Vitamin D-licious recipes for night shift nurses....

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Nursing can be strenuous under even the most standard conditions. So, when you flip the switch on daily life to battle through a night shift, things can really get tricky.

Suddenly, all those “givens” you used to enjoy are no longer readily available to you—the market isn’t necessarily open on your way home from work, restaurants are serving pancakes when all you want is a hamburger and you can’t call your sister to chat after a long shift because, well, she won’t be awake for another three hours.

Then there’s that one thing you never thought your career choice might rob you of: daylight. But the fact is, there are times when a nurse simply can’t get enough of that good ol’ sunshine—especially if the night shift has come to be your bread and butter. The upside? Less exposure is a definite “yes, please” for your skin. The downside? You’ll need to seek out your daily dose of vitamin D elsewhere, keeping in mind that vitamin D is essential for healthy bones. Plus, research suggests that vitamin D may boost immunity and combat depression—all important benefits for nurses.

That said, foods rich in vitamin D can be hard to come by, and with the daily recommended value at 600 IUs, you’ve got a ways to go. So, because we want you to be as healthy and happy as can be, we thought we might put together a list of foods high in vitamin D that you can begin to incorporate into your diet now, along with some D-licious recipes that will have you eager to hop on the bandwagon (even if you’re a daytime-dweller).

1. Fatty fish. Some of the more common options include salmon, trout, mackerel, tuna and eel—also known as a sushi-lover’s dream lineup.

• Salmon. Salmon is a favorite source of heart-healthy omega-3 fatty acids, but fewer fans realize that a 3-ounce sockeye salmon fillet also contains roughly 450 IU of the daily recommend 600 IU of vitamin D. And it’s easy to work with. Use this recipe to whip up a simple, delicious and filling meal you can bring to work and reheat later.

BBQ Salmon with Greens and a Sweet Potato

You’ll need:

• 4 ounces salmon
• 2 tablespoons barbecue sauce
• 1 garlic clove, minced
• 3 cups kale, chopped
  
• 2 teaspoons olive oil
• 1 small sweet potato
• 2 teaspoons of maple syrup
• Pinch of cinnamon

Depending upon the thickness, broil the salmon for roughly 8 minutes in tinfoil and brush it with barbecue sauce. While the fish broils, sauté the garlic and kale in oil for about 6 minutes (or until tender). After washing the potato, puncture it several times prior to microwaving it for 10 minutes, and turn it just once. Top the potato with the syrup and cinnamon and serve it along with with the salmon atop the bed of kale.

Recipe source.

• Tuna. Three ounces of canned tuna contain 200 IU, or 50 percent of your recommended daily value of vitamin D. Like salmon, tuna is also a fabulous source of protein and omega-3s, and easy to introduce to an on-the-go nurse’s diet. Preparing the salad below for lunch or dinner at work is one way to go about it: 

Salad Niçoise

You’ll need:

• 1 tablespoon extra virgin olive oil
• 2 tablespoons balsamic vinegar
• 1 garlic clove, minced
• 4 cups lettuce, torn into pieces
• 1 cup string beans, steamed until just tender
• 2 red potatoes, cooked and diced into quarters
• 1 tomato, cut into small wedges
• 1 hard-boiled egg, cut into 4 wedges
• 1 (7-ounce) can tuna in water, drained

In a small bowl, combine the olive oil, vinegar and minced garlic. Drizzle half the dressing over the lettuce prior to adding all the remaining ingredients. Finish with the second half of the dressing.

Recipe source.

2. Fortified breakfast cereal. Cereal has a special place in our heart. Easy on the tummy, easy to prepare and easy to store, it’s the perfect breakfast companion for any nurse. Reach for fortified cereal and you can add “an easy source of vitamins and minerals” to that same list.

Not entirely sure what you’re looking for? General Mills and Kellogg’s are two readily available cereal brands with many a’ fortified flavor:

General Mills cereals

• Wheaties
• Cheerios
• Fiber One
• Rice Chex (also gluten-free)

Kellogg’s cereals

• Special K
• Rice Krispies
• Corn Flakes
• Raisin Bran

3. Fortified milk. No, really—drink your milk. One cup of fortified milk contains 98 IU, which is about 25 percent of the recommended daily value of vitamin D. Soy and almond milk tend to be safe choices, since they often undergo the process of fortification to match the nutrient content found in cow’s milk. 

4. Eggs. We know that egg-white omelets are all the rage right now, but before you “nope” the yolk, you should know that one egg yolk contains about 20 IU, or roughly 6 percent of your daily value of vitamin D. Plus, eggs are rich in protein, so you can enjoy that full feeling a bit longer. 

Ready to reintroduce the jilted yolk to your diet? Start over (and start your day) with an egg-cellent breakfast burrito you can make in a pinch. Oh, and look—we have a recipe, comin’ in at only five ingredients:

Black Bean Breakfast Burrito

You’ll need:

• 2 eggs
• ¼ cup canned black beans, rinsed and drained
• 2 tablespoons shredded low-fat cheddar cheese
• 1 small whole-wheat tortilla
• 2 tablespoons salsa

This is simple enough—just scramble the eggs along with the black beans and cheddar. Spoon the scramble onto a tortilla, top it with salsa and then wrap up that bad boy nice and tight.

5. Orange juice. Aside from serving as a refreshing start to any day, 1 cup of fortified orange juice contains about 100 IU, or 25 percent of your recommended daily value of vitamin D, along with a healthy dose of vitamin C.

6. Fortified yogurt. A fabulous pack ‘n’ go addition to any nurse’s lunch bag, fortified yogurt contains about 80 IU, or 20 percent of the recommended daily value of vitamin D.

