CHAPTER 53
Nutritional Supplements
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What to Know About
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Nutritional Supplements
• Dietary products used to provide
nutritional support
• Can be given in a variety of ways
• Vary in amounts and complexity of
carbohydrates, protein, and fat content
• Electrolytes, vitamins, minerals, and
osmolality may also vary
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Nutritional Supplements (cont'd)
• Malnutrition: the body’s nutritional needs are
not met by nutrient intake
• Enteral nutrition
– Provision of food or nutrients through the GI tract
• Parenteral nutrition
– Nutrients are delivered directly into the circulation
by means of an intravenous solution
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Enteral Nutrition
• Provision of food or nutrients through
the GI tract
• Oral consumption is the most common
and least invasive route
• Feeding tubes through various routes
can be used for enteral nutrition
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Enteral Nutrition (cont'd)
• Feeding tubes are used for those with:
– Abnormal esophageal or stomach
peristalsis
– Altered anatomy secondary to surgery
– Depressed consciousness
– Impaired digestive capacity
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Four Enteral Formulation Groups
• Provide the basic building blocks for
anabolism
• Supply complete dietary needs through the
GI tract by oral route for by feeding tube
–
–
–
–
Elemental
Polymeric
Modular
Altered amino acid
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Enteral Formulation Group:
Elemental
• Vivonex Plus, Peptamen, Vital HN
• Minimum digestion needed; residual is
minimal
• Used for partial bowel obstruction,
irritable bowel disease, other conditions
• Hyperosmolarity of formulas may cause
GI problems
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Enteral Formulation Group:
Polymeric
• Complete, Ensure, Ensure-Plus, Isocal,
Osmolite, Sustacal
• Preferred over elemental formulations
for patients with fully functional GI tracts
and few specialized nutrient
requirements; causes fewer GI
problems
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Enteral Formulation Group:
Modular
• Three types
– Carbohydrate: Moducal, Polycose
– Fat: MICT oil, Microlipid
– Protein: Casec, ProMod, Stresstein
• Single nutrient formulas
• Can be added to other formulas if
needed
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Enteral Formulation Group:
Altered Amino Acid
• Amin-Aid, Hepatic-Aid, Lonalac,
Stresstein, Travasorb Renal
• Contain varying amounts of specific
amino acids
• Used for patients with genetically
altered metabolism problems
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Enteral Nutrition
Interactions
• Various nutrients can interact with drugs to
produce significant food-drug interactions
• Enteral nutrition can delay absorption of
some medications
• Enteral nutrition may inactivate some
medications (i.e., tetracycline and nutrient
formulations that contain calcium)
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Parenteral Nutrition
• Totally digested nutrients are given
intravenously, directly into the
circulatory system
• The entire GI system is bypassed,
eliminating the need for absorption,
metabolism, or bowel elimination
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Parenteral Nutrition (cont'd)
• Amino acids
– Nonessential amino acids
– Essential amino acids
– Semiessential amino acids
• Trace elements
– Chromium
– Iodine
– Copper
– Manganese
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Parenteral Nutrition (cont'd)
• Also known as total parenteral nutrition
(TPN) or hyperalimentation
• Formulations will vary according to
individual patient nutritional needs
– Amino acids
– Carbohydrates
– Lipids
– Trace elements
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Figure 53-2 One gram of dextrose, fat, or protein will provide varying
amounts of energy as calories.
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Parenteral Nutrition (cont'd)
• Peripheral administration
– Temporary, short term (less than 2 weeks)
– Dextrose concentration generally less than
10%
• Central administration
– Long-term use (7 to 10 days)
– Dextrose concentrations may be 10% to
50%
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Peripheral TPN
• Used to provide nutrients to patients who
need more nutrients than present oral intake
can provide
– Procedures that restrict oral feedings
– Anorexia caused by chemotherapy or radiation
treatments
– GI illnesses that prevent oral food intake
– After surgery
– When nutritional deficits are minimal, but oral
nutrition will not be started for more than 5 days
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Peripheral TPN:
Side/Adverse Effects
• PHLEBITIS is the most devastating
adverse effect
– Can lead to loss of a limb
• Fluid overload
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Central TPN
• Delivered through a large central vein
– Subclavian
– Internal jugular
• Long-term use (more than 7 to 10 days)
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Central TPN (cont'd)
• Disadvantages are the risks associated
with central line insertion, use, and
maintenance
• Higher risk for infection, catheterinduced trauma, metabolic alterations
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Central TPN (cont'd)
• Delivers total dietary nutrients to
patients who require nutritional
supplementation
– Patients with large nutritional requirements
(metabolic stress or hypermetabolism)
– Patients who need nutritional support for
more than 7 to 10 days
– Patients who are unable to tolerate large
fluid loads
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Central TPN:
Side/Adverse Effects
• Most common are those surrounding
the use of the central line for the
delivery of TPN
– Infection
– Catheter-induced trauma
• Greater chance for hyperglycemia due
to the larger and more concentrated
volumes given
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Nursing Implications
• Ensure that a complete nutritional
assessment is taken, including a dietary
history, weekly and daily food intakes,
and weight and height measurements
• Consult with a registered dietitian
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Nursing Implications
• Assess baseline laboratory studies,
such as total protein, albumin, BUN,
RBC, WBC, cholesterol, etc.
• Collect anthropometric data
• Assess for allergies to components of
enteral nutritional supplements (such as
whey, egg whites)
• Assess for lactose intolerance
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Nursing Implications
• If administering enteral nutrition by tube
feedings, follow facility policy for
ensuring proper tube placement and for
checking residual before giving a
feeding
• Follow procedures for flushing tubing to
prevent clogging the feeding tube with
formula
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Nursing Implications
• Monitor how the patient is tolerating
enteral feedings carefully
• Most enteral feedings are started slowly
and the rate is increased gradually
• Monitor for signs of lactose intolerance
– Cramping, diarrhea, abdominal bloating,
flatulence
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Nursing Implications
• Follow facility policies and procedures
for care and maintenance of TPN IV
lines, including tubing changes
• Monitor patient’s temperature; report
any increase immediately
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Nursing Implications
• Monitor blood glucose levels with a
glucometer
• Monitor for hyperglycemia
– Headache, dehydration, weakness
• Monitor for hypoglycemia
– Cold, clammy skin, dizziness, tachycardia,
tingling of the extremities
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Nursing Implications
• While on TPN, the pancreas is providing
increased amounts of insulin to cover the
increased glucose levels
• If TPN is discontinued abruptly, rebound
hypoglycemia may occur until the pancreas
has time to adjust to changing glucose levels
• If TPN must be discontinued abruptly, then
infuse 5% to 10% glucose to prevent
hypoglycemia
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Nursing Implications
• Monitor for fluid overload while on TPN
– Weak pulse, hypertension, tachycardia,
confusion, decreased urine output, pitting
edema
• Monitor daily weights and intake and
output volumes
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Nursing Implications
• Monitor for therapeutic responses to
nutritional supplementation
– Improved well-being, energy, strength, and
performance of activities of daily living
– Increased weight
– Laboratory studies that reflect a more
positive nutritional status
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