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Section 1 - Introduction

Introduction

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. Please support this web site


This multi-media tutorial is divided into four sections. Each section is divided into individual topics.

  1. Nutrition concepts

  2. Enteral nutrition

  3. Parenteral nutrition

  4. Home Nutritional Support

  5. TPNassist software



For each topic there is an interactive quiz which reviews the important concepts to be learned.

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

A toolbar diplayed at the top and bottom of each page contain icons for navigating through the tutorial. If an icon is "greyed-out" then that action is disabled.
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References and Glossary


System requirements

This multi-media tutorial requires a web-browser which is both Java and Javascript-enabled. In plain English, this means that you will need Microsoft's Internet Explorer 4.0 or higher, or Netscape's Navigator 4.06 or higher. Older versions will not work. If you are using an older version of either program, please be aware that you can upgrade them for free.


Definitions

Let's begin with some definitions of our main subject matter:
Malnutrition
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.
Kwashiorkor
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.
Marasmus
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.


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Section 1 - Introduction