7. Swiss cheese. All right, so one serving of Swiss cheese only contains about 6 IU, or 2 percent of the recommended daily value of vitamin D, but small changes add up, right? Plus, it’s hard to be bummed out by any suggestion that comes in the form of fresh, non-processed cheese, and to solidify our point, we went ahead and found a recipe you can make in a flash.

Apple, Ham and Swiss Cheese Quesadilla

You’ll need:

• 1 teaspoon honey
• 1 teaspoon Dijon mustard
• 1 (10-inch) burrito-size whole-grain tortilla
• ½ cup shredded Swiss cheese
• 2 ounces shaved deli ham
• 1 handful spinach
• ½ green apple, thinly sliced

Heat a skillet over medium heat. Spread the honey and Dijon mustard over half of the tortilla, followed by the cheese, ham, spinach and apple slices. Fold the tortilla and heat on both sides for two to three minutes, or until the cheese has melted and the tortilla is slightly browned.

BY SCRUBS EDITOR • JULY 22, 2015

Find a Balance...

I wish I had that kind of energy every day....

I put some links for you to check out when your not at work doing what she is doing hee heee....

How to Stay Energized Throughout Your Nursing Shift

Working a 12-hour shift is challenging in any field, and nurses specifically must deal with physical, emotional and relational stressors that can deplete their energy more than many other workers. 

A number of factors can also determine how taxing a nurse’s shift is, including:

•  Patient load and acuity levels; 

•  Amount of ancillary staff support;

•  Documentation requirements; 

•  Level of co-worker/provider engagement; 

•  Ability to take breaks and make nutritious food choices; 

•  Personal health status; 

•  Ergonomics of the work environment;

•  Type of flooring and shoes worn; 

•  Available patient handling assistance devices; and 

•  Shift schedule.

With so many factors at play, what can a nurse do to survive and thrive through a long and challenging shift? NurseZone.com spoke to some clinical health and wellness experts who offer these tips:

1. Control what you can control 

“While you may not have any control over your patient load or acuity, you can make use of any assistance devices available to you. You may not get to choose what shift you work, but you can do your best to maintain a regular routine. Likewise, you probably don’t get to choose the flooring at your facility, but you can invest in a good pair of running shoes,” remarked Dan Donahue, MEd, director of employee health and wellness at Providence St. Peter Hospital in Olympia, Wash.

2. Focus on eating and movement 

Cathy Turner, MS, encourages nurses to focus on their long-term health and energy over just making it through the next nursing shift.

“In order to keep their energy up, nurses should especially pay attention to their eating and their movement,” offered Cathy Turner, MS, director of health promotion at Virginia Hospital Center in Arlington. “It is ideal to eat both regular meals and to have an energy-boosting snack between meals such as a piece of fruit and some cheese.  I recommend that every time you eat that you include a protein source because protein takes longer to digest and it is what feeds our energy levels over the long haul.”

“Often people think they have to have a 30-minute, heart-rate-increasing workout for it to count for anything.  But research is showing that just 5-10 minutes of exercise can boost your energy levels.” Turner explained. “There are yoga poses you can do at your workstation, do a quick stairs workout, or even some seated chair exercises if you just need to get off your feet.” 

3. Be wise about caffeine and energy drinks 

When it comes to caffeine consumption, Donahue said that moderation is key. 

“In the right amount and time, caffeine can be beneficial and help improve mood, attention, concentration and energy levels. Too much sugar or caffeine [>400mg] early or through mid-shift will have a negative effect later when the consumer will experience a drop in their energy level. It's better to have a little bit throughout the shift,” he said. 

“Nurses should be aware that energy drinks can also contain high levels of taurine and guarana and other ingredients that may boost the caffeine levels and have other undetermined effects,” Donahue added. “Instead of looking to caffeine to boost energy, nurses should be concentrating on staying hydrated. I recommend trying to drink 90 ounces of water a day.”

4. Realign your attitude, reinforce your team 

“An important part of having a successful shift is about attitude and remembering what you are there for--your calling and desire to go in and help these patients,” offered Christine Slohe, RN, BSN, PHN, emergency room nurse at St. Mary Medical Center in Apple Valley, Calif. 

“Also, I think it is often overlooked how important co-workers are to the success of a shift,” Slohe continued. “When I have some downtime, I go and help another team member, then they reciprocate later--it helps to keep the flow instead of having highs and lows throughout the shift. I am fortunate to work with a great group. Our motto is: If you see a need, fill a need.”

5. Make breaks count 

While the “ideal” schedule for nurses’ breaks would be approximately every three hours throughout a 12-hour shift, Donahue knows that in reality most nurses try to work a break in whenever they can get it.

“The most important thing is they at least get some sort of break and it would be nice if they could remove themselves from their work environment and get their mind, eyes and body in a whole different state,” he said.

Turner recommends deep, mindful breaths as a way to come back to your center and to reenergize. 

“When you are taking your break, it is a mental recharge to sit there and have your mind focus on something different,” reflected Slohe. “I like to go outside and get out of the enclosed environment. That is more rejuvenating than just sitting in the break room.”

6. Don’t forget the long run 

Getting through a single nursing shift shouldn’t be the only focus, though.

“Nurses should be looking at their long-term health and energy levels and making an investment there, not just figuring out how to make it through the next shift,” encouraged Turner. “Being an effective caregiver means caring for yourself.”

“I always tell people to seek balanced input for the body, mind and spirit. I believe we need input on all three levels to feel whole and healthy and have a good outlook and positive energies,” Donahue said. “I believe we also need to schedule body/mind/spirit ‘time’ in order for it to consistently happen and to gain the benefits.”

