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1.
Pharyngostomy.
Koonce, CJ, Richards, WO, Rodning, CB
The American surgeon. 2015;(4):349-53
Abstract
A retrospective analysis of a prospective observational study of a cohort of patients who required prolonged foregut/midgut decompression/intraluminal stenting and/or enteral nutritional support was conducted. Those patients were intolerant of protracted nasogastric intubation. They also manifested hostile peritoneal cavities and therefore were not candidates for a laparoendoscopic gastrostomy or jejunostomy. Accordingly, they underwent insertion of a pharyngogastric or pharyngojejunal tube. With patients properly positioned and anesthetized and with attention to the anatomy of the superior carotid cervical triangle, those pharyngostomies and cannulations were performed safely and efficiently. The tubes remained indefinitely or were changed/removed ad libitum. Morbidity was nil and no mortality attributable to the procedure was observed. Pharyngostomy should be part of the armamentarium of all general surgeons.
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2.
Nutrition support after neonatal cardiac surgery.
Owens, JL, Musa, N
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2009;(2):242-9
Abstract
Congenital heart disease is the most common birth defect in the United States, with an estimated frequency of approximately 12-14 of 1000 live births per year. Neonates with congenital heart disease often need palliative or corrective surgery requiring cardiopulmonary bypass during the first weeks of life. The neonate undergoing cardiopulmonary bypass surgery experiences a more profound metabolic response to stress than that seen in older children and adults undergoing surgery. However, compared with older children and adults, the neonate has less metabolic reserves and is extremely vulnerable to the negative metabolic impact induced by stress, which can lead to suboptimal wound healing and growth failure. There are complications associated with the metabolic derangements of neonatal surgery requiring cardiopulmonary bypass, including but not limited to acute renal failure, chylothorax, and neurological dysfunction. This article discusses the importance of nutrition and metabolic support for the neonate undergoing cardiopulmonary bypass and the immediate postoperative nutrition needs of such a patient. Also, this article uses a case study to examine the feeding methodology used at one particular institution after neonatal cardiac surgery. The purpose of the case study is to provide an illustration of the many factors and obstacles that clinicians often face in the provision and timing of nutrition support.
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3.
Managing under-nutrition in a nursing home setting.
Ali, PA
Nursing older people. 2007;(3):33-6; quiz 37
Abstract
This article considers interventions and strategies used to manage the problems of an undernourished older adult residing in a nursing home. A brief introduction to the patient is followed by a discussion of the process of identifying care needs, and the planning and provision of care based on current evidence and outcome evaluation. The crucial role of nurses in meeting the nutritional needs of older patients is also emphasised.
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4.
Severe acute liver damage in anorexia nervosa: two case reports.
De Caprio, C, Alfano, A, Senatore, I, Zarrella, L, Pasanisi, F, Contaldo, F
Nutrition (Burbank, Los Angeles County, Calif.). 2006;(5):572-5
Abstract
OBJECTIVE Two female patients (18 and 30 y old, body mass indexes 14.1 and 13.2 kg/m2) with severe, restrictive anorexia nervosa developed sudden severe liver damage. In addition to overt protein-energy malnutrition, they showed marked hypotension, bradycardia, dry skin, acrocyanosis, and hypothermia. Most common causes of liver failure, such as hepatotropic viruses, hepatotoxic drugs, alcohol, cannabis, and cocaine abuse, were excluded. METHODS Therapeutic intervention consisted of immediate plasma volume support, progressive parenteral or oral nutritional rehabilitation, and parenteral potassium and phosphorus supplements to avoid the refeeding syndrome. RESULTS AND CONCLUSION Improvement of initial clinical symptoms and rapid recovery of liver enzymes after this type of treatment suggest that severe liver damage in anorexia nervosa may be secondary to acute hypoperfusion.
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5.
The refeeding syndrome and hypophosphatemia.
Marinella, MA
Nutrition reviews. 2003;(9):320-3
Abstract
The refeeding syndrome is an underappreciated entity characterized by acute electrolyte derangements--notably hypophosphatemia--that occur during nutritional repletion of patients with significant suboptimal caloric intake. Adverse effects of hypophosphatemia include cardiac failure, muscle weakness, immune dysfunction, and death. Hypokalemia and hypomagnesemia commonly complicate refeeding syndrome as well; however, this report briefly reviews the clinical manifestations of refeeding-induced hypophosphatemia.
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6.
Ethical decisions regarding nutrition and the terminally ill.
Schwarte, A
Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates. 2001;(1):29-33
Abstract
Care of the terminally ill is rewarding and challenging. Nurses have the potential to affect the quality of these patients' lives. A recurrent theme voiced by terminally ill patients and their families is the nutritional ramifications associated with the cessation of nutritional intake. Various ethical perspectives provide a useful guide for decision making when determining whether fluids and nutrition should be continued in the terminally ill. This article will discuss various ethical perspectives in relation to nutrition cessation in the terminally ill. Basic physiologic changes that occur in the terminal patient will also be addressed. Nurses play an important role in insuring quality of care, particularly in supporting patients and families as they make decisions regarding nutritional management at the end of life.
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7.
A team approach to the treatment of AIDS wasting.
Abbaticola, MM
The Journal of the Association of Nurses in AIDS Care : JANAC. 2000;(1):45-56
Abstract
Despite the aggressive use of antiretroviral agents, AIDS wasting (AW) affects many persons infected with HIV. AW is characterized by a disproportionate loss of metabolically active tissue, specifically body cell mass--tissue involved with glucose oxidation, protein synthesis, and immune system function. AW correlates with poor quality of life and clinical outcomes. This condition requires a multidisciplinary team approach for effective management. Optimal maintenance of lean body mass and reversal of AW involves a combination of appropriate antiretroviral use, opportunistic infection prophylaxis, optimal nutrition, exercise, body composition monitoring, anabolic agents including growth hormone (rhGH[m]) and testosterone supplementation, mental health support, economic aid, and legal assistance. The team approach to treatment of AW requires the coordinated activity of nurses, dietitians, physicians, pharmacists, social workers, case managers, reimbursement personnel, caregiver(s), physical therapists, and the patient. This article, based on clinical experience treating AW, explains how the condition is managed using a multidisciplinary team approach.