chapter 55 nutritional supplements copyright © 2014 by mosby, an imprint of elsevier inc

Chapter 55

Nutritional Supplements

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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

Nutrition Supplements

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

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

Delivery of nutrients directly into the circulation by means of an intravenous solution

Nutrition Supplements (cont’d)


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


Feeding tubes are used for those with: Abnormal esophageal or stomach peristalsis Altered anatomy secondary to surgery Depressed consciousness Impaired digestive capacity

Enteral Nutrition (cont’d)


Provide basic building blocks for anabolism Supply complete dietary needs through the GI tract

by oral route or by feeding tube Elemental Polymeric Modular

• Carbohydrate formulations

• Fat formulations

• Protein formulations

Altered amino acid formulations Impaired glucose tolerance

Enteral Formulation Groups


Peptamen, Vital HN, Vivonex Plus, Vivonex TEN Minimal digestion needed; residual is minimal Used for malabsorption, partial bowel

obstruction, irritable bowel disease, other conditions

Hyperosmolarity of formulas may cause GI problems

Enteral Formulation Group:Elemental


Complete, Ensure, Ensure Plus, Isocal, Osmolite, Portagen, Jevity, Sustacal

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

Most closely resemble normal dietary intake

Enteral Formulation Group:Polymeric


Three types Carbohydrate: Moducal, Polycose Fat: MCT Oil, Microlipid Protein: Casec, ProMod, Propac, Stresstein

Single nutrient formulas Intended for use with monomeric or polymeric

formulations

Enteral Formulation Group:Modular


Amin-Aid, Hepatic-Aid, Travasorb Renal, Traum-Aid HBC

Contain varying amounts of specific amino acids Used for patients with diseases associated with

altered metabolism capabilities

Enteral Formulation Group:Altered Amino Acid


Classroom Response Question

A patient who has a history of type 1 diabetes mellitus is in need of enteral nutrition. Which enteral formulation does the nurse anticipate administering to this patient?

A. Ensure

B. Glucerna

C. Polycose

D. Jevity


Glucerna Contains proteins, carbohydrates, fat, sodium,

potassium Used in patients with impaired glucose tolerance

(e.g., diabetic patients)

Enteral Formulation Group:Impaired Glucose Tolerance


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 (e.g., tetracycline and nutrient formulations that contain calcium)

Enteral Nutrition:Interactions



The nurse is administering tube feeding to a patient taking multiple medications. The nurse is most concerned about absorption of which medication when administered with tube feedings?

A.digoxin

B.penicillin

C.phenytoin

D.furosemide


Gastrointestinal intolerance Dumping syndrome Aspiration pneumonia

Enteral Nutrition:Adverse Effects



The nurse identifies which condition as the most common adverse effect of nutritional supplements?

A. Infection

B. Phlebitis

C. Diarrhea

D. Hyperglycemia


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

Hyperalimentation Total parenteral nutrition (TPN)

Parenteral Nutrition


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

Parenteral Nutrition (cont’d)


Protein synthesis, or anabolism Types of amino acids

Essential Nonessential Semiessential

Amino acid crystalline solutions (Aminosyn 3%, 5%, and 10%, and FreAmine III 8.5% and 10%)

Amino Acids


Carbohydrates are usually supplied to patients through dextrose Peripheral parenteral nutrition (PPN) dextrose

concentrations are usually kept below 10% to decrease the possibility of phlebitis

Central TPN dextrose concentrations can range from 10% to 50%, but they are commonly 25% to 35%

Supplemental insulin may be given simultaneously in nutritional supplements

Carbohydrates


Intravenous fat emulsions serve two functions Supply essential fatty acids Source of energy or calories

Essential fatty acid deficiency Lipid emulsions, Intralipid and Liposyn, are

available as 10%, 20%, or 30% emulsions

Fats


Varying Amounts of Energy from 1 g of Dextrose, Fat, or Protein


Peripheral total parenteral nutrition Temporary, short term (less than 2 weeks) Dextrose concentration generally less than 10%

Central total parenteral nutrition Long-term use (over 2 weeks) Dextrose concentrations may be 10% to 50%, but are

commonly 25% to 35%

Parenteral Nutrition (cont’d)


Used to provide nutrients to patients who need more nutrients than present oral intake can provide

Indicated for: Procedures that restrict oral feedings Anorexia caused by chemotherapy or radiation

treatments GI illnesses that prevent oral food intake Postsurgical patients When nutrition deficits are minimal, but oral nutrition will

not be started for more than 5 days

Peripheral TPN



When caring for a patient receiving PPN, it is most important for the nurse to assess for the development of which adverse effect?

A. Hypertension

B. Anemia

C. Renal failure

D. Phlebitis


Phlebitis is the most devastating adverse effect Can lead to loss of a limb

Fluid overload

Peripheral TPN:Adverse Effects


Delivered through a large central vein Subclavian Internal jugular

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

Central TPN


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 (cont’d)


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

Greater chance for hyperglycemia because of the larger and more concentrated volumes given

Central TPN:Adverse Effects


Chromium Copper Iodine Manganese Molybdenum Selenium Zinc

Trace Elements


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

Nursing Implications


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

Collect anthropometric data Assess for allergies to components of enteral

nutritional supplements (such as whey, egg whites)

Assess for lactose intolerance

Nursing Implications (cont’d)


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

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



Carefully monitor how the patient is tolerating enteral feedings

Keep in mind that 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 and dressing 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




A patient is receiving peripheral parenteral nutrition (PPN). When the current bag is empty, the nurse discovers that the next ordered bag is not yet ready from the pharmacy. What will the nurse do?

A.Convert the IV to an IV lock until the next bag is ready.

B.Hang a bag of 10% dextrose.

C.Hang a bag of 20% dextrose.

D.Notify the physician that the bag is not ready.


While on TPN, the pancreas provides 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 according to facility policy



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




The nurse is assessing a patient admitted to the unit following major bowel surgery. The nurse anticipates administering which type of nutrition for this patient?

A. Enteral feedings through a percutaneous endoscopic gastrostomy (PEG) tube

B. Peripheral parenteral nutrition

C. Total parenteral nutrition

D. A high-residue diet


chapter 55 nutritional supplements copyright © 2014 by mosby, an imprint of elsevier inc

Documents

imprint of elsevier

fewer gi problemsmost

functional gi tracts

gi tractoral consumption

dietary products

bodys nutritional needs

nutritional supportcan

partial bowel obstruction