Related articles and resources:NurseZone.com’s Time for You page
Nurse on the Run: A Border-to-Border Message of Wellness
New Safe Patient Handling Standards Announced by ANA 

Nurses' Wheel of Life: Creating Balance and Wellness

 By Claire Westwood

- See more at: http://www.nursetogether.com/nurses-wheel-of-life-creating-balance-and-wellness#sthash.1If71zh6.dpuf

One of my favourite tools to create balance and wellness while nursing is the ‘Wheel of Life’. You may have seen this before in articles or books. I think its simplicity is its strong point, and I have used one every 12 weeks for the past 4 years to assess how my life is going. I then use it to set my 12 week goals and actions. Many of my clients find it a useful starting point too.

Using it can highlight imbalances in your life or make you think about areas of you and your life that you have been ignoring. There are no right or wrong answers; it is only for you.

The Wheel of Life:

1. Health - Physical and psychological
    
2. Work - Do you like your job, does it 'suit you’?
    
3. Money - Income vs spending and debts
   
4. Your ‘inner circle’ - Friends and social life
    
5. Your family, partner, parents, and pets.
    
6. Home - Town, area, house/flat
    
7. Fun, challenge and excitement - Travel, performing, hobbies
    
8. Development and learning/spirituality/community

Spend some time thinking about each life area, and be honest, how ‘happy’ are you with each one right now? Give each area a score ‘out of 10’ to indicate how happy you are with that area at the current time. This will be from 0 (it couldn't be worse) to 10 (it is absolutely perfect!)

Then be bold! What would make that area a ‘10 out of 10’ score? What would be the best thing for your psychological well-being regarding money, work, or family relationships?

This is to challenge you to think about what you really want in your life. Think big. If you feel that ‘something is missing’, then this simple exercise can help to point to what that may be.

You can organize this information in a way that suits you. You can use these action pages or use a journal/ notebook or A4 papers in a smart file, or a spreadsheet - it’s up to you!

When I started to do the exercises 10 years ago, I used an A4 file to hold the information for each section with sheets of notes, pictures from magazines, and lots of colours. I still use a similar system in an A5 notebook - my 12 week action book - as this works for me. Put it on whatever format you like to use, as long as you look at it regularly (daily is best), write lots of information in it, and use it to inspire you.

                            

When you have identified what you would like in life, think of one action for each section that will move you closer to your ultimate goal. Then decide exactly when you will do it - the sooner the better - then do it! It can be as simple as buying a health magazine this afternoon, eating an extra piece of fruit each day this week, phoning an old friend for a chat, taking your child to the cinema - whatever is right for you. Do it today, or at least this week. Make a start!

You can work through with a coach, a friend or a nursing co-worker, which will help. With the first coaching book that I used, I worked through the exercises with one of my sisters, and it was very helpful to share our experiences, motivate each other, and have someone to be accountable to for nursing wellness.

- See more at: http://www.nursetogether.com/nurses-wheel-of-life-creating-balance-and-wellness#sthash.1If71zh6.dpuf

Diabetes and Diet and Excercise

A healthy diet, not a "diabetes diet"

Diets for people with diabetes, weight, heart disease or other health problems are all very similar. That is because a healthy diet is the same for almost everyone. That means:

• Eat less fat and less sugar 
• Eat smaller portions of meats and dairy products
• Eat more vegetables, fruits and whole-grain or unprocessed starches 

It is true you will have to reduce sweets because they usually have high fat and high sugar. Cake, cookies and ice cream can all be part of your diet if you control the size of your servings.
 

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Plan healthy meals

It is important to plan so you are balancing the different foods you need each day. Every meal should include something from each of the basic food groups:

• Vegetables and starches (carbohydrates)
• Low-fat meats, dairy products or certain types of beans (proteins)
• Margarine, oils or fats present in the foods you eat or prepare

Here is an easy way to think of what a balanced meal might look like on your plate: three-quarters of the plate surface should be covered with vegetables, fruit or grains. The other quarter should have meat or dairy products.

Done correctly, good meal planning can reduce the need for insulin or other medicines. The best way to find a way that will work for you and your family is to talk to a dietician. Either your doctor or Priority Health can suggest a dietitian available to help in your local area.

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Watch portions

 For example, a healthy portion of protein - chicken breast, or steak, or a hamburger - is 3 oz., which is about the size of a pack of cards. Some people weigh their food to make sure they are eating the right amounts. There are other ways that your doctor or a dietitian can show you.

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Eating smaller meals more often during the day is a good way to keep your blood sugar at the best levels for you.

• Eat about the same amount of sugars and starches at each of your meals and snacks to keep your blood sugar consistent.
• Don't skip meals so you can avoid having blood sugar levels from going up and down like a yo-yo.

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• Avoid fried foods.
• Eat smaller servings of foods with cheese or creamy sauces.
• Choose low-fat offerings.
• Restaurants serve very large portions. Split your entrees with others or ask for half-orders. Ask for a doggie bag before you eat and put half your plateful into it to limit the food in front of you.
• Choose broiled, grilled or baked meat or fish. These cooking methods reduce fat and usually do not have fats added.
• Ask for steamed vegetables and ask your waiter or host not to put any other butter or sauces on them

Exercising is essential when you have diabetes, pass this information on to your clients....

Whether you have Type 1 or Type 2 diabetes, exercise can help you live a longer and better life.

Exercise can help to strengthen your heart, control your weight, and increase how much you enjoy life. If you have Type 2 diabetes, exercise could eliminate your need to take insulin or other drugs. 

If you haven't been exercising up until now, you have plenty of good reasons to start. And if you have been exercising, congratulations. 

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Set goals

Start without goals and it is too easy to stop. Most people start a fitness program for personal reasons. Some common reasons are:

• "My clothes are a little tight around the waist."  
• "It's getting a little harder to keep up with the kids or grandkids."
• "I miss going out with my friends."  

