Question:
Discuss about the Academy of Nutrition and Dietetics.
Patients in critical conditions are at higher risk of malnutrition, occurring in almost 40% of all patient cases. The patient’s body, in response to stress, suffers metabolic changes that are the cause of the increase in protein catabolism. The ultimate outcome for such patients is a significant loss of body mass and subsequent higher risks of health complications. Such complications might be an infectious disease of increase in wound dehiscence. In either case, the outcomes are unfavourable. The strategy under such condition is to provide nutritional support for achieving optimal body functioning. Prevention of malnutrition and the related complications is the chief aim. The aim is to provide appropriate doses of micro and macro nutrients for meeting the body needs, avoid complications and reduce nitrogen deficits (McClave et al. 2016). Enteral nutrition is defined as the provision of a supply of nutrients through the gastrointestinal tract of the patient under conditions when the patient is not able to ingest, chew or swallow food but is able to digest and absorb the same. Early enteral nutrition is the process of enteral nutrition commenced within 24-48 hours after admission of the patient to the critical care unit (Yu et al. 2014).
The advantages presented by early nutritional support are continually being reported in a vast pool of literature. According to Boelens et a. (2014), intensive care unit patients presented with malnutrition during their hospital stay as well as those who are not supposed to be on the full oral diet within three days are to receive specialised enteral nutritional support. Malnutrition has been linked with morbidity, mortality and increased hospital stay length. Evidence points out that patients admitted to the critical care unit and having the gut in the functional state must be given nutrition through the enteral route. The rationale is that administration of nutrition through other routes of feeding is associated with increased chances of compilations due to infections. In case of early enteral nutritional support, the feeding is to commence on the very first day after admission to the care unit for facilitation of diet tolerance and reduction of risk of intestinal barrier dysfunction. The desirable outcomes are mechanical ventilation and reduced hospital stay length (Sun et al. 2013). As per the authors, favourable impacts of early enteral nutrition include prevention of mucosal atrophy, better substrate utilization, preservation of immunocompetence and preservation of the integrity of gut flora. Early enteral feeding has also been linked to the amelioration of oxidative stress after a patient has undergone surgery. The decrease in postoperative mortality in patients is also a benefit of such nutritional support. In modern times, healthcare professionals are focusing on feeding patients as soon as possible through such measures in order to sustain stable patient conditions.
As highlighted by Blaser et al. (2017) early enteral nutrition is imperative is a crucial element of the management plan for patients who are in critical condition. Nutrition is important as it supplies antioxidants, vital cell substrates, minerals and vitamins that optimize recovery from heath complications in a speedy process. Specialized immune-enhancing nutritional formulations are into use at the present time that has been reported to decrease inflammation, and augment cell-mediated immunity. Early enteral nutrition is elementary for a decrease of organ failure, and in comparison to delayed enteral nutrition early enteral nutrition improves wound healing, nitrogen balance and immunity. Augmenting the cellular antioxidant systems is the mechanism of increasing the hypermetabolic response to tissue injury and preserving the intestinal mucosal integrity. The decrease in bacterial translocation and increase in mucosal permeability are the other possible mechanisms (Yang et al. 2014). Shankar et al. (2015) reported that early enteral feeding protects the liver injury if there is endotoxemia or haemorrhage, and kidney damage if there is rhabdomyolysis. They further demonstrated that immediate enteral nutrition improves protein synthesis.
In the present patient case study, 55-year-old Helen had been shifter from thee emergency department to the intensive care unit after suffering a high-speed motor vehicle injury at 22:30. The patient had suffered several high rib fractures and major lung contusion/ haemothorax. In addition, she had a fractured left humerus, left femur and a collapsed pelvis. While in the ICU, she was commenced on maintenance fluid and saline. Vital signs were observed for the next two days whose reports indicated that the patient was haemodynamically stable. Enteral nutrition was after that commenced for the patient. In this case, the patient was not given early enteral feeding since the definition for the same indicates that the feeding is to be given one the very first day of admission to the clinical setting. The observed feeding pattern was late enteral feeding as it was commenced after 48 hours of patient admission to the unit.
Bakiner et al. (2013) have pointed out that late enteral feeding in case of patients who have suffered tissue and organ injury are linked to intestinal inflammation and other adverse outcomes. Under certain conditions, clinicians have the decision making process pertaining to enteral feeding in favour of late enteral nutrition. Delay in advancing enteral nutrition has been criticised widely. Compelling evidence indicates that there are certain drawbacks associated with such practices. Studies have shown that prolonged period of lack of adequate nutritional support delays mucosal atrophy, mucosal nutrition, and causes dysregulation of secretion of trophic hormones. Late enteral nutrition in case of patients suffering trauma augments the chances of mortality. Further, lack of early enteral feeding might lead to sepsis and increased chances of a systematic inflammatory response. Enteral nutrition is to be started soon after the injury to achieve haemodynamic stability and ensure that resuscitation is complete (Jeejeebhoy 2016).
