NFSC 470 Seminar MNT Review of Clinical Nutrition. What are some signs/symptoms of dysphagia? What labs might be affected?. If dysphagia doesn’t resolve and you must recommend a tube feeding, where would you recommend it be placed and why?.
What are the nutrition implications of chronic gastritis? In other words, the absorption of what vitamin might be affected, and this would lead to what condition?
What are the signs of fat malabsorption? What are the nutritional implications? What are your dietary recommendations for someone with fat malabsorption, in general??
___uric acid ___K+ (potassium)
___ PO4 (Phosphorus)
___ Hgb/Hct __albumin
Recommended IntakeWhat are the main tenets for the TLC diet? (Therapeutic Lifestyle Changes)
rate (ml/hr) x 24 hours = ml total volume/day
volume x kcal/ml = kcals
g_ x volume (L) = g prot/day
volume x %free water (plus flushes) = ml/day
(Review Homework Problems)
1. Patients for whom EN would meet requirements
2. Terminally ill patients.
Utilization of peripheral veins for the administration of nutrients
Indications for use:
Peripheral site more prone to inflammation/infection
Fewer kcals administered
Remember: PPN solution needs to have:
NS: normal saline (0.9% sodium chloride solution)
500 ml 10% lipid/d
500 ml 8.5% AA/L
500 ml D50W/L
to be run@75ml/hr.
plus 500ml 10% lipid
= 1 liter ‘admixture’
In this example, lipids are hung separately
Kcalories (per L):
Calculate total kcals and protein grams provided in this per-day formula
960ml 8.5% AAs
to run @ 80ml/hr (X 24h = 1920ml)
plus 250 ml 20% lipids q day
b. Monitor tolerance: electrolytes, blood glucose, triglycerides, ammonia, etc.
4. Introduce lipids gradually to avoid adverse reactions (fever, chills, backache, chest pain, allergic reactions, palpitations, rapid breathing, wheezing, cyanosis, nausea, and unpleasant taste in the mouth)
5. When pt. is taken off TPN, rate must be tapered off gradually to prevent hypoglycemia.
6. ( TPN by ½ X 2 hrs, then DC – usually sufficient to prevent hypoglycemia)
7. PPN doesn’t need to be tapered off (uses more dilute solution w/less dextrose)
(Chronically high insulin levels may inhibit fat mobilization fatty liver)
C. Discontinue TPN when oral/enteral intake provides