Take out a sheet of paper and at the top, write, "Why Exercise?" Then start writing why you think exercise would help you. Those reasons become your goals.

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No excuses

You are not alone in thinking you have good reasons not to get started. But those are probably just excuses. The American Diabetes Association dedicates an entire page on their website (www.diabetes.org) just to the excuses people have for not getting exercising. Here are a few we hear all the time:

• "I don't have time."
  You can get positive benefits just by starting with a few minutes a day. Work up to 30 min. a day.
• "I'm too tired."
  Try walking at lunchtime, in the morning or whenever you're rested and ready.
• "It hurts."
  If exercise leaves you with sore muscles, go easy at first. Build up over time and there is no reason to be sore or uncomfortable. If your knees or joints hurt when you walk, consider pain-free alternatives like swimming or lifting light weights.
• "I can't afford a gym."
  The sidewalk in front of your house is free. The bike in your garage can be dusted off. Some people do more housework for exercise.  
• "It's boring."
  It's a simple truth: if you don't enjoy it, you won't do it. So bring a friend along. Read a magazine on a treadmill. Walk in a mall and window-shop along the way. Ride your bike in a new direction. If one exercise is getting boring, add others.

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Get professional advice

Talk with your doctor. Everybody can add or enjoy some form of exercise, but diabetics have good reason to make certain they choose an activity that fits their current health. 

• If you have experienced numbness in your feet, you should not do an impact sport like running or step aerobics without your doctor's approval.
• If your eyes have been impacted by diabetes, you probably should not be doing an activity that either causes impact or raises your blood pressure (like weight lifting).
• For people who are already active in sports, there are a lot of sources of online information dedicated to athletes with diabetes. For example, a group called the Diabetes Exercise and Sports Association has information and many links to help anybody from weekend warriors to professional sportspeople continue enjoying their fitness routines and activities.

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Get geared up

Don't start by investing a lot of money in equipment. Start with a good pair of shoes and absorbent, seamless socks, some comfortable clothes and you're ready. Get a medical ID bracelet in case you are exercising and experience any difficulties.

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Plan your blood tests

Until you know for certain how an exercise is going to affect you, test your blood glucose levels before and after an activity. Your doctor can provide good advice on what to look for and what any changes mean.

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Get moving!

• Write a plan, be realistic
  Just the act of writing what you intend to do and patting yourself on the back when you do it is a big boost to building fitness. Write down what you will do on a calendar and watch how it all adds up.
• Don't rush it  
  Improving fitness takes time. It takes time during your day and it takes days or even weeks to reach your goals. If you push too hard, you'll feel uncomfortable. Take your time, enjoy the trip and you will enjoy the goal when you reach it.
• Make it a team sport  
  To have a plan and stick to it is a lot easier if you have the encouragement and support of friends and family members. Invite someone to join you.
• Everything counts  
  When all is said and done, fitness is what you get for moving a little more than you did the day before. Every move you make during your day adds to your fitness. If it's raining outside, get out your vacuum cleaner. If your day is going to be too busy, park at the far end of the parking lot and walk a little further.

-source page here....

What is a TPN all about?.....Enteral/Paraenteral Nutrition Part 2 of 2

TPN- is a intravenous fluid for patients in need of nutrition requirements who are unable to eat or cannot get enough nutrition from foods they eat. TPN's contained as dextrose, normal saline, etc also lactated ringers such as potassium, calcium (electrolytes),etc. TPN's are prepared in a laminar flow hood using the aseptic technique. TPN's are given in large amounts that have varieties of ingredients/solutions, so in this case healthcare professionals need to be accurate when preparing a TPN so the patient won't get harmed। TPN's are given at the hospital, long-term care centers, or at home......

Who specifically needs a TPN?

• Patients with infections or problems in their pancreas, intestines (bowel), or other body organs
• Food tubes going into their stomach that cannot give them enough nutrition
• AIDS (acquired immunodeficiency syndrome)
• Some types of cancer
• Starvation or anorexia
• Serious burns
• 
  

How is a TPN given? A healthcare professional will place a special IV line in the patients arm, upper chest, or neck. Their TPN will be connected to a pump that controls how fast the TPN goes into their vein.



What is the difference between a TPN and a PPN (peripheral parenteral nutrition) ?

First of all a TPN and a PPN are used for the same cause which is to give the nutrition requirements that a patient needs. The difference is that a TPN must be given through a central venous catheter and the PPN may be given through a regular IV. Also TPN's are preferred nutritional supplement for a long time because it delivers through a central vein as for PPN's are only preferred partially because it is not safe to use hyperosmolar solutions in peripheral veins for a very long time. Also TPN comes in a higher concentration & it can only be administer through a large vein such as the chest or neck as for PPN comes in a lesser concentration that can be delivered through a peripheral vein.

EXTRA:

Sodium: Helps control water distribution and maintain a normal fluid balance
Potassium: Needed for cellular activity and tissue synthesis
Magnesium: Helps absorb carbohydrates and protein
Calcium: Needed for bone and teeth development also aids in clotting
Phosphate: Minimizes the threat of peripheral parenthesis
Chloride: Regulates the aid base equilibrium and maintains osmotic pressure
Acetate: Added to prevent metabolic parenthesis
Ascorbic acid: Helps in wound healing
Vitamin A: Maintaining integrity of skin and essential to vision
Vitamin D: Essential for bones and maintenance of serum calcium levels
Vitamin B complex: Helps in final absorption of carbohydrates and protein
Folic acid: DNA formation and promotes growth and development
Vitamin K: Helps prevent bleeding disorders
Trace elements: Help in wound healing and red blood cells synthesis
Interferon: May be added as a iron supplement
Insulin: Metabolize high glucose load

EX) You are preparing a TPN with 500ml of 7.5% Travasol and 500ml of 50% dextrose injection. What is the final % concentration of the Travasol and the dextrose in the TPN?