Post surgery, for fixing the pelvis and pinning the femur, the condition of the patient deteriorated considerably. The patient suffered circulatory and ventilation problems, demanding more detailed monitoring. She required blood products due to coagulation disorders, as well as inotrope support for peripheral oedema. While the albumin was 26 g/L, the blood glucose was 8.5 mmol/L. The normal range of albumin in adults is 35-55 g/L, while that of blood glucose is 3.9–5.5 mmol/L (Pocock, Richards and Richards 2013). The laboratory results indicated higher levels of creatinine and urea at 120 umol/L and 12 mmol/L respectively. The reference range for the same is 50-110 umol/L and 1.5-7 mmol/L respectively (Shier, Butler and Lewis 2015). The results indicated kidney damage and increased protein catabolism due to stress and major illness. Normal levels of Haemoglobin in adult females is 120-156 g/L while in the present case it was found to be low at 98 g/L. Further, the patient reported lactic acidosis since the value of lactate was 2.6 mmol/L. The common causes of lactic acidosis are ischemia, respiratory failure, renal dysfunction and sepsis.
On the sixth day, and after a percutaneous tracheometry, there was a rise in the patient’s body temperature with an increased count of WBC. This suggested that the patient had incurred an infection for which antibiotics had to be administered. An early enteral nutrition would have increased the immunity level of the patient and would have prevented infection through bacterial translocation. Laboratory reports indicated renal and liver function impairment. Further, a loose stool indicated complications in the digestive tract. On the tenth day, the patient suffered a circulatory collapse after complaining of nausea, vomiting and abdominal discomfort. Upon discharge, she was found to have lost body fat and reported of weakness. As opined by White, Guenter and Jensen (2017) late enteral nutrition often is unable to cope with the immediate nutritional requirements of a patient in case of severe trauma and injury. For preventing secondary infection, it is pivotal to deliver nutritional support the moment possible. An early enteral nutrition would have better supported the patient in achieving optimal health outcomes.
References
Bakiner, O., Bozkirli, E., Giray, S., Arlier, Z., Kozanoglu, I., Sezgin, N., Sariturk, C. and Ertorer, E., 2013. Impact of early versus late enteral nutrition on cell mediated immunity and its relationship with glucagon like peptide-1 in intensive care unit patients: a prospective study. Critical Care, 17(3), p.R123.
Blaser, A.R., Starkopf, J., Alhazzani, W., Berger, M.M., Casaer, M.P., Deane, A.M., Fruhwald, S., Hiesmayr, M., Ichai, C., Jakob, S.M. and Loudet, C.I., 2017. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Medicine, 43(3), pp.380-398.
Boelens, P.G., Heesakkers, F.F., Luyer, M.D., van Barneveld, K.W., de Hingh, I.H., Nieuwenhuijzen, G.A., Roos, A.N. and Rutten, H.J., 2014. Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial. Annals of surgery, 259(4), pp.649-655.
Jeejeebhoy, K.N., 2016. Nutrition Needs Should Be Modified to Consider Nutrition Status and Acuity of Illness Lessons From the INTACT Trial. Journal of Parenteral and Enteral Nutrition, 40(1), pp.10-11.
McClave, S.A., Taylor, B.E., Martindale, R.G., Warren, M.M., Johnson, D.R., Braunschweig, C., McCarthy, M.S., Davanos, E., Rice, T.W., Cresci, G.A. and Gervasio, J.M., 2016. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Journal of Parenteral and Enteral Nutrition, 40(2), pp.159-211.
Pocock, G., Richards, C.D. and Richards, D., 2013. Human physiology. Oxford university press.
Shankar, B., Daphnee, D.K., Ramakrishnan, N. and Venkataraman, R., 2015. Feasibility, safety, and outcome of very early enteral nutrition in critically ill patients: Results of an observational study. Journal of critical care, 30(3), pp.473-475.
Shier, D., Butler, J. and Lewis, R., 2015. Hole’s essentials of human anatomy & physiology. McGraw-Hill Education.
Sun, J.K., Mu, X.W., Li, W.Q., Tong, Z.H., Li, J. and Zheng, S.Y., 2013. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World journal of gastroenterology: WJG, 19(6), p.917.
White, J., Guenter, P. and Jensen, G., 2017. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition)(vol 36, pg 275, 2012). Journal of parenteral and enteral nutrition, 41(3), pp.520-520.
Yang, S., Wu, X., Yu, W. and Li, J., 2014. Early enteral nutrition in critically ill patients with hemodynamic instability: an evidence-based review and practical advice. Nutrition in Clinical Practice, 29(1), pp.90-96.
Yu, J.H., Cha, W., Wang, H.J., Liu, X.L., Chen, X.F., Yin, Q.H., Ye, G.S., Wang, J., Fang, Y. and Fu, S.N., 2014. The Effect of Tpf Enteral Nutrition on Nutritional Status and Prognosis in Elderly Stroke Patients. Journal of the American Geriatrics Society, 62, pp.S360-S361.
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download