The nursing care of a patient with enterocutaneous faecal fistulae

This article discusses the nursing care given to a patient with a large abdominal, enterocutaneous faecal fistula. It highlights classification, signs, symptoms and some causal factors related to fistulas. Fistulas are rare and there is minimal evidence-based knowledge on the subject. However, incorporating knowledge from other specialties, such as tissue viability, can assist in caring for this client group. Diagrams illustrate the extent of the problems and assist with understanding the appliance techniques. There are many problems that may be encountered in the care of fistulas that are not encountered with planned stomas. Difficulties may include containment of the faecal matter within a wound, problems associated with skin care, leakage and dietary issues. The author's methods of confronting and coping with these problems in this case study are discussed, with the aim of assisting other nurses in similar situations.

Parenteral hydration and nutrition in the geriatric patient: clinical and ethical issues

A common ethical and legal issue in elder care involves the decision to withhold or withdraw parenteral hydration and nutrition (PHN) at the end of life and in the terminal stage of dementia. The aging of the population will impact the frequency with which nurses face this situation in their practices and with their families. The ethical, legal, and clinical issues involving PHN discussed in this article will assist the nurse in his or her practice.

Nutrition strategies in neurotrauma

A basic understanding of metabolic alterations that occur following neurotrauma is essential for addressing nutritional requirements. Interventions must be research based and must focus on the support of metabolic alterations, minimizing the effect of catabolism and optimizing caloric delivery to meet metabolic demand. The goal of accuracy in the delivery of nutritional support is to ensure a reduction in patient morbidity. Nutritional support requires an ongoing, daily assessment of caloric goals, protein requirements, patient responses, and assessment of nutritional laboratory values. Using this strategy, neurotrauma patients will have the greatest opportunity for a positive outcome.

Parenteral nutrition for the acutely ill

Parenteral nutrition (PN) is one of the most sophisticated forms of intravenous therapy in use today. Intravenous feeding is a life-saving technology for patients unable to maintain their nutritional status using the gastrointestinal tract. Although PN has become an integral component of patient care, the risks associated with this therapy must be weighed against the potential benefits. Comprehensive clinical management includes selection of candidates, implementation and monitoring of therapy, and ensuring a seamless transition when PN is no longer required. Optimal parenteral nutrition demands expertise in caring for vascular access devices. A collaborative approach to care minimizes the risks associated with PN and ensures positive patient outcomes.

The effect of a 1-hour training program on the incidence of bacteremia in pediatric patients receiving parenteral nutrition

The effect of a 1-hour nurse training program on the frequency of bacteremia in patients receiving parenteral nutrition was evaluated in a pediatric tertiary center. All of the nurses had previous instruction on aseptic techniques in nursing school. The current program focused on aseptic management of intravenous catheters and implanted subcutaneous ports in patients receiving parenteral nutrition (PN). One hundred eighty-four nurses had a 1-hour training session in groups of three to five. The frequency of bacteremia in children receiving PN was not reduced (9.2% versus 8.9%), and there was no significant difference in time from the start of PN to the diagnosis of bacteremia (P = 0.31). The authors conclude that a 1-hour training session for the nursing staff was not sufficient. It is suggested that staff training for prevention of bloodstream infections associated with intravascular devices should cover a wider range of topics and take place over a longer period of time.

If the gut works use it

Using education and increased monitoring, a nutritional support team lowered parenteral nutrition days from 84 to 5 per quarter, increased the proportion of patients meeting their nutritional requirements from 75% to 97%, and saved money.

