- Four steps to developing a successful nutrition plan include definition of nutrition goals, determination of nutrition requirements, determination of appropriate route of delivery of nutrients, and subsequent monitoring of the nutrition regimen to evaluate suitability of the regimen as a patient’s clinical condition changes and to minimize or treat complications.
- 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.
- Identifying the patient who is most likely to benefit from parenteral nutrition (PN) therapy includes consideration of the patient’s age, nutrition status, expected duration of GI dysfunction, and potential risks of initiating therapy.
- PN formulations include IV sources of protein, dextrose, fat, water, electrolytes, vitamins, trace elements, and other additives.
- PN solutions may be appropriately formulated for administration by peripheral or central venous access.
- PN solutions may be infused continuously or intermittently.
- Biochemical and clinical measurements considered necessary for effective monitoring of patients receiving PN include serum chemistries, vital signs, weight, total daily fluid intake and losses, and nutritional intake.
- Non–catheter-related complications of PN therapy are minimized with application of age-appropriate nutrient dosing guidelines, frequent monitoring, and rational adjustments to the PN regimen when metabolic abnormalities occur.
- Individualized PN therapy is based on goals determined from a patient-specific nutrition assessment, type of available IV access, and macronutrient and micronutrient requirements. Nutrient requirements are affected by age, degree of metabolic demand, organ function, other drug therapy, exogenous losses, acid–base status, and enteral intake in patients with recovering GI function.
On completion of the chapter, the reader will be able to:
List the four fundamental steps to providing optimal nutrition support.
Discuss indications for parenteral nutrition in infants, children, and adults.
Calculate amounts of fluid, calories, protein, nitrogen, and carbohydrate provided by a given parenteral nutrition regimen.
Define conditionally essential amino acids and list three reported in pediatric or adult patients.
Discuss content and caloric concentration of IV fat emulsion.
Describe the mechanism for essential fatty acid deficiency and requirements for prevention.
Discuss considerations for use of peripheral and central parenteral nutrition.
Calculate the osmolarity of a parenteral nutrition regimen.
Given gram amounts of protein and dextrose and calculate volumes of dextrose, crystalline amino acids, and water required to compound a parenteral nutrition solution.
Discuss considerations for determining the method of administration (continuous or intermittent infusion) of a parenteral nutrition solution.
List an example of each of the three types of complications associated with parenteral nutrition.
Discuss the prevention and treatment of complications associated with parenteral nutrition therapy.
Describe characteristics of the refeeding syndrome and outline a plan to minimize the risk of occurrence.
Outline a plan for monitoring a patient receiving parenteral nutrition.
Discuss considerations for personalizing parenteral nutrition therapy.
Maintenance of adequate nutrition status during illness has been recognized for more than 50 years as an integral part of the medical treatment plan for patients who are unable to ...