Adults II-Exam 3.docx - Nutrition in High Acuity Patient Refeeding Syndrome Alterations in Nutritional Status Nutritional Therapies Illness can lead to

Adults II-Exam 3.docx - Nutrition in High Acuity Patient...

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Alterations in Nutritional Status: Nutritional Therapies Nutrition in High Acuity Patient Illness can lead to drastically increased metabolic demands when sick Burn unit—2x to 3x metabolic need (the sicker they are the higher the metabolic demand) Nutrition important for wound healing and muscles so that you can breathe well Malnutrition : full spectrum of insufficient needs and people that eat too much can negatively affect all body systems Patients that are unable to consume adequate nutrition orally will need to have enteral (tube feeds) or parenteral (IV) nutrition in place to prevent malnutrition many risks with feeding this way Best method is for someone to eat normally (many benefits to this!) Must assess for “Refeeding Syndrome” May eat and get tube feeds Oral Enteral Parenteral Refeeding Syndrome What caused a high acuity patient’s admission poor intake and then start giving large doses of tube feedings—get abundance of glucose IV body needs in the insulin in the body to handle the large amount of glucose Risks associated: insulin goes into the cells but also electrolytes CAUSES electrolyte imbalances Giving Dextrose insulin helps bring it into the cells but also forces electrolytes into the cells Prevent refeeding through starting feeds slowly (giving time to adjust), monitor electrolytes FEED VERY SLOWLY Enteral Feedings About Tube Feedings **Eating by mouth preferred—want natural process to occur If unable to do so, tube feeding preferred to parenteral nutrition because of: Maintains gut integrity (food still going into gut) – closest to the natural process Prevents translocation of bacteria (if not feeding the stomach, bacteria can move and go into systemic circulation) potential infectious process because we aren’t feeding them More cost effective Easy to administer: basic nursing skill Routes of Administration Intragastric Gastric Feeding: better for the body because follows natural process Nasogastric/Orogastric (nose or the mouth orogastric more common with ET tubes—tape to the ET tube; benefit of bypassing the nasal cavity is decreasing sinusitis rates) Gastrostomy : basic peg tube (straight into the gastric area) Postpyloric (needs to migrate past the stomach; not that easy to insert) Small-bore tube via nose or mouth (smaller than salem-sump tube (Dob-hoff)) If take out the ET tube, might also take the feeding tube if through nasal cavity, not as likely when they remove the ET tube Core-Track : Can be placed at the bedside ultrasound equipment to track where the tube it (Core-track tube); needs to migrate past the stomach Jejunostomy : peg tube into the stomach but has a bridge that puts it also into post-pylroic area; long term use Patient that needs Post-pyloric tube : anatomical reasons in stomach, something going on in the stomach, delayed gastric emptying (high residuals aspiration risk) shouldn’t be able to
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