Parenteral nutrition: an overview of current practice

Nutritional support should always be provided via the gastrointestinal tract if possible, but parenteral nutrition, i.e. infusion of nutrients directly into the venous circulation, can be a safe and effective method of nutritional support when used in carefully selected patients and monitored appropriately. A multidisciplinary team approach to patient selection, assessment and monitoring is recommended. Access for parenteral feeding is traditionally via a central vein, but the peripheral route can be used for short-term feeding and should be considered for the majority of patients. Nutritional requirements should be assessed on an individual basis and a feeding regimen designed using standard formulations where possible. The transition back onto oral or enteral nutrition should be closely supervised by a dietitian. Parenteral feeding can be provided to the community if appropriate, but thorough training, monitoring and support are essential.

Parenteral nutrition

Patients with a non-functioning gastrointestinal tract, those who require bowel rest or cannot receive enteral nutrition will be considered for parenteral feeding. This Update looks at indications, venous access, administration and complications.

Intradialytic parenteral nutrition therapy for the malnourished hemodialysis patient

Intradialytic parenteral nutrition (IDPN) is a type of parenteral nutrition therapy designed to meet the unique needs of the malnourished patient with end-stage renal disease (ESRD) on chronic hemodialysis (HD). It is given during the HD treatment three times a week through the HD machine blood lines. Because of renal failure, the patient with ESRD must receive a kidney transplant (cadaver or living related donor) to preserve his/her life, or choose one of two forms of renal replacement therapy: HD or peritoneal dialysis (PD). This article will focus on the hemodialysis patient and IDPN therapy.

The value of IDPN as a supplemental therapy when elderly patients fail to thrive--two case studies

On the last day of his life, H.J. came into the dialysis unit smiling and joking. He spent the time watching a movie and visiting with visitors and staff. He reported feeling better than he had in a long time. His predicted 3-day death watch had become nearly 5 months of improved quality of life and precious time spent with his large extended family. He frequently expressed gratitude for the chance to prolong those few days into such an unexpected extension. He and his family attributed this gift to the nursing care and encouragement he received in the dialysis unit. Everyone was aware that the IDPN therapy, along with improvement in his own daily nutritional intake, was a critical element. Later that night, H.J. had a cardiac arrest, and he died peacefully at home with his family. There is no doubt that without the financial resources available to him to pay for his IDPN, the outcome would not have been the same. As it was, all the intended patient outcomes were achieved.

Meeting the special nutritional needs of sick infants with a percutaneous central venous catheter quality assurance program

Adequate nutrition is important in infancy because it can affect brain growth. A critical period for brain growth is the end of the fetal growth period and the first 2 years of life. Delivery of nutrition to infants in the neonatal intensive care unit is challenging because illness and prematurity increase nutritional need and create access difficulties. One technique, percutaneous central venous catheter (PCVC) placement, eliminates access difficulties. Nevertheless, safe delivery of parenteral nutrition through PCVCs is dependent on minimizing infectious and mechanical complications. With the implementation of a PCVC quality assurance program, problems can be identified early, and appropriate, timely interventions can be initiated.

[The meaning of parenteral nutrition for the hospitalized patient]

The need to understand the meaning of parenteral nutrition to the client in hospital context has come from my personal questioning on nursing care. Participative observations have been made as well as interviews and diligences with seven clients in hospital, who have been having parental nutrition. These information have been analysed through interactive approach, showing the situation faced by patients who have hospital assistance; how they say parental nutrition within this context; and what meaning has been given to it. This study revealed feelings, behaviours and attitudes related to the biological, emotional and social cultural aspects of the patient. All of them have been linked to parental nutrition. The limits faced by parental nutrition and its obstacles in the nursing assistance were finally understood.

Systemic inflammatory response syndrome, sepsis, and nutritional support

This article reviews the metabolic alterations that occur in SIRS and sepsis and the management of these patients nutritionally. Practical clinical assessment parameters that can be used by the critical care nurse to determine the nutritional and metabolic needs of the patient are presented. Issues related to enteral and parenteral routes of delivery are presented, and a discussion of disease-specific nutritional formulas is included. An understanding of the determination of metabolic and nutrition needs and the provision of adequate support to meet those needs are vital to the care of the hypermetabolic septic patient.