Implementation - Powerpoint - Short Version · Those are discussed on the next 2 slides, and found...

1

PEP uP Powerpoint - Short Version

Teaching points:

Use to initiate group discussion – Sample questions could be:

What does it feel like when you are hungry?What do you do when you miss a break/meal?

Key point: Worldwide 50% of critically ill patients are iatrogenically malnourishedKey point: Worldwide, 50% of critically ill patients are iatrogenically malnourished.Helps to get group involved in why this protocol is important.

2


Hit the highlights of why nutrition is important with a focus on critically ill

Key point: Well nourished patients get better faster with fewer complications.

3


Key point:

NPO causes loss of structural and functional integrity of the gut. This is associated with increased complications.

4


Teaching points:

Peptamen is the initial formula for all study patients. This will be reassessed by unit dietitians and the formula may be changed.

What does not change is volume based feeding.

Metoclopramide is started immediately and reassessed daily. If the patient is tolerating feeds motility agent should be stopped after 24 hours tolerating feeds.

All patients are started on protein and motility agents whether they start on volume based or trophic feeds. THE NEED TO THESE IS TO BE REASSESED DAILY.


Teaching point:

All patients are started on volume based feeds unless they meet criteria to be unable to start. Those are discussed on the next 2 slides, and found in the pre‐printed orders.

6


Teaching point:

These feeds are started in patients who would traditionally have been left NPO. The small volume helps protect the gut until the patient is ready for volume based feeding.

Daily reassessment is essential.

7


Teaching point:

Must have a contraindication to enteral nutrition.

Reassessment essential.

8


All participants will have a copy of the flowchart to refer to as well. Remind that they will be using this flowchart during the case study to follow.Key points:Tube placement confirmedHOB 45 – contraindications could include spinal precautions, subarachnoid hemorrhage. Consider reverse trendelenburg when appropriate.Monitor gastric residuals q4h, acceptable residuals 300 ml and less.

9


10


11


Correct answer:

Volume based feeding because he is not receiving any vasopressors

Teaching points:Lack of bowel sounds is not a reason to keep him NPOStable so does not require trophic feeds used to maintain gut health in patients not readyStable, so does not require trophic feeds, used to maintain gut health in patients not ready for volume based feedingMetoclopramide is to be started on all patients

12


Correct answer: Yes he requires protein supplements because we want to avoid a nutrition deficit.

Teaching point:All patients in the protocol are started on protein supplements immediately.

13


Teaching point:

How many hours remain in the feeding day? Answer – 9 hours (2200h‐0700h)

Preprinted orders – According to his weight what volume should he receive?


According to the preprinted orders, his weight of 75 kg means that he should received (1100 ml x 9 hours remaining in day 1) / 24 hrs = 412.5ml

15


Correct answer:46 ml/hr (413/9)This is based on the amount of time left in the 24 hour period (0700 – 0700), there are 9 hours left.

16


Correct answer:46 ml/hr (1100/24)

The rate needs to be set at 0700, but remind that this could be changed once he is assessed by the dietitan. The important point to remember that it remains volume based feeding so it should be a volume target, not a ml/hr order.

17


Correct answer:

Implement the diarrhea management guidelines.

Emphasize that the feeds are not to be stopped.

Metoclopramide is for gastric motility only, it does not cause diarrhea

Increasing the TF will not likely help

18


Correct answer:

80 ml/hr

Feeds were off at 1300h so the patient received 6 hours of volume. This means there are 18 hours of volume remaining to be delivered in 14 hours (1700h – 0700h).

1500 – 378 = 1122/14= 80 ml/hr

1500/24=63 ml/hr original rate

19


20


Implementation - Powerpoint - Short Version · Those are discussed on the next 2 slides, and found...

Documents

Transcript of Implementation - Powerpoint - Short Version · Those are discussed on the next 2 slides, and found...