Ensure Plus

Prior to her admission, SC was prescribed Ensure Plus cartons three times daily in addition to her usual diet. However, despite the additional nutrition provided by the Ensure Plus, SC has failed to gain sufficient weight. The surgical team caring for SC have decided they need to increase her nutritional intake and plan to commence tube feeding. SC has developed a sore throat and painful mouth due to oral thrush and she is unable to swallow her medication. SC s medications will now need to be administered via an NG tube. 

Ensure Plus is milk-based ready-to-drink sip feed. 

First check whether SC is aware of the range of flavours of Ensure that are available. An alternative flavour or variety of flavours may be all that is needed. Feeds are also often more palatable when chilled. Ensure Plus is a milk-based sip feed an alternative that may be more appealing to SC is a fruit juice-based feed, for example, Enlive. 

Another possibility for simulating the fed stomach is to use a nutritional drink, like Ensure Plus (Ensure) or Nutrison (Nutricia Nordica), which has a composition that resembles a regular meal, but lacks solids. This approach has been used by Klein et al. (Klein et al., 2004), who suggested the use of Ensure Plus containing 0.45% pectin, as a viscosity enhancer, based on comparison with physicochemical parameters of a homogenized standard breakfast. 

In response to these reports. Ensure, Ensure-Plus, and OsnwUte were reformulated to reduce the vitamin K] content to 50 micrograms in 240 mL (140 micrograms per 1000 calories). However, further case reports for Ensure Plus and Osmolit suggested that this lower level of vitamin K may still be sufficient to cause an interaction. The vitamin Kj content of these products was reduced further to 36 to 37 micrograms per 1000 calories, but even then one further case of increased warfarin requirement was reported with Ensure. In another case, a patient taking... 

Osmolite and intermittent Ensure Plus (total mean vitamin Kj dose 81 mierograms daily) only aehieved satisfaetory antieoagulation with warfarin when the Osmolite was stopped, whieh redueed the vitamin Kj intake to 36 mierograms daily. Another patient given Osmolite (vitamin Ki 68.4 mierograms daily), only aehieved satisfaetory anticoagulation with warfarin when the dose was given separately from the Osmolite. 

Michaelson R, Kempin SJ, Navia B, Gold JWM. Inhibition of the l oprothrombinemic effect of warfarin (Coumadin ) by Ensure-Plus, a dietary supplement. CUn Bull (1980) 10, 171-2. 

Griffith LD, Olvey SE, Triplett WC, Stotter Cuddy ML. Increasing prothrombin times in a warfarin-treated patient upon withdrawal of Ensure Plus. Crit Care Med ( 9S2) 10,799-800. 

Because monocalcium phosphate is incongmently soluble, it is typically contaminated with various amounts (6—10%) of dicalcium phosphate and free phosphoric acid resulting from in-process disproportionation of the monocalcium salt. Free phosphoric acid may render the product hygroscopic, and absorbed water plus acid catalyzes further decomposition to additional free acid and dicalcium phosphate. For this reason, industrial monocalcium phosphate may contain some dicalcium phosphate resulting from excess lime addition and then aged to ensure the removal of residual free phosphoric acid. 

Pressure Vessel Code as it existed in the past (and will continue). Division 2 was brought out as a means of permitting higher design stresses while ensuring at least as great a degree of safety as in Division I. These two divisions plus Secs. HI and X will be discussed briefly here. They refer to Secs. II and IX. 

Ensure fast-aeting showers are available elose to site of use/storage plus eye-wash fountains or similar faeilities for eye iiTigation. 

The absolute pressure at the inlet to the pump is usually the atmospheric pressure in the receiver, plus the static head from the water surface to the pump inlet and minus the friction loss through the pipes, valves and fittings joining the pump to the receiver. If his absolute pressure exceeds the vapor pressure of water at the temperature at which it enters the pump, then a net positive suction hand (NPSH) exists. If this NPSH is above the value specified by the pump manufacturer, the water does not begin to boil as it enters the pump suction and cavitation is avoided. If the water entering the pump is at a higher temperature, its vapor pressure is increased and a greater hydrostatic head over the pump suction is needed to ensure that the necessary NPSH is obtained. 

The term solvent is loosely applied to the volatile component of a paint, though this component may in fact consist of a true solvent for the medium plus a non-solvent or diluent. When such a mixture is used, usually with the aim of reducing cost or obtaining a higher solids content at a given viscosity, care must be taken to ensure that the diluent is more volatile than the true solvent in order that the medium shall remain in solution during the drying process. 

Mixtures of triglycerides, triglycerides plus free fatty adds or triglycerides plus fatty acid alkyl esters are used as reactants in fat modification processes. These mixtures are exposed to lipases supported on macroporous particles in the presence of a small amount of water. Liquid substrates (oils) can be reacted without use of a solvent, but with solid reactants (fats) it is necessary to add a solvent to ensure that the reactants and products are completely dissolved in the organic phase. Various water immisdble solvents can be used, but hexane is preferred for commercial operation because this solvent is already used industrially for the processing of oils and fats. 

This term refers to the sum total of the arrangements made to ensure that the final product is of the quality required for its intended purpose. It consists of good manufacturing practice plus factors such as original product design and development. 

The transition metals are also good conductors as they have a similar sp band as the free-electron metals, plus a partially filled d band. The Group IB metals, copper, silver and gold, represent borderline cases, as the d band is filled and located a few eV below the Fermi level. Their sp band, however, ensures that these metals are good conductors. 

The model is based on a fixed duration of tasks as shown in constraint (3.7). This constraints states that the time at which the output state from unit j exits, is the time at which the input state entered the unit at the previous time point plus the duration of the task. The binary variable ensures that the constraints holds whenever the unit is used at the precise time, i.e. p — 1. 

The above account of selectivity of inorganic plus organic chemistry in synthesis is given rather extensively to stress three points. All the four (Mg, Fe, Co and Ni) porphyrin products came from one source, the synthesis of uroporphyrin. The basis of selection is very different from that in primitive centres which use thermodynamic stability constant selectivity based on different donor atoms for different metal ions. Here, all ion complexes have the same donor atoms, nitrogen, the most constrained being the coordination of Mg2+ by five nitrogens exactly as is seen for Fe in haemoglobin. Hence, there also has to be a new control feedback to ensure that the appropriate quantities of each metal cofactor is produced in a balanced way, that is synthesis from uroporphyrin has to be divided based upon... 

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