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TOTAL NUTRITIONAL SUPPORT: PARENTERAL/ENTERAL FEEDING Nutritional status is a key factor in patient’s overall immune function and a patient’s ability to mount a stress response. Underfeeding a patient may lead to increased nosocomial infections, poor wound healing, respiratory muscle dysfunction, and respiratory failure. Overfeeding patients, in contrast, may increase physiological stress and lead to problems such as hyperglycemia, fluid overload, azotemia, and hepatic dysfunction. Therefore, measuring energy expenditure and determining the patient’s caloric requirements and feeding status should be included in a thorough nutritional assessment. Specifically designed nutritional therapy can be administered by the parenteral or enteral route when the use of standard diets via the oral route is inadequate or not possible or enteral route when the use of standard diets via the oral route is inadequate or not possible to prevent/correct protein-calorie malnutrition. Enteral nutrition is preferred for the patient who has a functional GI tract but is unable to consume an adequate nutritional intake or for whom oral intake is contraindicated/impossible. Feeding may be done via NG or orogastric tube, esophagostomy, gastrostomy, duodenostomy, or jejunostomy. Parenteral nutrition may be chosen because of altered metabolic states or when mechanical or functional abnormalities of the GI tract prevent enteral feeding. Amino acids, fat, carbohydrates, trace elements, vitamins, and electrolytes may be infused via a central or peripheral vein. CARE SETTING May be any setting, including community/home care RELATED CONCERNS Burns: thermal/chemical/electrical (acute and convalescent phases) Cancer COPD Fluid and electrolyte imbalances Inflammatory bowel disease Pancreatitis Psychosocial aspects of care Renal failure: chronic Surgical intervention Patient Assessment Database Clinical signs listed here depend on the degree and duration of malnutrition and include observations indicative of vitamin, mineral, and protein/calorie deficiencies. ACTIVITY/REST May exhibit: Muscle wasting (temporal, intercostal, gastrocnemius, dorsum of hand); thin extremities, flaccid muscles, decreased activity tolerance CIRCULATION May exhibit: Tachycardia, bradycardia Diaphoresis, cyanosis ELIMINATION May report: Diarrhea or constipation; flatulence associated with food intake May exhibit: Abdominal distension/increased girth, ascites; tenderness on palpation Stools may be loose, hard-formed, fatty, or clay-colored FOOD/FLUID May report: Recent weight loss/weight loss of 10% or more of body weight within previous 6 mo Problems with chewing, swallowing, choking, or saliva production Changes in the taste of food; anorexia, nausea/vomiting; inadequate oral intake (NPO) status for 7–10 days, long-term use of 5% dextrose intravenously May exhibit: Actual weight (measured) as compared with usual or pre-illness weight is less than 90% of
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