500ml X 0.075 (7.5% / 100) = 37.5% Travasol
500ml X 0.5 (50% / 100) = 250 / 100 = 2.5------<25%




Nutrition /nu·tri·tion/ (noo-trish´un) the taking in and metabolism of nutrients (food and other nourishing material) by an organism so that life is maintained and growth can take place.nutri´tional

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enteral nutrition the delivery of nutrients in liquid form directly into the stomach, duodenum, or jejunum.

parenteral nutrition administration of nutriment intravenously.

total parenteral nutrition (TPN) intravenous administration, via a central venous catheter, of the total nutrient requirements of a patient with gastrointestinal dysfunction.

Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Parenteral nutrition

Nutrition supplied intravenously, thus bypassing the patient's digestive tract entirely.

Mentioned in: Electrolyte Supplements, Necrotizing Enterocolitis

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

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parenteral nutrition,

the administration of nutrients by a route other than the alimentary canal, such as subcutaneously, intravenously, intramuscularly, or intradermally. The nutrients, or parenteral fluids, usually consist of physiologic saline solution with glucose, amino acids, electrolytes, vitamins, and medications. They may not be nutritionally complete but maintain fluid and electrolyte balance during the immediate postoperative period and in other conditions, such as shock, coma, malnutrition, and chronic renal and hepatic failures. See also total parenteral nutrition.

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

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parenteral [pah-ren´ter-al]

by some route other than through the alimentary canal, such as by subcutaneous, intramuscular, intrasternal, or intravenous injection.

parenteral nutrition a technique for meeting a patient's nutritional needs by means of intravenous feedings; sometimes called hyperalimentation, even though it does not provide excessive amounts of nutrients. Nutrition by intravenous feeding may be either total parenteral nutrition or only supplemental.


Total parenteral nutrition provides all of the carbohydrates, proteins, fats, water, electrolytes, vitamins, and minerals needed for the building of tissue, expenditure of energy, and other physiologic activities. The procedure originated as an emergency life-saving technique following surgery for severe and massive trauma of the gastrointestinal tract but has now become a relatively common means of providing bowel rest and nutrition in a variety of conditions in spite of inherent risks. Although primarily used as a short-term temporary measure until either surgical or medical treatment corrects the gastrointestinal dysfunction, it has also been used with some success as a long-term therapy for selected patients on an outpatient basis.


Parenteral nutrition may be used in the following conditions: malnutrition from such acute and chronic inflammatory bowel diseases as regional ileitis (crohn's disease) and ulcerative colitis, partial or total obstruction of the gastrointestinal tract that cannot be relieved immediately by surgery, congenital anomalies in the newborn prior to surgery, massive burns that produce critical protein loss, and other disorders in which malnutrition is a threat to the life of the patient who cannot receive nutrients via the digestive tract.


The nutrient mix is tailored to the individual needs and tolerance of the patient. There is not complete agreement among the experts as to the ideal mix, especially of amino acids. The nutrient solutions usually are prepared in clean-air rooms in the pharmacy of a hospital under aseptic conditions to avoid contamination.


Administration of the nutrients is accomplished via a central venous catheter, usually inserted in the superior vena cava. The route of administration, constant rate of flow required, and potential patient sensitivity to the elements administered, all contribute to the potential complications of parenteral nutrition.


Of the many complications that may develop, the most common are febrile reactions arising from patient intolerance to the required rate of flow, reactions due to individual sensitivity to some of the elements in the nutrient mix, and infection from contamination of either the site of insertion of the catheter or the apparatus used to administer the nutrients. Other complications that may develop include phlebitis and thrombosis of the vena cava, electrolyte imbalance, hyperglycemia, cardiac overload, dehydration, metabolic acidosis, and mechanical trauma to the heart.

Patient Care। Principles of strict aseptic technique must be followed in the daily changing of dressings and in handling the nutrient solution and the administration equipment. The catheter through which the nutrients are administered should not be used for administration of medication, blood, or any other substance that may induce clotting in the vein.

Superior vena cava administration of parenteral nutrition through a subclavian venous line. From Lammon et al., 1996.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

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parenteral

adj literally, “aside from the gastrointestinal tract”; not through the alimentary canal (i.e., by subcutaneous, intramuscular, intravenous, or other nongastrointestinal route of administration).

parenteral nutrition,

n the administration of nutrients by a route other than the alimentary canal, such as subcutaneously, intravenously, intramuscularly, or intradermally. The parenteral fluid usually consists of physiologic saline with glucose, amino acids, electrolytes, vitamins, and medications, which are not nutritionally complete but maintain fluid and electrolyte balance.

Mosby's Dental Dictionary, 2nd edition. © 2008 Elsevier, Inc. All rights reserved.

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nutrition

1. the sum of the processes involved in taking in nutriments and assimilating and utilizing them.

2. nutriment.

It includes all the processes by which the body uses food for energy, maintenance and growth. See also malnutrition, inanition, starvation, thirst, nutritional.

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critical care nutrition
provision of nutritional support for patients in critical care units; usually requires modification of normal nutritional requirements to meet the demands of stress, injury and disease, and to support recovery from these states.

enteral nutrition

see enteral feeding.

intravenous nutrition

see parenteral nutrition (below).

nutrition Labeling and Education Act of 1990

an amendment to the (US) Federal Food, Drug, and Cosmetic Act which defines how foods, claimed to affect disease, are not regulated as drugs।

parenteral nutrition

a technique for meeting a patient's nutritional needs by means of intravenous feeding; sometimes called hyperalimentation, even though it does not provide excessive amounts of nutrients. Nutrition by intravenous feeding may be total parenteral nutrition (TPN) or supplemental. TPN provides all of the carbohydrates, proteins, fats, water, electrolytes, vitamins and minerals needed for the building of tissue, expenditure of energy, and other physiological activities.

total parenteral nutrition

called also TPN; see parenteral nutrition (above).

