Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Enteral and Parenteral Nutrition 529

➣parenteral

aggressive nutrition support not desired

■relative

➣enteral

Intrinsic small bowel disease

severe short-bowel syndrome

cardiorespiratory insufficiency impairinf hemodynamics

➣parenteral

functioning GI tract

patient’s prognosis

risks outweigh benefits

follow-up

parenteral (initial 72 hours/critically ill):

■serum Ca, Mg, LFT’s, P (2–3/week)

■electrolytes, BUN, Cr (daily)

■serum TG (weekly)

■CBC with differential (weekly)

■PT, PTT (weekly)

■capillary glucose (TID)

■weight (daily)

■intake and output (daily)

■nitrogen balance (as needed)

enteral:

■weight (daily)

■intake and output (daily)

■serum glucose (daily)

■gastric residuals <=every 4 hours (gastric feeding)

■bowel movements/consistency

■electrolytes, BUN, creatinine (daily then, 2–3/week)

■phosphorus, calcium, magnesium, CBC (weekly)

■feeding tube site care (daily)

complications and prognosis

■mechanical, gastrointestinal, metabolic complications

➣corrected with close monitoring

➣hospital-based nutrition support complications associated with

medical treatment, procedures, medications rather than solely

nutrition support

lowest complications with home nutrition support