After studying the course materials located on
Module 7: Lecture Materials & Resources
page, answer the following:
Are we morally obliged to this? Why? Example
Briefly describe Enteral Nutrition (EN), including:
NJ tube
NG tube
PEG
Briefly describe Parenteral Nutrition (PN), including:
a. Total parenteral nutrition
b. Partial parenteral nutrition
Submission Instructions:
NUTRITION and HYDRATION
CURE / CARE
BASIC CARE:
• NUTRITION
• HYDRATION
• SHELTER
• HUMAN INTERACTION
SWALLOW TEST (THICKENED FLUIDS)
MEDICALLY ASSISTED N/H
ENTERAL NUTRITION (EN) (GI TRACT)
NUTRITION / HYDRATION (N/H)
PARENTERAL NUTRITION (PN) (LINE; PORT)
ENTERAL NUTRITION (TUBE FEEDING):
• NASO-GASTRIC TUBE (NG TUBE)
• NASO-JEJUNAL TUBE (NJ TUBE)
• PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (
PEG
)
EXAMPLES
OF
ENTERAL
ACCESS
NPO = NOTHING PER ORAL (6-12 HRS)
PURPOSE:
• PREVENT ASPIRATION PNEUMONIA
• UNDERGO GENERAL ANESTHESIA
• WEAK SWALLOWING REFLEX
• GASTRO-INTESTINAL BLEEDING OR BLOCKAGE
PARENTERAL NUTRITION (INTRAVENOUS = IV):
• PARTIAL PARENTERAL NUTRITION (PPN)
• TOTAL PARENTERAL NUTRITION (TPN)
VASCULAR ACCESS
TO
PARENTERAL
NUTRITION
(VENOUS CIRCULATION)
TPN solutions :
• Concentrated
• can cause thrombosis of peripheral veins
• central venous catheter usually required
TPN not used routinely in patients with an intact GI tract
disadvantages:
• It causes more complications
• It does not preserve GI tract structure and function as well (PERISTALSIS)
• It is more expensive
Indications
TPN may be the only feasible option for patients who do not have a
functioning GI tract or who have disorders requiring complete bowel rest.
NUTRITION / HYDRATION
IN PRINCIPLE, ORDINARY CARE
MEDICALLY ASSISTED N/H
ENTERAL NUTRITION (EN) (GI TRACT)
NUTRITION / HYDRATION (N/H)
PARENTERAL NUTRITION (PN) (LINE; PORT)
PEG
ERD 56. A person has a moral
obligation to use ordinary or
proportionate means of preserving
his or her life. Proportionate means
are those that, in the judgment of
the patient, offer a reasonable
hope of benefit and do not entail
an excessive burden or impose
excessive expense on the family or
the community.
ERD 57. A person may forgo
extraordinary or disproportionate
means of preserving life.
Disproportionate means are those
that, in the patient’s judgment, do
not offer a reasonable hope of
benefit or entail an excessive
burden, or impose excessive
expense on the family or the
community.
ERD 58. There should be a
presumption in favor of providing
nutrition and hydration to all
patients, including patients who
require medically assisted nutrition
and hydration, as long as this is of
sufficient benefit to outweigh the
burdens involved to the patient.
N/H, IN PRINCIPLE, ARE ORDINARY MEANS OF LIFE SUPPORT
2 EXCEPTIONS:
• WHEN N/H CAN NO LONGER BE ABSORBED OR ASSIMILATED
• WHEN, IN THE ESTIMATION OF THE DYING PATIENT,
N/H BECOMES AN EXCESSIVE BURDEN
CASE STUDY: TERRY (SCHINDLER) SCHIAVO
(1963 – 2005; AGED 41)
TERRI SCHIAVO TIMELINE
“QUALITY OF LIFE” (SUBJECTIVE)
VS
“SANCTITY OF LIFE” (OBJECTIVE)
SACRED QUALITY OF HUMAN LIFE
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