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Parenteral Nutrition for Diabetics

Parenteral Nutrition for Diabetics

Sample Answer 

Parenteral Nutrition for Diabetics

People diagnosed with diabetes are already at a high risk of having poor health and healing outcomes. This is due to the disease’s complications. However, even with the increased risks, often, malnutrition goes undetected and consequently untreated (Shrivastava et al., 2013). This paper will discuss the relationship between malnutrition and diabetes, the use of parenteral treatment for malnutrition in diabetics, and the potential complications that can arise from this treatment modality.

The Relationship between Malnutrition and Diabetes

Nurses have the ideal position of quickly identifying a diabetic patient who suffers from malnutrition. Interventions should be put in place to prevent unnecessary admission to the healthcare facility. Diet for diabetic patients remains a treatment essential, but carers and the patients themselves may be uncertain as to which kinds of foods to choose. This uncertainty can result in inappropriate food restrictions (deFaria, 2013). The nurse can play a critical role in educating patients and alerting other physicians who specialize in the same area when necessary.

Some of the contributing factors to malnutrition include medical conditions such as dementia, altered bowel conditions, and eating disorders, among others; social conditions such as drug and alcohol abuse, limited income, and limited cooking skills, among others; physical conditions such as dysphagia, ill-fitted dentures, and poor dentition, among others. Additionally, diabetics may also have higher incidences of gastroparesis, depression, and an increased risk of coeliac disease and eating disorders (Mangou et al., 2012).

Raucoules & Quilliot (2010) point out that the dietary interventions may vary with the duration and depend on the underlying factors that contribute to the patient’s condition and their individual needs. A patient should be screened for BMI, as well as the weight lost unintentionally. It should also consider the duration in which there has been an unintentional reduction of nutrient intake or the possibility of impairment in taking nutrients. A tool such as the Malnutrition Universal Screening Tool (MUST) can be used to achieve these objectives. Once a patient is identified as at risk of malnutrition, an appropriate care plan should be drawn that contains specific treatment goals.

How the Modality of Nutrition Support You Have Chosen Can Be Used to Treat Malnutrition

Parenteral nutritional support (PN) should be offered to people with diabetes. This is used where the GI tract becomes non-functional. In people with diabetes, PN is also used when patients develop diarrhea or intractable vomiting, a small-bowel leak, chylothorax, severe colitis, graft vs. host disease, radiation enteritis, intestinal or mesenteric ischemia, paralytic ileus, severe malabsorption, short-bowel syndrome, high-output enterocutaneous fistula, or a small-bowel obstruction (Via & Mechanik, 2011).

Additionally, when the patient’s GI becomes unsafe or inaccessible, PN will be a good option to take. An unsafe GI could be caused by hemodynamic instability or bleeding or when the enteral option fails to meet the nutritional needs (Jakoby & Nannapaneni, 2012).

Rationale For Selection

People with diabetes with controlled blood sugar benefit from PN, including fluid maintenance and enhanced immune system functionality. Glycemic control reduces critical illness, mortality, inflammation, bacteremia, and polyneuropathy. Additionally, controlled blood sugar improves fluid balance. For patients who are not critically ill, it is recommended that they maintain a glucose range of 100-150mg/dl, while those who are critically ill should have 80-100mg/dl (Jakoby & Nannapaneni, 2012).

Potential Complications Associated With Nutrition Support Due to the Disease State Chosen

Study Group of Hyperglycemia in Parenteral Nutrition (2015) points out that hypoglycemia will be most likely observed in patients with Type 1 Diabetes and which can result in parenthesis, tremors, sweating, heart palpitations, and anxiety. Patients may also experience neurological symptoms, including coma, seizures, cognitive dysfunction, and behavioral changes. A reduction in sympathoadrenal responses in patients with a long diabetes history could have hypoglycemic unawareness. Additionally, hyperglycemia is the most common complication of metabolism in diabetics and non-diabetics. The high levels of glucose negatively affect the cardiovascular system at the micro and macro levels. This also causes dysfunction of the endothelial cells. Additionally, hyperglycemia causes cell injury from oxidative stress and brain ischemia from neuronal damage.

In conclusion, diabetic patients should be assessed for malnutrition every time they walk into a healthcare facility. Doing so will help improve the patient’s outcomes and avoid further complicating the patient’s illness. Early detection of malnutrition is preferred as this will also avert the need for in-hospital admission.

References

de Faria Maraschin, J. (2013). Classification of Diabetes. In Diabetes (pp. 12-19). Springer, New York, NY.

Jakoby, M. G., & Nannapaneni, N. (2012). An insulin protocol for management of hyperglycemia in patients receiving parenteral nutrition is superior to ad hoc management. Journal of Parenteral and Enteral Nutrition36(2), 183-188.

Mangou, A., Grammatikopoulou, M. G., Mirkopoulou, D., Sailer, N., Kotzamanidis, C., & Tsigga, M. (2012). Associations between diet quality, health status and diabetic complications in patients with type 2 diabetes and comorbid obesity. Endocrinología y nutrición59(2), 109-116.

Raucoules-Aime, M., & Quilliot, D. (2010). Feeding malnourished diabetic patients. In Conference proceedings.

Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2013). Role of self-care in management of diabetes mellitus. Journal of diabetes & Metabolic disorders12(1), 14.

Study Group of Hyperglycemia in Parenteral Nutrition, Olveira, G., Tapia, M., Ocón, J., Cabrejas-Gómez, C., Ballesteros-Pomar, M., … & García-Manzanares, Á. (2015). Prevalence of diabetes, prediabetes, and stress hyperglycemia: insulin therapy and metabolic control in patients on total parenteral nutrition (prospective multicenter study). Endocrine Practice21(1), 59-67.

Via, M. A., & Mechanick, J. I. (2011). Inpatient enteral and parental nutrition for patients with diabetes. Current diabetes reports11(2), 99-105.

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Question 


Parenteral Nutrition for Diabetics

Malnutrition is a significant problem among hospitalized patients. Extended length of hospital days are associated with complications associated with disease processes and invasive medical interventions. Many patients have complications which require nutrition support as an alternative to consuming food by mouth. Further complications arise when diseases such ass diabetes, renal disease or heart disease are present.

The purpose of this discussion is the use Peer Reviewed Research on Nutrition related to Chronic disease states and Nutrition Support options to treat or prevent malnutrition in hospitalized patients.

Parenteral Nutrition for Diabetics

Parenteral Nutrition for Diabetics

This discussion will:

  • Relate the problems associated with Malnutrition to one of three specific disease states, Diabetes, Renal Disease or Heart Disease.

Include a modality of nutrition support, either Enteral Nutrition support or Parenteral Nutrition Support.

  • You will select 1. One of the stated disease states 2. One mode of the two nutrition support options.
  • Your discussion should include: a thesis statement (Hospitalized patients with the respiratory disease receiving enteral nutrition via a percutaneous endoscopic gastrostomy (PEG) tube feeding are example: at a reduced risk for malnutrition due to the ability to meet EER needs and protein needs exhibited by NCP process outcomes.), the body of your discussion and a reference list as well as in-text citation. Follow APA guidelines
  • You will gather 3 articles (web articles must be from a .edu, .org, .gov or other academic association) which support your thesis statement.
  • Your discussion will include the following points:
    • The relationship between malnutrition and the chosen disease state.
    • How the modality of nutrition support you have chosen can be used to treat malnutrition. State your rationale for your selection.
    • Potential complications associated with nutrition support due to the disease state chosen.

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