Nutritional support

Rhoads, J.E Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult An affirmative answer Ann Surg (1969), 169, 974 - 984 ... 

The fiber of rice bran products, especially the RiceMucil is helpful in maintaining normal gastrointestinal and colon health (Tomlin and Read, 1988). It helps in bowel regularity. Patients with irritable bowel syndrome, inflammatory bowel disease and colitis get excellent relief with RiceMucil . As has been mentioned in the earlier part of this chapter, the fiber of rice bran is non-bloating and lactose free, and the acidic environment the fiber creates during the fermentation of undigested food improves colon health and induces all the healthy enzymes and fnendly bacteria to proliferate (Folino et al, 1995 Life Sciences News Letter, 1999). It has been scientifically demonstrated to have an excellent nutritional support for gut and colon health. 

Always address the need for stress-ulcer prophylaxis, deep vein thrombosis (DVT) prophylaxis, anemia prophylaxis, and nutrition support... 

Adjunctive therapy with fluid and electrolyte replacement should be initiated. Nutritional support with enteral or parenteral nutrition may be indicated for patients unable to eat for more than 5 to 7 days.2 Some evidence suggests that enteral nutrition provides anti-inflammatory effects in patients with active CD.40,41... 

Describe the components of PN and their role in nutrition support. 

Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, poor wound healing, prolonged hospital stay, and increased mortality, especially in surgical and critically ill patients.1 Specialized nutrition support refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 Parenteral nutrition (PN), also... 

Parenteral nutrition can be a lifesaving therapy in patients with intestinal failure, but the oral or enteral route is preferred when providing nutrition support ( when the gut works, use it ). Compared with PN, enteral nutrition generally is associated with fewer infectious complications (e.g., pneumonia, intraabdominal abscess, and catheter-related infections) and potentially improved outcomes.1-3 However, if used in appropriate patients (i.e., patients with questionable intestinal function or when the intestine cannot be used), PN can be used safely and effectively and may improve nutrient delivery.4 Indications for PN are listed in Table 97-1.1... 

Preoperative nutrition support in patients with moderate to severe malnutrition who cannot tolerate enteral nutrition and in whom surgery can be delayed safely for at least 7 days... 

The first step before delivering specialized nutrition support is to perform a nutritional assessment and determine nutrient requirements based on the patient s nutritional status and clinical conditions. Collect subjective and objective data to determine a patient s level of nutrition, to identify patients with malnutrition or at risk for malnutrition, and to identify risk factors that may put a patient at risk for nutrition-related problems.1 A nutrition assessment should include 1,19... 

After performing a nutrition assessment and estimating nutritional requirements, determine the optimal route to provide specialized nutrition support (e.g., oral, enteral, or parenteral). If PN is deemed necessary, venous access (i.e., peripheral or central see below) for PN infusion must be obtained. Finally, formulate a PN prescription, and administer PN according to proper safety guidelines. 

Merritt R, ed. The ASPEN Nutrition Support Practice Manual. 2nd ed. Silver Spring, MD American Society for Parenteral and Enteral Nutrition 2005. 

It might be expected that EN via tubes would have been used widely before the development of parenteral nutrition (PN) however, this was not actually the case. EN via tubes inserted down the mouth or nose into the stomach and also via rectal tubes was used occasionally in the decades before the development of PN in the 1960s.1 However, modern techniques for enteral access, both the placement of the tubes themselves and the materials for making pliable, comfortable tubes, had not yet been developed. Before the PN era, the formulas delivered by the tube route often were blenderized foods. The National Aeronautics and Space Administration effort in the United States in the 1960s led to the development of low-residue (monomeric) diets for astronauts. These diets were adapted for use in sick patients requiring EN. Nonvolitional feedings in patients who cannot meet nutritional requirements by oral intake thus include EN and PN these techniques are collectively known as specialized nutrition support (SNS). 

Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enteral Nutr 2003 27 355-373. Kudsk KA, Croce MA, Fabian TC, et al. Enteral versus parenteral feeding Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992 215 503-513. 

Program Director Nutrition Support Pharmacy Practice... 

Moreover, adequate nutritional support is mandatory. The aim of this therapeutic measure should be the reintegration of both caloric and vitamin requirements, often defective in these patients. The nutritional defect is caused both by the predisposing condition and by the malabsorption syndrome. 

Nutritional support with enteral or parenteral nutrition should be initiated if it is anticipated that oral nutrition will be withheld for more than 1 week. 

Important therapeutic adjuncts include adequate hydration (by IV route if necessary), optimal nutritional support, and fever control. 

Debilitated patients may require therapy for other medical conditions, including substance abuse and HIV infection, and some may need nutritional support. 

Anthropometric measures are probably most useful with long-term nutrition support. 

EN has replaced parenteral nutrition (PN) (see Chap. 60) as the preferred method for the feeding of critically ill patients requiring specialized nutrition support. Advantages of EN over PN include maintaining GI tract structure and function fewer metabolic, infectious, and technical complications and lower costs. 

Goals of nutrition support include correcting caloric and nitrogen imbalances, fluid or electrolyte abnormalities, and vitamin or trace element abnormalities, without causing or worsening other metabolic complications. 

Peripheral PN (PPN) is a relatively safe and simple method of nutritional support. PPN candidates do not have large nutritional requirements, are not fluid restricted, and are expected to begin enteral intake within 10 to 14 days. 

PN regimens for adults can be based on formulas (Fig. 60-2), computer programs, or standardized order forms. Order forms are popular because they help educate practitioners and foster cost-efficient nutrition support by minimizing errors in ordering, compounding, and administering. 

To define the incidence of fractures and rickets that we were encountering in infants who required prolonged parenteral feeding, we reviewed the roentgenograms of a series of preterm infants who developed necrotizing enterocolitis and who required at least four weeks of total parenteral nutritional support (4). These data are recorded in Table I. 

A nutritional deficit often exists in hospitalized patients. There are many conditions and diseases for which nutritional support is recommended by enteral or parenteral routes of administration. Provision of nutrients by vein, in amounts sufficient to maintain or achieve anabolism, is referred to as total parenteral nutrition (TPN). 

Elsas LJII, Acosta PB. Nutrition support of inherited metabolic disease. In Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia Lea Febiger, 1994, 11471206. 

Under DSHEA, manufacturers who make statements of nutritional support must have substantiation that such statements are truthful and not misleading. The law also requires that the Secretary of Health and Human Services (HHS) be notified no later than 30 days after the first marketing of a supplement for which the statement is made. The law does not define substantiation. 

Function begins to return as soon as nutritional support is introduced, even before any tissue gain, suggesting an immediate and direct effect on cellular function. Skeletal and respiratory muscle function deteriorates steeply after a loss of 20% of body protein stores (equivalent to 15% total body weight loss) and improves by 10-20% within the first few days of nutritional support. 

Malnutrition, and its ultimate form cachexia, are encountered every day in cancer and haematology wards. Malnutrition results from the parasitic metabolism of the tumour at the expense of the host, from the impact of the tumour on the metabolism of the host... The major consequence is an increased risk of complications and death during the course of chemotherapy, radiation therapy and major surgery. It is thus important to offer nutritional support, in order to stop or reverse the process of malnutrition. Nutritional intervention should be founded on the abundant literature devoted to cancer cachexia, including the pathophysiology of the disease. .. 

Improved gastrointestinal function Short bowel syndrome in patients who are also receiving specialized nutritional support... 

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