PEP uP Powerpoint ‐ Long Version
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PEP uP Powerpoint ‐ Long Version
Teaching points:
Use to initiate group discussion – Sample questions could be:
What does it feel like when you are hungry?What do you do when you miss a break/meal?
Key point: Worldwide 50% of critically ill patients are iatrogenically malnourishedKey point: Worldwide, 50% of critically ill patients are iatrogenically malnourished.Helps to get group involved in why this protocol is important.
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PEP uP Powerpoint ‐ Long Version
Hit the highlights of why nutrition is important with a focus on critically ill
Key point: Well nourished patients get better faster with fewer complications.
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PEP uP Powerpoint ‐ Long Version
Key point:
NPO causes loss of structural and functional integrity of the gut. This is associated with increased complications.
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PEP uP Powerpoint ‐ Long Version
Teaching point:
Ultimately we want to improve the delivery of nutrition to critically ill patients.
The PEP uP Protocol gives nurses the tools and responsibility to manipulate enteral nutrition rates to make sure that patients receive nutrition to meet their metabolic requirements.
PEP uP Powerpoint ‐ Long Version
PEP uP Powerpoint ‐ Long Version
Teaching points:
Peptamen is the initial formula for all study patients. This will be reassessed by unit dietitians and the formula may be changed.
What does not change is volume based feeding.
Metoclopramide is started immediately and reassessed daily. If the patient is tolerating feeds motility agent should be stopped after 24 hours tolerating feeds.
All patients are started on protein and motility agents whether they start on volume based or trophic feeds. THE NEED FOR THESE IS TO BE REASSESED DAILY.
PEP uP Powerpoint ‐ Long Version
Teaching point:
All patients are started on volume based feeds unless they meet criteria to be unable to start. Those are discussed on the next 2 slides, and found in the pre‐printed orders.
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PEP uP Powerpoint ‐ Long Version
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PEP uP Powerpoint ‐ Long Version
Teaching point:
These feeds are started in patients who would traditionally have been left NPO. The small volume helps protect the gut until the patient is ready for volume based feeding.
Daily reassessment is essential.
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PEP uP Powerpoint ‐ Long Version
Teaching point:
Must have a contraindication to enteral nutrition.
Reassessment essential.
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PEP uP Powerpoint ‐ Long Version
All participants will have a copy of the flowchart to refer to as well. Remind that they will be using this flowchart during the case study to follow.Key points:Tube placement confirmedHOB 45 – contraindications could include spinal precautions, subarachnoid hemorrhage. Consider reverse trendelenburg when appropriate.Monitor gastric residuals q4h, acceptable residuals 300 ml and less.
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PEP uP Powerpoint ‐ Long Version
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PEP uP Powerpoint ‐ Long Version
Correct answer: Trophic feeds
Teaching point:Continuing to titrate levophed to maintain goal MAP, so not eligible to start volume feeding.Trophic feeds will help protect his gut, and he has no contraindications to feeding.Will need to be reassessed the next day for readiness to transition to volume based feedingfeeding.
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PEP uP Powerpoint ‐ Long Version
Correct: 5 mg q6h
Teaching point: All patients are started on metoclopramide immediately, reduce the dose for patients showing signs of renal impairment.
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PEP uP Powerpoint ‐ Long Version
Key point:
Hemodynamically stable
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PEP uP Powerpoint ‐ Long Version
Correct:Start volume feeds at a target goal rate determined by dietitian.Second , and subsequent days always rely on the dietitan’s assessment of feeding requirements.Key point:These remain volume based feeds so orders should be for a target volume.
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PEP uP Powerpoint ‐ Long Version
Correct: Infuse 300 ml and decrease rate by 25 ml/hr
Refer to gastric feeding flowchart
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PEP uP Powerpoint ‐ Long Version
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PEP uP Powerpoint ‐ Long Version
Correct: 75 ml/hr
Since he needs to be NPO at midnight all of his feed volume needs to be infused by midnight, or in 17 hours total. He has received 150 ml since 0700: 50 ml/hr x 3 hours.1200 – 150 = 1050 ml remaining. 1050ml/14 hours remaining = 75 ml/hr
Teaching point:Need to change the rate so that the 24 target volume is given before the NPO order beginsNeed to change the rate so that the 24 target volume is given before the NPO order begins.Remind that the rate cannot be higher than 150 ml/hr.
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PEP uP Powerpoint ‐ Long Version
Correct: 150Teaching point – reinforcing protocol
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PEP uP Powerpoint ‐ Long Version
Correct answer: 92%
Teaching point:
Report at daily rounds needs to include the percentage of the target volume the patient received in the previous 24 hours. This is calculated by dividing the actual amount given by the target volume and multiplying x 100.
Actual volume/target volume x100 % of target deliveredActual volume/target volume x100 = % of target delivered
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PEP uP Powerpoint ‐ Long Version
Correct : Consider Erythromycin 200 mg Q12hCorrect : Consider Erythromycin 200 mg Q12hRefer to gastric feeding protocol
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PEP uP Powerpoint ‐ Long Version
Correct answer 60 ml/hr
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PEP uP Powerpoint ‐ Long Version
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