Inland Power Exception

Dr. Zulema B. Stolarz

Nutritional Support

Consists of the implementation of special measures to address malnutrition in pa

tients with various diseases or to prevent malnutrition in patients at nutrition
al risk. It covers a range of techniques graded according to the needs of each p
atient, beginning with an oral adaptation or implementation of alternative tube
(enteral nutrition) or through intravenous catheters (parenteral nutrition).
Endocrinol Nutr 2004, 51 (4) :149-57
By way of emergency food
A) Enteral (tube) 1) Nonsurgical nasogastric intubation or nasogastric or orogas
tric orogastroyeyunal 2) intubation surgical gastrostomy jejunostomy 3) percutan
eous endoscopic intubation B) parenteral nutrition (intravenous) for direct veni
puncture through a catheter.
Dr. Zulema Stolarz
Enteral feeding
It consists of the arrival of food to some sector of the digestive tract through
a tube. For this reason only be used liquid diets
Enteral feeding
Reduce patient morbidity and mortality. Decreases the hospital stay. With the co
mplete digestive system function. Prevents complications. Da sustained nutrition
, more convenient and less expensive than parenteral. You can continue at home
.
Directions
From infancy to geriatrics. include injury at birth and psychomotor retardat
ion in children and cerebrovascular accident (CVA), senile dementia, trauma and
neurosurgical sequelae in adults. The important prerequisites include a functi
onal gastrointestinal tract and longevity significantly.
Indications for enteral feeding
A) They can not eat
1) Coma 2) swallowing mechanics impairment 3) mechanical impairment (stenosis of
the esophagus,
pyloric syndrome)
B) You must not eat 1) high output GI fistula 2) Acute Pancreatitis 3) extensive
small bowel resection 4) Severe malabsorption 5) chronic inflammatory bowel dis
eases in acute period (Crohn's and ulcerative colitis)
Dr. Zulema Stolarz
Indications for enteral feeding
C) Do not want to eat
1) Reasons for psychiatric disorders (anorexia nervosa) 2) socio-political groun
ds (hunger strike)
D) They eat but do not meet their requirements 1) hypercatabolic (burned, septic
, trauma) 2) Anorexia (cancer, sepsis, sensory disturbances and sensory) 3) Fear
(eating is painful or causes diarrhea, or increase an existing, etc. )
Dr. Zulema Stolarz
Management Methods
The liquid diet can be supplied b) gravity can be in the form:
• Continuous • Discontinuation: 4-6 servings of 500 ml and last approximately 2
hours. c / u • Continuous • Cyclic: the food is supplied during the night and st
opped for the day.
c) the method is infuser pump
Highways

In jejunum feeds should use the method with continuous infusion pumps. In reachi
ng the stomach by gastric emptying: • Normal: discontinuous • Alternate method:
A method with continuous infusion pumps gastrointestinal tolerance: in case of d
ifficulty digestoabsortiva continuous method is used with infusion pumps, starti
ng with low volumes.
Short Term Visits:
Routes of administration
Placement of the probe:
• bloodless: using natural orifices (nose, mouth) • Surgical: surgical procedure
s performed by at the stomach (gastrostomy), small intestine (jejunostomy) or le
ss frequent at the level of the pharynx (faringostomía) or esophagus (esophagost
omy) .
Enteral feeding
Enteral feeding pumps
Gastrostomy
Gastrostomy tubes
Enteral feeding
Type of nutrients

A full enteral feeding should supply the amount of water, calories and protein n
eeded by each patient.