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parenteral

not through the alimentary canal, e.g. by subcutaneous, intramuscular, intrasternal or intravenous injection, e.g. parenteral fluid therapy.

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parenteral alimentation

see parenteral nutrition (below).

parenteral hyperalimentation

see parenteral nutrition (below).

parenteral nutrition

the provision of adequate carbohydrate, protein, vitamins, minerals and fluids parenterally to maintain the animal over a relatively long period of several weeks. Called also parenteral alimentation, parenteral hyperalimentation. See also parenteral nutrition.

parenteral therapy

treatment by the parenteral route is limited to those substances that are soluble in a solvent that can be injected into tissues including the bloodstream। The choice of routes may depend on the nature of the vehicle used, e.g. oily preparations are injected into tissues, irritant substances are injected intravenously slowly.

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parenteral nutrition

IV feeding, parenteral alimentation The administration of nutrients parenterally, usually IV. See Total parenteral nutrition. Cf Forced feeding.

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

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Artificial nutrition is the delivery of a patient’s nutritional support in a fashion that does not require the patient to chew and swallow. This can be given with total parenteral nutrition (TPN), or through a nasogastric tube (NG tube) or gastrostromy tube (G tube or PEG tube)।

There are many things that can cause loss of appetite and reduced oral intake of food and fluids near the end of life. Some causes are reversible, such as constipation, nausea, and pain। Other causes may not be treated effectively, such as certain cancers, altered states of consciousness, and weakness of the muscles necessary to eat. Reversible causes should be identified by the patient’s physician and addressed. If the cause is unknown or not treatable, the decision whether to withhold or withdraw support may need to be made.

Making the decision to withhold or withdraw artificial nutrition and hydration raises intellectual, philosophical and emotional conflicts for many people। It is often helpful for people faced with that difficult decision to understand what science and medicine have found regarding artificial nutrition and hydration at the end of life.

The Benefits and Risks of Artificial Nutrition and Hydration

In our society and culture, food and fluids are viewed to be essential to sustain life and to speed healing and recovery from illness। It goes against most peoples values to withhold food and fluids from a critically ill or dying patient. Yet we all know that knowledge is power. As with any medical decision you are faced with, it is important to understand the benefits of risks. Is artificial nutrition beneficial for the terminally ill patient? Let’s take a look at what medical research can tell us:

• Total Parenteral Nutrition –TPN is an imperfect form of nutrition that is only used short term। It is delivered through a central line, which is usually inserted at the neck or armpit and threaded through a vein where it ends up near the heart। It was once thought that patients with cancer could benefit from TPN. The hope was that it could reverse the loss of appetite and severe weight loss that cancer patients suffer and improve their prognosis. However, several studies found that it neither helped cancer patients gain weight nor improve their quality of life. On the contrary, it actually increased the risk of infections and problems with the central line that were dangerous to the patients.

• Nasogastric (NG) Tubes – For patients who are unable to swallow, whether it’s due to invasive tumors, weakness, or neurological disorders, feeding through a tube has been the standard delivery of nutrition। The nasogastric tube is the easiest way to achieve this. A tube is inserted through the nose and down the throat into the stomach. A liquid food formula is given through the tube continuously at a slow rate or several times a day with a larger dose. Like TPN, however, multiple medical studies have shown that survival rates for terminally ill patients are no different if they are artificially fed rather than not. Again, the risks are dangerous. Patients with NG tubes have a higher risk of pneumonia which can significantly lower their survival rate. NG tubes can also be easily pulled out, causing distress to both the patient and their loved ones.

• Gastostomy (G) Tubes – A gastrostomy tube is one that inserted directly into the stomach by a surgical procedure। A percutaneous-endoscopic gastrostomy, or PEG tube, is done endoscopically and is less invasive. With either of these tubes there is less risk of the patient pulling the tube out. There is still the risk of pneumonia, however. Just like the nasogastric tube, there is little evidence that feeding through a gastrostomy tube will increase the health or life expectancy of terminally ill patients.

• Intravenous (IV) Hydration – If a patient can no longer drink fluids or isn’t drinking what his caregivers think is enough fluid, the caregiver may be tempted to ask for IV fluid. Fluids can be delivered through a small needle that is inserted in a vein and hooked up to tubing. Studies have shown that administering fluids to a terminally ill patient at the end of life offers little, if any, benefit. Risks include infection at the insertion site or in the blood, and fluid overload resulting in swelling or even breathing problems in more severe cases.

For source click title please...additional resources below

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601166.html

http://www.nutritioncare.org/WorkArea/showcontent.aspx?id=4534

TPN Calculator- http://www.globalrph.com/tpn.cgi

http://en.wikipedia.org/wiki/Total_parenteral_nutrition

http://jn.nutrition.org/search?fulltext=Tube+Feeding&submit=yes&x=0&y=0

Nutrition, Diet, and Weight Control Resources and Information.......

