Nutritional support for the patient with pancreatobiliary disease.

Critically ill patients with severe pancreatobiliary disease exhibit multiple nutritional alterations compounded by the stress response. Acute pancreatitis may present as a life-threatening illness; patients are likely to be hypermetabolic and may have hyperglycemia and hypocalcemia. Nutritional support from parenteral or enteral feeding will probably be required in patients presenting with three or more positive risk factors as determined by Ranson criteria. Nutritional therapies for liver disease vary according to the specific disorder manifested. Patients with fulminant hepatic failure need to be monitored for profound hypoglycemia. Encephalopathy may develop in patients with acute-on-chronic liver disease, necessitating a protein restriction. Patients undergoing liver transplant are a perioperative challenge due to the combination of preoperative malnutrition, an extensive surgical procedure, and postoperative stress. Such patients require individualized assessment and management.

Advances in nutritional care of medical-surgical patients.

Malnutrition and its related complications occur at an alarming rate in medical-surgical patients. New technology and other advances in clinical nutrition can now significantly enhance the nutritional care that medical-surgical nurses provide to their patients.

The relationship between enteral formula contamination and length of enteral delivery set usage.

Twenty-one delivery sets were collected from 21 patients who had received continuous Osmolite feedings over 24 hours. Delivery sets were than taken to the laboratory and hung for an additional 48 hours. In the laboratory, the delivery sets were rinsed with tap water and Osmolite was added every 12 hours. Formula samples were obtained from the delivery sets after they had been used for 24 hours, and every 12 hours during the additional 48 hours in the laboratory. Formula contamination was assessed by determining bacterial counts. Unacceptable contamination was defined as bacterial counts greater than or equal to 10(5) cfu/mL. The mean bacterial count was 2.8 x 10(5) cfu/mL at 24 hours, and all subsequent mean counts increased over time. There were statistically significant differences among the mean log bacterial counts at all time periods (p less than or equal to 0.0005) except between 36 hours and 48 hours (p = 0.019). Of the 21 delivery sets, 23.8% were unacceptably contaminated at 24 hours, and by 48 hours, 42.9% were unacceptable. These findings suggest that if 10(5) cfu/mL is used as a criterion, delivery sets should not be used for more than 24 hours in a hospital, and 24-hour use of delivery sets may even be too long.

Managing nutritional problems in people with AIDS.

The complicated clinical picture presented by people with AIDS is often exacerbated by compromised nutritional status. Oral and esophageal pain, diarrhea, malabsorption, and weight loss frustrate efforts to achieve or maintain adequate nutrition. It is, therefore, an important and challenging responsibility for nurses to ascertain and implement appropriate interventions to assist patients with HIV infections to improve their nutritional status, thereby potentially delaying disease progression and significantly contributing to improved quality of life.

Enteral nutrition. Potential complications and patient monitoring.

Enteral feedings are safely tolerated by most patients. When complications occur, gastrointestinal disturbances are most frequently encountered, followed by mechanical and metabolic complications. Nurses can prevent many of the problems associated with enteral feeding through careful monitoring. Based on the current literature, the authors make the following recommendations: 1. All patients receiving tube feedings should be placed on a protocol that provides guidelines for (a) confirming correct tube placement; (b) preventing/managing tube obstruction; (c) handling and selecting formulas; (d) administering formulas; and (e) monitoring patients. 2. Fine-bore tubes are easily misplaced or dislodged; ensure correct positioning both before and during feeding. Food coloring should be added to all feedings to help detect aspiration/tube displacement. 3. Multiple factors can cause diarrhea in tube-fed patients and, therefore, require periodic assessment. These factors include concomitant drug therapy; malnutrition/hypoalbuminemia; formula-related factors (for example, lactose content, osmolality); and bacterial contamination. 4. Urine sugar and acetone levels should be checked every 6 hours (until stable). Vital signs and fluid intake and output should be determined every 8 hours, and weight should be measured on a daily basis. Serum electrolytes, blood urea nitrogen, and glucose levels should be determined daily, until serum levels stabilize. Weekly measurements of trace elements should be made to ensure adequate mineral replacement. 5. Use a controller pump to administer continuous feedings at a constant rate or to administer formulas that are viscous. Flush feeding tubes with water every 4 hours during continuous feedings, after giving intermittent feedings, after giving medications, and after checking for gastric residuals. If tube obstruction occurs, attempt to irrigate the tube with either water or cola. 6. Select feedings that contain appropriate nutrient sources, caloric density, and osmolality; handle feedings in a way that minimizes bacterial contamination. 7. Ongoing nutritional assessments are necessary to provide information about the overall adequacy of the enteral feeding in restoring or maintaining nutrition.

Gravidas' responses to realtime ultrasound fetal image.

One hundred women in various stages of pregnancy were questioned before and after viewing their fetuses through realtime ultrasonographic scanning. For the majority of these women, perceptions of the fetus changed following this visualization. Viewing gave some a greater sense of attachment to the fetus, but for a few, this attachment also gave a greater sense of vulnerability with regard to the outcome of the pregnancy.