Water boiled or mineral, or as cooking fruit juice and / or vegetables or in inf

usions. Carbohydrates: soluble mono or disaccharides (used at concentrations <10
-15% to avoid hyperosmolarity). Oligosaccharides: maltodextrin. Protein: calcium
caseinate, hydrolyzed protein, soy or milk powder or skim milk (in lactose into
lerance: lactose-free milk) Fat: cream or milk, which are already emulsified. Vi
tamins and minerals such as pharmaceutical preparations (syrup or pediatric drop
s).
Percutaneous endoscopic gastrostomy for a period of time (two months).
 The PEG is a minimally invasive technique. It is performed with local anesth
esia and sedation. Requires a gastroenterologist and / or surgeon. In expert
s is safe, quick with very low morbidity and mortality.€ The original tube can
stay for 8-12 months. Do not bother the patient, easy to use and cleaning. Y
ou can hide under clothing and replace it with a button. May be withdrawn at a
ny time.
Endoscopic enteral access methods
Access nasal / oral
Probe nasal / oral gastric feeding gastric decompression gastric decompression g
astric gastric Food Food Food jejunal jejunal Less than 1 month
Probe nasal / oral gastrojejunal
1 month
Probe nasal / oral small bowel
1 month
Dr. Zulema Stolarz
Endoscopic enteral access methods
Percutaneous or surgical
Gastrostomy
Used for
Gastric decompression gastric feeding
Time Required
1 month and more
Gastrojejunostomy
Jejunal Feeding Gastric Decompression
6 months and more
Jejunostomy
Jejunal feeding
1 month and more
Dr. Zulema Stolarz
Complications
Aspiration. Peritonitis. Displacement of the probe. Leakage around the
site. Obstruction of the probe.
Complications of enteral feeding
Complication
Brocoaspiración tube blockage
Cause
• Lack of maintenance. • Passage bad diluted medication. • Gastric emptying inad
equate. • Gastroesophageal reflux. • Probes inappropriate. • Long retention of t
he probe.
Control
• Wash every 6 hours. of the probe. • prokinetic
Injuries decubitus
• Use appropriate. • No more than six weeks.
Dr. Zulema Stolarz
Complications of enteral feeding
Mechanical
Cause
• Lack of control of the probe Rx • Loss perisonda.
Complication
• Linked to the obstruction of the probe. • Linked to the ostomy.
Control
• Control Rx before infusion.
• Displacement or accidental release.
• For cough or vomiting.
• Change thicker tube
Dr. Zulema Stolarz
Complications of enteral feeding
Digestive
Complication
• • • • •
Cause
Mixed Lactose intolerance hyperosmolar Pollution prepared by antibiotics Hypoalb
uminemia
Control
• Adequate preparation of the food mixture • Use pump • Continue feeding
• Diarrhea
• Constipation
• Lack of fiber • Altered motility
• Add fiber • prokinetic
Dr. Zulema Stolarz
Complications of enteral feeding
Digestive
Cause
• Drip • Osmolarity speed mixing
Complication
• Nausea and vomiting
Control
• Adjust speed • Edit Formula
• abdominal distension
• Air Ticket • Indigestion • Osmolarity
• Avoid air tubulatura • Edit Formula
Dr. Zulema Stolarz
Complications of enteral feeding
Infectious
Cause
• Poor drainage • Lack of gastric cardia
Complication
• aspiration pneumonia
Control
• prokinetic
• Related • Surgical Site Infection • Optimising care for the ostomy surgery • P
eritonitis
Dr. Zulema Stolarz
Complications of enteral feeding
Metabolic
Cause
• Diabetes • Stress • Use of steroids • Excess or deficit of water or sodium • •
• • Excess or deficit of potassium Diarrhea Diuretics Hypokalaemia
Complication
• Hyperglycemia • Hyper-or hypo-or hyperkalemia hyponatremia • Feedback • Syndro
me
Control
• Insulin • Modify type and amount of H.de C. • Edit • Add sodium formula • • •
• Suspend Edit Formula Treating Diarrhea Diuretics Potassium Supplement
• Excessive intake calóricoproteica
• Adjust caloric and protein value
Dr. Zulema Stolarz
Commercial preparations
Commercial preparations
Parenteral nutrition
Is to provide the nutrients directly into the bloodstream, bypassing the digesti
ve system, through a catheter inserted into a rich vein flow.
Parenteral nutrition
Purpose: Maintain or restore the patient's nutritional status. Objectives:
d) meet the requirements or dietary needs. e) maintaining balances as possible
energy, protein, water, mineral and vitamin content. f) seek to recover the rese
rves consumed because of the disease.
Dr. Zulema Stolarz
Parenteral feeding patterns
a) Total or complete b) Complementary c) Prolonged d) calorie e) Cyclic.
Dr. Zulema Stolarz
Control and monitoring of the patient receiving parenteral nutrition
Clinical management: Appearance of the patient. Vital Signs. weight daily.
Daily control of inflow and outflow of fluid, electrolytes, calories and prot
ein. Control of glycemia and glucosuria. Monitor the catheter insertion site
.
Dr. Zulema Stolarz
Frequent indications of parenteral nutrition
hypermetabolism. intestinal obstruction. Short bowel. Severe diarrhea.€
fistula or high output ileostomies. intestinal ischemia. bacterial overgrow
th. severe gastrointestinal tract hemorrhage
Dr. Zulema Stolarz
Type of nutrients
Nutrient
H.
Sun Type dextrose solution 5, 10, 25, 50% emulsion to 10, 20%. Amino acids 3.5,
5, 7, 10, 11.5%
C.: Lipids: Protein:
Water Requirements
According According
balance: revenues and expenditures. caloric intake: 1ml/cal adults, children: 1.
5 ml / cal body weight
According
Parenteral nutrition
Causes of infectious complications
1) Pollution in the puncture site 2) during the pipe handling 3) Obtaining blood
samples from the catheter 4) Administration of medications by catheter 5) Use o
f contaminated solutions 6) Determination of central venous pressure 7) Links wi
th outside guides
Dr. Zulema Stolarz
central
Metabolic complications of parenteral nutrition
A) In the carbohydrate metabolism
1) Hyperglycemia (most common) 2) Glycosuria. Osmotic diuresis 3) acidotic hyper
osmolar dehydration. 4) in the diabetic ketoacidosis. 5) reactive hypoglycemia
Dr. Zulema Stolarz
Metabolic complications of parenteral nutrition
B) The protein metabolism
1) Hypoalbuminemia 2) hyperchloremic metabolic acidosis 3) Imbalances in serum a
mino acid 4) hyperammonemia. Azotemia
C) in fat metabolism
1) Hyperlipidemia 2) essential fatty acid deficiency 3) Changes in liver functio
n
Dr. Zulema Stolarz
D) In the metabolism of minerals and vitamins
sHipofosfatemia. Hyperphosphatemia. sHipocalcemia. Hypercalcemia. sHiponatremia.
Hypernatremia. sHipokalemia. Hyperkalaemia. sHipomagnesemia. sCarencias of trac
e elements (Zn, Cu, Mn, Se, Cr). sAnemias (folic acid, vitamin B12, iron). sMani
festaciones bone. sHipovitaminosis (hydro-and fat-soluble vitamins).
Dr. Zulema Stolarz
Metabolic complications of parenteral nutrition
10) Hypervitaminosis (fat-soluble vitamins).
Parenteral nutrition
Lipids
Parenteral nutrition
The benefit is very little risk and the cost is justified