• Weight loss: Assess your readiness to change
• Weight loss: 6 strategies for success
• Weight-loss goals: 10 tips for success
• Getting past a weight-loss plateau
• Counting calories: Get back to weight-loss basics
• Metabolism and weight loss: How you burn calories
• Fast weight loss: What's wrong with it?
• Weight-loss hypnosis: Does it work?
• Slide show: Low-calorie foods for weight control
• Body fat: What happens to lost fat?
• Metabolism: What's the best way to boost it?
• Slow metabolism: Is it to blame for weight gain?
• Breakfast: Why is it so important to weight control?
• Carbohydrates: How carbs fit into a healthy diet
• Menopause weight gain: Stop the middle age spread
• Childhood obesity: Make weight loss a family affair
• Weight loss after pregnancy: Reclaiming your body
• Teen weight loss: Healthy habits count
• BMI calculator
• Calorie calculator

Grilled vegetable kebabs

Vegetables are often considered a side dish, but with a little creativity, they can become the featured entree. These five vegetable recipes add interest to your diet and help you meet nutritional guidelines.
For grilled vegetable kebabs, use as many vegetables as you'd like — about 1.5 cups are shown here, which is about 1.5 servings in the Mayo Clinic Healthy Weight Pyramid. First, soak wood skewers in water for at least 10 minutes before using. Brush Italian dressing on whole cherry tomatoes and button mushrooms, as well as slices of zucchini, red onions and bell peppers. Thread vegetables on skewers and grill over medium heat, turning often, until the vegetables are tender, about 5 to 8 minutes. Serve and enjoy.
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Portobello mushroom burgers

Instead of meat for a main dish, try a hearty portobello mushroom burger. Marinate a large portobello mushroom (or several if you're sharing this dish) in French or Italian dressing. If you prefer, make your own marinade by mixing together 1 1/2 tablespoons balsamic vinegar, 1 teaspoon olive oil, 1 clove of minced garlic, and pepper or other herbs, such as rosemary, to taste. Marinate the portobello mushrooms for 15 to 30 minutes. Grill the portobello mushrooms over medium heat until tender, about 5 minutes on each side. Serve alone or on a whole-grain bun with healthy condiments and enjoy. Instead of grilling, you can also broil these mushrooms using the medium setting.---------------------------------------------------------------

Spring greens with butternut squash

For this vegetable recipe, start with a winter squash of your choice — butternut (as shown here), acorn, Hubbard, autumn cup or another favorite. Remove the rind from the squash. Cube the squash and brush lightly with olive oil. Roast squash in preheated oven at 350 degrees for about 30 minutes or until golden brown on edges. Place 1 cup of spring greens or leaf lettuce on a plate. In a small bowl, mix together 1/4 cup roasted butternut squash cubes, 1/2 tablespoon brown sugar and 1/2 tablespoon olive oil. Top the spring greens with the squash mixture and 1/2 tablespoon sunflower seeds and then drizzle with 1 teaspoon honey. Serve and enjoy.
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Vegetable pita pockets

In a small bowl, combine chopped cauliflower and broccoli florets, sliced green onions, and diced tomatoes and cucumbers — about 1 cup total. Cut 1 whole-wheat pita bread in half and fill each half with the vegetable mixture and 1 tablespoon crumbled feta cheese. Warm the pita in the microwave for about 40 seconds. Top with 1 1/2 teaspoons low-fat buttermilk salad dressing or cucumber ranch salad dressing and enjoy — there may be enough to share a pita half.

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Expert Answers

about Nutrition and healthy eating

Nutrition basics

• Water softeners and sodium
• Olive oil
• Fat grams
• Phenylalanine
• Sodium in processed foods
• Stevia
• MUFAs
• High-fructose corn syrup
• Juicing
• Taurine in energy drinks
• High-protein diets
• What are functional foods?
• Acai berry products
• Coffee and health
• Energy drinks
• Alkaline water: Better than plain water?
• Multigrain vs. whole grain
• Is chocolate healthy?
• Yerba mate
• Monosodium glutamate (MSG)
• Nutrition rating system
• Diet soda: Is it bad for you?
• Underweight? See how to add pounds healthfully
• Caffeine: Is it dehydrating or not?
• Grape juice health benefits
• Foods for healthy skin
• Can whole-grain foods lower blood pressure?
• Depression and diet
• Omega-6 fatty acids

Healthy diets

• Diverticulitis diet
• Butter vs. margarine
• Detox diets
• Canola oil
• Water after meals
• Diverticulitis: No nuts or seeds?
• Polymyositis: Can a gluten-free diet reduce symptoms?
• Mediterranean diet
• Eggs: Are they good or bad for my cholesterol?

Healthy cooking

• Food safety
• Lentils
• Moldy cheese
• Thanksgiving turkey
• E. coli in food
• Canned pumpkin

Healthy menus and shopping strategies

• White whole wheat
• What is BPA?
• Sodium nitrate in meat: Heart disease risk factor?
• Calories in sushi
• Vegetable juice
• Sea salt vs. table salt: Which is healthier?
• Grass-fed beef

Nutritional supplements

• Fiber supplements
• Calcium supplements
• Vitamin D toxicity
• Wheatgrass
• Calcium supplements
• Multivitamins for kids
• Percent Daily Value
• Chocolate and calcium absorption
• Vitamin C megadoses
• Ground flaxseed
• Vitamin water: Better than plain water?
• Prenatal vitamins: OK for women who aren't pregnant?
• Can vitamins help prevent a heart attack?
• Eye vitamins: Can they prevent or treat glaucoma?

