The main focus of this course is the practical application of clinical nutrition
principles in day-to-day pharmacy practice. Therefore, the tutorial will cover only
those aspects of basic nutrition support which apply to parenteral and enteral
nutrition. This cursory review is not meant to be a substitute for a course
in clinical nutrition. For more in-depth coverage of this complex subject,
please refer to the publications listed in the
reference section of this review.
This multi-media tutorial is divided into four sections. Each section is divided into
- Nutrition concepts
- Enteral nutrition
- Parenteral nutrition
- Home Nutritional Support
- TPNassist software
For each topic there is an interactive quiz which reviews the important concepts to
At the end of the tutorial, a comprehensive "competency exam" may be taken to
assess your knowledge of the material. The topic quizes prepare you for the "final".
Navigating the tutorial
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through the tutorial. If an icon is "greyed-out" then that action is disabled.
References and Glossary
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Let's begin with some definitions of our main subject matter:
- is a significant loss of lean tissue or inadequate diet for a prolonged period in the setting of severe stress. It is a significant component of many diseases.
- is another term for protein malnutrition.
- Protein malnutrition
- (also Kwashiorkor) is a type of malnutrition classically considered to be caused by dietary deficiency (particularly of protein) that develops over several weeks or months. It is characterized by hypoalbuminemia, anemia, edema, muscle atrophy, delayed wound healing, and impaired immunocompetence. In acute care hospitals in the developed world, a syndrome with important similarities (including rapid development of hypoalbuminemia, impaired immunocompetence, and delayed and ineffective wound healing) follows the stress response. It can be persistent and severe if feeding is not commenced within 7 to 10 days.
- is another term for protein-calorie malnutrition.
- Protein-calorie malnutrition
- (also marasmus) is a type of malnutrition classically considered to be caused by dietary deficiency of protein and calories that develops over months and occasionally years. It is characterized by weight loss, reduced basal metabolism, depletion of subcutaneous fat and tissue turgor, bradycardia, and hypothermia. This type of malnutrition usually results from a mild injury response caused by chronic disease that produces anorexia or semistarvation, with loss of lean tissue.
- Total parenteral nutrition (TPN)
- is a means by which protein, energy, nutrient and metabolic requirements can be delivered by direct venous infusion for those patients who are unable to tolerate, absorb or accumulate sufficient nutrients by the usual enteral route.
- Peripheral parenteral nutrition (PPN)
- is an adjunctive nutritional intervention when central venous alimentation is not possible or necessary. PPN therapy is administered by the small superficial veins of the extremities where blood flow is a fraction of that which streams through the large central veins of the body, where TPN is usually provided.
- Home parenteral nutrition (HPN)
- is indicated for demonstrated small bowel failure and other diseases where hospitalization is not needed and there is potential for improving the patientís quality of life. Adequate care must exist in the home environment for HPN to be successful.
- Cyclical parenteral nutrition
- is the administration of parenteral nutrients only at night. Home parenteral nutrition is generally administered this way.
- Enteral nutrition
- is nutrition provided by long-term (gastrostomy or jejunostomy) or short-term (nasogastric, nasoduodenal, or nasojejunal) tube feedings.