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Enteral
Impaired ingestion
Inability to consume adequate nutrition orally
Impaired digestion, absorption, metabolism
Severe wasting or depressed growth
Parenteral
Gastrointestinal incompetency
Hypermetabolic state with poor enteral tolerance
or accessibility
1.
2.
3.
4.
5.
6.
Applicable
Site placement
Formula selection
Nutritional/medical requirements
Rate and method of delivery
Tolerance
Macronutrient ratios
Cost effectiveness
Tidak (1)
Enteral Nutrisi
Long-term
Gastristomy
Jejunostomi
Parenteral Nutrisi
Short-term
Nasogastric
Nasoduodenal
Nasojejunal
compromised
Short-term
TPN
PPN
Farmula
khusus
Tdk Mencukupi
(3)
Longterm/retriksi
cairan
Ya
Mencukupi
(4)
TDK
1.
2.
3.
4.
kcal/ml x ml given
= kcal
% protein x kcal
= kcal as protein
kcal as protein x 1 g/4 kcal
= g protein
Example: Patient drinks 200 cc of a 15.3%
protein product that has 1 kcal/ml
1 kcal/ml x 200 ml
= 200 kcal
Liquids
Water in food
Water from metabolism
With tube feeding, nurse will flush tube
with water about 3 times dailyinclude
this amount in estimated needs
Example: flush with 200 cc tid
Pediatrics
Low residue
High protein
Volume restriction
Diabetic
Pulmonary/COPD
1.
Blender
2.
Polimer
3.
Monomer
Nama dagang
Diabetasol
Ensure
Entraso
Falkamin
Isocal
Neprishol
Nutrison
Peptisol
Pepti 2000 variant
Sustacal
Indikasi
DM
Diit TKTP dengan rendah residu
Cachesia dan pasien dg diit TKTP
Isufisiensi hati yang memerlukan
asupan protein yang rendah
terutama BCAA
malnutrisi
Isufisiensi ginjal bersama diit rendah
protein
Pasien yang tidak bisa, tidak boleh,
dan tidak mau makan dan minum
Cachesia atau pasien yang
memerlukan diit protein
Gangguan pencernaan dan absorbsi
dg kebutuhan TKTP
Cachesia dan malnutrisi
Central access
TPN both long- and short-term placement
Peripheral or PPN
New catheters allow longer support via
this method limited to 800 to 900 mOsm/kg
due to thrombophlebitis
Central sites:
Internal jugular
Subclavian vein
Femoral vein
15- 30
Kcal required
(10% dextrose max. PPN conc.)
Fluid tolerance
Osmolarity
Duration
Central line contraindicated
GI non functioning
NPO >5 days
GI fistula
Acute pancreatitis
Short bowel syndrome
Malnutrition with >10% to 15 % weight
loss
Nutritional needs not met; patient refuses
food
GI tract works
Terminally ill
Only needed briefly (<14 days)
Carbohydrate
glucose or dextrose monohydrate
3.4 kcal/g
Amino acids
3, 3.5, 5, 7, 8.5, 10% solutions
Fat
10% emulsions = 1.1 kcal/ml
20% emulsions = 2 kcal/ml
Fluid30 to 50 ml/kg
Electrolytes
Use acetate or chloride forms
to manage acidosis or alkalosis
Vitamins
Trace elements
Nama Dagang
Aminofusin
Aminofusin PAED
Aminofusin TPN
Aminoleban
Aminovel 600/1000
Amiparen
EAS primer
Indikasi
Keadaan katabolik, seperti infeksi berat, luka
bakar, cidera berat dengan balance nitrogen
negatif
Neonatus prematur dan bayi yang menderita
defisiensi protein atau penyakit dengan
peningkatan kebutuhan protein
Keadaan katabolik dengan balance nitrogen
negatif
Keadaan ensefalopati pada penderita penyakit
hati yang akut/kronis. Aminoleban tidak boleh
diberikan pada keletihan ginjal yang berat dan
gangguan metabolisme asamamino lainnya
Status gizi yang tidak memadai dan memerlukan
nutrisi parenteral seperti short bowel syndrome,
anoreksia dan gangguan gastrointestinal yang
berat
Hiponatremia, malnutrisi, pra/pasca bedah
Keadaan azotemia, GGA, dan isufisiensi renalyang
kronik. AES jugadapat diberikan pada penderita
pasca dialisis untuk menggantikan asam amino
yang hilang. Keadaan yang memerlukan nutrisi
Intrafusin 10%
Intralipid 105/20%
(ivelip)
PE 90
Pan Amin G
Triofusin 500
Start slowly
(1 L 1st day; 2 L 2nd day)
Stop slowly
(reduce rate by half every 1 to 2 hrs
or switch to dextrose IV)
Cyclic give 12 to 18 hours per day
Infection
Hemodynamic stability
Catheter care
Refeeding syndrome
Hypophosphatemia
Hyperglycemia
Fluid retention
Cardiac arrest
Weight
(daily)
Blood
Daily
Electrolytes (Na+, K+, Cl-)
Glucose
Acid-base status
3 times/week
BUN
Ca+, P
Plasma transaminases
Blood
Twice/week
Ammonia
Mg
Plasma transaminases
Weekly
Hgb
Prothrombin time
Zn
Cu
Triglycerides
Urine:
Glucose and ketones (4-6/day)
Specific gravity or osmolarity (2-4/day)
Urinary urea nitrogen (weekly)
Other:
Volume infusate (daily)
Oral intake (daily) if applicable
Urinary output (daily)
Activity, temperature, respiration
(daily)
WBC and differential (as needed)
Cultures (as needed)
PPN
Site irritation
TPN
1. Catheter sepsis
2. Placement problems
3. Metabolic
Energy
Infant
50 to 60 kcal/kg/day maintenance
70 to 120 kcal/kg/day growth
Child >1yr
BEE
1to 8 yrs 70 to 100 kcal/kg/day
8 to 12 yrs 60 to 75 kcal/kg/day
12 to 18 yrs 45 to 60 kcal/kg/day
Injury factors
1.25 mild stress
1.50 nutritional depletion
2.00 high stress
Protein:
Infant
2.4 to 4 g/kg/day <1500 g
weight
2.0 to 2.5 g/kg/day 0 to 12
months
normal weight
Carbohydrate
Infant preterm:
4 to 6 mg/kg/minute begin rate
Term infants:
8 to 9 mg/kg/minute begin rate
Fat
Infants:
0.5 to 1.0 g/kg/day min for EFA
needs
2 to 3 g/kg/day max