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• Pyramid or plate? Explore these healthy diet options
• Added sugar: Don't get sabotaged by sweeteners
• Sodium: How to tame your salt habit now
• Alcohol use: If you drink, keep it moderate
• Caffeine: How much is too much?
• Dietary fats: Know which types to choose
• Carbohydrates: How carbs fit into a healthy diet
• New dietary guidelines: How to make smart choices
• Artificial sweeteners: Understanding these and other sugar substitutes
• Water: How much should you drink every day?
• Nutrition Facts: An interactive guide to food labels
• Dietary fiber: Essential for a healthy diet
• Slide show: Healthy meals start with smart meal planning
• Water softeners: How much sodium do they add?
• Olive oil: What are the health benefits?
• Fat grams: How to track your dietary fat
• Phenylalanine in diet soda: Is it harmful?
• Low-sodium diet: Why is processed food so salty?
• Healthy diet: End the guesswork with these nutrition guidelines
• Stevia: Can it help with weight control?
• MUFAs: Why should my diet include these fats?
• High-fructose corn syrup: What are the health concerns?
• Juicing: What are the health benefits?
• Taurine in energy drinks: What is it?
• High-protein diets: Are they safe?
• What are functional foods?
• Acai berry products: Do they have health benefits?
• Coffee and health: What does the research say?
• Slide show: Guide to a high-fiber diet
• Calorie calculator
• Slide show: 10 great health foods for eating well
• Energy drinks: Do they really boost energy?
• Alkaline water: Better than plain water?
• Multigrain vs. whole grain: Which is healthier?
• Healthy chocolate — Dream or reality?
• Yerba mate: Is it safe to drink?
• Monosodium glutamate (MSG): Is it harmful?
• Nutrition rating system: What's behind the new food labels?
• High-fiber foods
• Diet soda: Is it bad for you?
• Underweight? See how to add pounds healthfully
• Caffeine: Is it dehydrating or not?
• Grape juice: Same heart benefits as wine?
• Trans fat is double trouble for your heart health
• Nuts and your heart: Eating nuts for heart health
• Cholesterol: Top 5 foods to lower your numbers
• Step up to MyPlate, the new food icon
• Mayo Clinic Healthy Weight Pyramid tool
• Tips for healthy eating
• Salmonella: Response to latest outbreak and recall
• Foods for healthy skin: Top picks
• Slide show: Guide to portion control for weight loss
• Can whole-grain foods lower blood pressure?
• Junk food blues: Are depression and diet related?
• Omega-6 fatty acids: Can they cause heart disease?
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Resources

for Nutrition and healthy eating.................

• Fix It and Enjoy It Healthy Cookbook
• The New Mayo Clinic Cookbook

Web sites

Nutrition and healthy eating

• Exiling the Happy Meal http://online.wsj.com/article/SB121668254978871827.html?mod=djemW...
• In Paris, Burgers Turn Chic http://www.nytimes.com/2008/07/16/dining/16paris.html?ei=5070&en=...
• CFSAN Constituent Update: FDA Posts Revised Questions and Answers on Acrylamide http://www.cfsan.fda.gov/~dms/cfsup182.html
• Additional Information on Acrylamide, Diet, and Food Storage and Preparation http://www.cfsan.fda.gov/~dms/acryladv.html
• Mediterranean Diet Pyramid http://www.oldwayspt.org/med_pyramid.html
• Your Guide to Lowering Your Blood Pressure with DASH http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/introductio...
• Vitamin and Mineral Supplement Use by Children and Adolescents (NHANES) http://archpedi.ama-assn.org/cgi/content/full/163/2/150
• Institute of Medicine: Progress in Preventing Childhood Obesity: How Do We Measure Up? http://www.iom.edu/CMS/3788/25044/36980.aspx
• Center for Science in the Public Interest: Obesity on the Kids Menus at Top Chains http://www.cspinet.org/new/200808041.html
• Environmental Protection Agency Water Quality Reports http://www.epa.gov/safewater/ccr/
• FDA News - FDA Issues Draft Guidance on Regulating Genetically Engineered Animals http://www.fda.gov/bbs/topics/NEWS/2008/NEW01887.html
• Genetically Engineered Animals http://www.fda.gov/cvm/GEAnimals.htm
• Americans Consume Too Much Salt http://www.cdc.gov/media/pressrel/2009/r090326.htm
• BBC online: Broccoli may undo diabetes damage http://news.bbc.co.uk/2/hi/health/7541639.stm
• Diabetes online: Activation of NF-E2-related factor-2 reverses biochemical dysfunction of endothelial cells induced by hyperglycemia linked to vascular disease http://diabetes.diabetesjournals.org/cgi/content/short/db06-1003v...
• Botany.com: Brassica http://www.botany.com/brassica.html
• U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition http://www.cfsan.fda.gov/~dms/lab-cat.html#gluten
• Latin American Diet Pyramid http://www.oldwayspt.org/latin_pyramid.html
• Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. http://www.ajcn.org/cgi/rapidpdf/ajcn.2008.27240v1
• President's Food Safety Working Group http://www.foodsafetyworkinggroup.gov/Home.htm

Healthy cooking

• National Center for Home Food Preservation http://www.uga.edu/nchfp/index.html

Healthy diets

• Food and Drug Administration http://www.cfsan.fda.gov/~dms/qatrans2.html

Healthy menus and shopping strategies

• The Content of Favorable and Unfavorable Polyunsaturated Fatty Acids Found in Commonly Eaten Fish http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B758G-4S...
• You Are What You Eat Applies to Fish, Too http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B758G-4S...
• USDA National Organic Program http://www.ams.usda.gov/nop/
• My Pyramid menu planner http://www.mypyramidtracker.gov/planner/
• Shopping list http://www.health.gov/dietaryguidelines/dga2005/healthieryou/html...
• Recipes and tips for healthy, thrifty meals http://www.cnpp.usda.gov/Publications/FoodPlans/MiscPubs/FoodPlan...

Nutrition basics

• United States Department of Agriculture, MyPyramid.gov: Steps to a Healthier You http://www.mypyramid.gov
• U.S. Department of Health & Human Services: Dietary Guidelines for Americans http://www.healthierus.gov/dietaryguidelines/
• Oldways Preservation Trust http://www.oldwayspt.org/

Nutritional supplements

• National Center for Complementary and Alternative Medicine http://nccam.nih.gov/

Credits...http://www.mayoclinic.com/health/nutrition-and-healthy-eating/MY00431/TAB=resources