patient's clinical condition changes.

  • image The appropriate route of nutrition support depends on the functional condition of the patient's gastrointestinal (GI) tract, risk of aspiration, expected duration of nutrition therapy, and clinical condition.

  • image Suitable candidates for parenteral nutrition (PN) therapy can be identified on the basis of their age, nutrition status, expected duration of GI dysfunction, and potential risks of PN therapy.

  • image PN formulations include injectable amino acids, dextrose, water, electrolytes, vitamins, trace elements, and other additives. Some formulations may include intravenous lipid emulsion (IVLE).

  • image PN solutions may be appropriately formulated for administration by peripheral or central venous access.

  • image PN formulations are available as standardized commercial premixed products or they may be compounded with an automated compounding device (ACD).

  • image PN solutions may be infused continuously or intermittently.

  • image Biochemical and clinical measurements for effective monitoring of patients receiving PN include serum chemistries, vital signs, body weight, total daily fluid intake and losses, and nutritional intake.

  • image Non–catheter-related complications of PN therapy can be minimized by using age-appropriate nutrient dosing guidelines, frequent monitoring, and implementing rational adjustments to the PN regimen when metabolic abnormalities occur.

  • image Individualized PN therapy should be based on nutrition therapy goals determined from a patient-specific nutrition assessment, type of available IV access, and macronutrient and micronutrient requirements.

  • image A patient's nutrient requirements are affected by age, degree of metabolic demand, organ function, drug therapy, exogenous losses, acid–base status, and enteral intake in patients with recovering GI function.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Watch the video entitled “PN Appropriateness: The General Approach” at the American Society for Parenteral and Enteral Nutrition (ASPEN) website. This 13.5-minute video provides a brief overview regarding selection of appropriate PN candidates. The video is useful to enhance student understanding regarding the COLLECT and ASSESS steps in the patient care process.

INTRODUCTION

Maintenance of adequate nutrition status during illness has been recognized for more than 50 years as an integral part of the treatment plan for patients who are unable to attain and sustain oral nourishment. Successful techniques for providing IV nutrition support were introduced to clinical practice in adults and subsequently, infants in the late 1960s.1 Use of central venous access was investigated to reduce risk of metabolic complications associated with IV fluid overload and electrolyte imbalances. The use of large central vessels permitted infusion of concentrated formulas, which decreased the fluid volume required and avoided the phlebitis that commonly occurred when hypertonic infusions were given peripherally.

Clinical experience and research fostered development of protocols that promoted better patient care and resulted in a decline in complications and costs associated with parenteral nutrition (PN) therapy....

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