Nutrition is a three-step process that gives the body materials needed to make the body grow and function. The process begins when food is ingested. Chemical reactions in the body then break down food into molecules that enter the blood stream and are distributed to different parts of the body where they are used to sustain life.
Some nutrients are used for cell growth and cellular functions. Other nutrients become involved in enzyme activities and carbohydrate-fat-protein synthesis. Nutrients are used to contract muscles and help wounds to heal. They also play a critical role in the integrity of the GI tract and in the immune system.
Think of nutrients as fuel for your car. Fuel is used as you drive your car. The same is true about your body. Your body uses nutrients to go about daily activities. And just like your car, your body can continue to operate without a full complement of nutrients that is, without a full tank of gas. A healthy, well-nourished person has a nutritional level to last 14 days before they begin to show signs of malnutrition. That is, your full tank of gas will last 14 days.
However, there comes a point when your performance sputters.the level of nutrients fall below the level needed to sustain your daily activity. You simply run out of fuel and become fatigued, irritable, and exhibit an abnormal appearance.
This is referred to as a nutritional deficit. A nutritional deficit can occur from a number of situations. The most obvious is not eating a balanced, nutritional diet. However, there are less apparent reasons that cause a nutritional deficit. These are surgery, trauma, malignancy, and other illnesses that break down (catabolize) the body.
The effect of a nutritional deficit can be dramatic. The body needs nutrients to recover from trauma and disease. A nutritional deficit prolongs healing and severe cases can prevent total recovery. Critically ill patients have sufficient nutrients to sustain them for a few days to a week before they begin to show signs of nutritional deficit.
Healthcare professionals provide nutritional support therapy for patients who are at risk for nutritional deficit. Nutritional support therapy replaces nutrients that the patient has lost and there by provide the patient with the fuel needed for a full recovery.
A nutritional deficit is called a negative nitrogen balance, which means that the patient lacks sufficient nitrogen to fight infectious disease. Healthcare professionals treat patients who are at risk for negative nitrogen balance by providing the patient with nutrients before the imbalance occurs. The patient is then able to fight infectious diseases.
A common misnomer is that dextrose 5% in water (D5W), normal saline, and lactated Ringer’s solution provide nutrients to the patient. However, these intravenous fluids are not forms of nutrients. These are electrolytes and fluids.
Nutrients are given to a patient via an enteral or parenteral route. Using the enteral route, food is administered by mouth or by a feeding tube that is directly inserted into the GI tract usually into the stomach or small intestine. A feeding tube is used whenever the patient cannot swallow.
The parenteral route is the use of high caloric nutrients administered through large veins such as the subclavian vein in a process called total parenteral nutrition (TPN) or hyperalimentation. The parenteral route is the least preferred because the process is three times more expensive than enteral with out a significantly improved benefit.
Furthermore, the parenteral route has a high rate of infection and does not promote GI function, liver function, or weight gain.
Enteral feeding is the preferred method of providing nutritional support to a patient. However, the patient must have adequate GI tract function to enable food to be digested, absorbed, and waste eliminated.
It is important to determine if the patient has GI motility and small bowel function. Otherwise, the patient may experience uncontrolled vomiting and become at high risk for aspiration should the intestine be obstructed. Decreased bowel sounds are common in critically ill patients. They may also have a decrease or absence of gastric emptying.
There are several methods used for enteral feeding. These are:
There are various mixtures that are given to patients who are receiving nutri¬tional support therapy based on the nutrient, caloric values, and osmolality that the patient requires.
These mixtures belong to one of the following groups:
Regardless of the group, these solutions consists of
Enteral feedings are administered as:
Enteral feedings expose the patient to complications. These are:
Table 11-1 contains commonly used preparations for enteral feeding.
Administering medications through the NG tube is discussed in Route of Administration.the drug must be in liquid form or dissolved into a liquid and must be properly diluted—it is usually given as a bolus and followed by water liquid medications should be diluted with water to reduce the osmolality to 500 mOsm/kg H2O (mildly hypertonic) to decrease GI intolerance
Calculation for dilution of enteral medications:
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An Inside Look At Pharmacology
Drug Action And Drug Interactions
Pharmacology And The Nursing Process
Principles Of Medication Administration
Route Of Administration
Vitamins And Minerals
Fluid And Electrolyte Therapy
Nutritional Support Therapies
Antimicrobials— Fighting Infection
Nervous System Drugs
Cardiac Circulatory Medications
Disorders Of The Eye And Ear
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