29-33: Patient Monitoring During Nutritional Support

Every patient receiving enteral or parenteral nutritional support should be monitored closely. Formal nutritional support teams composed of a physician, a nurse, a dietitian, and a pharmacist have been shown to decrease the rate of complications.

Patients should be monitored both for the adequacy of treatment and to prevent complications or detect them early when they occur. Because estimates of nutritional requirements are imprecise, frequent reassessment is necessary. Daily intakes should be recorded and compared with estimated requirements. Body weight, hydration status, and overall clinical status should be followed. Patients who do not appear to be responding as anticipated can be evaluated for nitrogen balance by means of the following equation:

Patients with positive nitrogen balances can be continued on their current regimens; patients with negative balances should receive moderate increases in calorie and protein intake and then be reassessed. Monitoring for metabolic complications includes daily measurements of laboratory tests including serum glucose, sodium, chloride, potassium, phosphorus, magnesium, calcium, creatinine, and BUN. Once the patient is stabilized, these laboratory tests should be obtained at least twice weekly. Red blood cell folate, zinc, and copper should be checked at least once per month.