Post on 08-Nov-2018
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Objectives in
Nutritional Screening
Weight, height,
Ask ideal weight
Lab (Alb, Hct, hgb,
FBS)
Appearance (edema,
skin tregor, cachexia,
ulcer,..)
3
.
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Malnourished people NICE guideline (2006) describes people
who are malnourished, as defined by any of the following:
a body mass index (BMI) of less than 18.5 kg/m2
unintentional weight loss greater than 10% within the last 3–6 months
a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.
People at risk of malnutrition
those who have:
eaten little or nothing for more than 5 days
and/or are likely to eat little or nothing for 5
days or longer
a poor absorptive capacity and / or high
nutrient losses and/or increased nutritional
needs from causes such as catabolism
Important tipIt is of important to consider
nutrition support for people who
are
either malnourished
or
at risk of malnutrition.
Who needs Nutrition Support?
Those with poor
nutritional status
Weight loss (>2.5
kg/month-
unintentionally)
Albumin < 3.5 g/dl)8
–
.
-
- ) (
.
What’s Nutrition Support?
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Methods to improve or maintain
nutritional intake are known
as nutrition support.
What’s Nutrition Support?
1- Oral (for example, fortified food, additional snacks and / or sip feeds)
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What’s Nutrition Support?
2- Enteral – the delivery of a
nutritionally complete feed directly into
the gut via a tube
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When select Enteral way?
If got still works,
But for 5 to 7 days did
not take enough food
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تغذیه روده ای زمانی در بیماران
استفاده می شود که عملکرد
دستگاه گوارش درست بوده اما
روز و حتی 7تا 5بیمار به مدت
ته بیشتر دربافت غذائی کافی نداش
ولذا نیازمندیهای غذائی وی از
.طریق خوراکی تامین نشده است
Short term Enteral feeding?
ه موارد استفاده کوتاه مدت از تغذ ی(:هفته4کمتر از )روده ای
می برای بیمارانی بکار:نازوگاستریک
رود که می توان از معده بطور کامل
استفاده کرد و نگرانی از جهت تهوع،
.استفراغ و آسپیراسیون وجود ندارد
ت برای بیمارانی که نیاز اس: نازوژژونال
ب معده و دئودنوم بای پس شود، مثال آسی
معده با اسید، بیمارانی که در معرض
ه آسپیراسیون هستند، و یا بیمارانی ک
.تهوع و استفراغ مداوم دارند
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< 4 weeks
Nasogastric
Nasojejunal
Long term Enteral feeding?
ه موارد استفاده بلند مدت از تغذ ی(:هفته4کمتر از )روده ای
ا به طریق جراحی ب: گاستروستومی
بیهوشی عمومی و یا از طریق زیر
، با یک تسکین داروئی،(PEG)پوستی
تحت کنترل اندوسکپی و با کیت
(.2)مخصوص این کار انجام می شود
ه می برای بیمارانی تعبی: ژژنوستومی
شود که الزم است بمدت بیش از چهار
(.2)هفته معده و دئودنوم بای پس شود16
> 4 weeks
Gastrostomy
Jejunustomy
The role of GI tract Immune competence and prevention of acute
phase reactions.
Metabolic function in amino acid metabolism
As a mechanical barrier for bacterial
translocation.
Its importance for infectious complications such
as nosocomial pneumonia.
Indication of Enteral Feeding:
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Dysphasia, coma, demencia
Those with depression, not
reluctant to eat food
) (
Indication of Parenteral Feeding:
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(
)
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1 Peripheral Parenteral Nutrition 2 Multiorgan failure 3 Centeral Line Parenteral Nutrition
• Not working gut
• Peripheral veins
• Central veins
Consider oral nutrition support
and
stop when the patient is established on adequate
oral intake from normal food
if patient malnourished/at risk of malnutrition
can swallow safely and gastrointestinal tract is working
Consider Enteral Nutrition
and
use the most appropriate route of access and mode
of delivery
stop when the patient is established on adequate
oral intake from normal food
has a functional and accessible gastrointestinal
tract
if patient malnourished/at risk of malnutrition
despite the use of oral interventions
Consider parenteral nutrition
use the most appropriate route of access and mode of delivery
stop when the patient is established on adequate
oral intake from normal food or enteral tube feeding
and has either
introduce progressively and
monitor closely
if patient malnourished/at risk of malnutrition
a non-functional,
inaccessible or perforated
gastrointestinal tract
inadequate or unsafe oral
or enteral nutritional intake
When to start feeding following
placement?1.After surgery: no need for flatus or BM
2. PEG tube may be utilized for feedings within 2 hours in
adults and 6 hours in infants and children. (B)
feeding can be initiated within 24-48 hours. (A)
The editorial of the 2006 ESPEN
guidelines on Enteral Nutrition
it is worth mentioning
“Although nutritional support is therapy in
most cases it is exactly what it says –
supportive rather than specific treatment
of the underlying disease.” (Lochs H, 2006)
Acknowledgment
• ICU patients
• MUMS
• Colleauges:
• Drs: Ghayour, Safarian, Norouzy, Azarpajooh, Alamdari.
• Mrs Siadat, Firouzy, and Tavallae
• Ms Shahsavan, Ghavami, Momenzadeh
• Mr Mohajery SAR
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Nutritional risk screening (NRS 2002)
In this study NRS 2002 method, a system for screening of nutritional risk was used to assess malnutrition [20]. It is based on the concept that nutritional support is indicated in patients who are severely ill with increased nutritional requirements, or who are severely undernourished, or who have certain degrees of severity of disease in combination with certain degrees of undernutrition. Patients were scored in each of the two components; undernutrition and disease severity, according to whether they were absent, mild, moderate or severe, giving a total score 0–6. If patient was more than 70 years, one point was added to the total score. Patients with a total score of ≥3 were classified as nutritionally at-risk. Undernutrition was estimated using three variables used in most screening tools: BMI, percent recent weight loss and change in food intake, since these have reasonable evidence base in the literature, correlating with changes in function and clinical outcome.
Hospital Malnutrition
Effectiveness of nutritional
supplements in hospitals varies,
probably due to the influence of poor
appetite (Miline et al. 2005)
Mechanism? Findings from Imperial's college's metabolic medicine lab suggested that
peptide hormones released from the gut, such as ghrelin and peptide YY
(PYY), which stimulate and inhibit the appetite, respectively, might play a role
in the altered eating behaviour of patients, particularly intensive care patients
because the anorexia in hospitalised patients is often characterised by a
premature feeling of fullness and loss of hunger.
Nematy, M. 2005
Batterham R, 2004
Nematy, M. 2007
Nematy, M 2006