nutrition part 2.docx

Adequate nutrition is evident by a person’s physical appearance, weight, and other measurements such as blood pressure and cholesterol levels. A healthy weight indicates that a person has the correct amount of body fat in relation to their overall body mass. A healthy weight promotes an energetic fe...

Adequate nutrition is evident by a person’s physical appearance, weight, and other measurements such as blood pressure and cholesterol levels. A healthy weight indicates that a person has the correct amount of body fat in relation to their overall body mass. A healthy weight promotes an energetic feeling, prevents premature aging, and deceases health risks. A body mass index (BMI) calculator can help determine if a person is at a healthy weight or needs to lose or gain weight. The BMI is calculated by determining a client’s weight in pounds and height in inches. The client’s weight is first divided by their height, and then this calculation is repeated once more. This number is then multiplied by 703 to obtain the client’s BMI. BMI categories include underweight, normal weight, overweight, and obesity. A BMI of less than 18.5 is considered underweight, while a BMI of 18.5 to 24.9 is considered normal (or healthy). A BMI of 25 to 29.9 is overweight, and a BMI of 30 or greater is categorized as obese. However, the calculation of the BMI does not always account for clients who are lean, such as athletes, and may overestimate their BMI because muscle weighs more than fat. Conversely, the BMI may be underestimated for clients who are less lean and have excess adipose tissue. While weight is of importance, cholesterol levels and blood pressure should be within the expected reference ranges as well. Elevated cholesterol levels and high blood pressure increase an individual’s risk of developing heart disease. A person can have an appropriate weight and BMI but have inadequate nutrition, leading to high blood pressure and cholesterol. To prevent this problem, clients should follow a healthy diet, exercise, lose weight if indicated, and quit smoking or using tobacco products. A diet rich in foods containing antioxidants helps protect the cells from free radicals, which promote the development of cancer, heart disease, and other diseases. The best sources of antioxidants are plant-based foods, including vegetables, whole grains, fruits, nuts, and seeds. A diet with adequate protein intake helps prevent brittle hair and hair loss. Assessing the condition of a person’s hair and skin can give an indication of their nutritional status. Energy levels are also affected by nutrition. Eating a balanced meal with adequate calories and nutrients allows a client to concentrate and have energy throughout the day. Consuming foods with easily identifiable ingredients and eating more real foods while cutting processed food intake supports a healthy diet. This includes avoiding frozen meals, cookies, and chips, and eating more fruits, grains, vegetables, protein, and healthy fats. This way of eating promotes portion control, decreased calorie intake, and increased nutrients. Adding adequate water intake will quench thirst while preventing overeating, since thirst is commonly confused with hunger. There are several signs that can indicate a person is not getting proper nutrition in their daily diet. Fluctuations in a person’s weight, teeth, hair, skin, brain, digestion, and immune system can all be driven by poor nutrition. A poor diet can lead to inflammation and bleeding in the gums, while too much sugar intake can lead to cavities. A diet low in vitamin C can cause irritation in the gums. Increasing vitamin C intake by eating foods such as tomatoes, leafy green vegetables, strawberries, and potatoes may improve oral health. Decreasing intake of sugary beverages and foods can help decrease cavities. Clients whose teeth and gums are affected by poor dietary choices require education on improving their diet and oral health. Hair requires an adequate intake of protein to be healthy. Without sufficient protein, hair can become brittle, and hair loss can occur. Diets lacking in vitamin C, zinc, iron, and essential fatty acids can also cause hair loss, thinning, and loss of pigmentation. Consumption of lean protein sources such as salmon and eggs, along with vegetables, fruits, seeds, and nuts, help promotes healthy hair. It is normal for the skin to show changes related to aging, but skin health is also directly related to nutrition. A healthy diet can delay signs of skin aging. Consuming a diet rich in vitamins A, C, D, and E will promote skin health, and eating five or more servings of fruits and vegetables per day can help improve the skin’s appearance. To support brain health, clients should consume a diet with adequate omega-3 fatty acids. Eating flax seed, walnuts, fish oil, and wild salmon increases omega-3 intake and can help prevent feelings of fatigue and loss of memory or concentration. Omega-3 fatty acids are also available in supplement form. Clients who have a deficit intake of omega-3 fatty acids should discuss the need for supplementation with their provider. When digestive issues such as constipation and diarrhea arise, they can indicate that a person is not getting enough fiber. Increasing daily fiber intake by eating more whole grains, including brown oats and rice, nuts, seeds, fruits, and vegetables, should help alleviate these discomforts. Females should eat 25 g of fiber per day, while men should get 38 g of fiber daily. Fiber is also available as a supplement, but clients should discuss its use with the provider before starting such supplementation. A diet with adequate nutrients, protein, and calories helps the body heal faster and can help prevent infection. Nutrient-rich foods, such as those high in vitamins A, C, and E, iron, zinc, and folic acid, boost the immune system and assist in preventing illness. Fresh fruits, vegetables, and whole grains promote a healthy immune system due to their high vitamin and nutrient content. Supplemental vitamins are available but should not be used in place of dietary choices. A nutritional assessment includes a collection and review of the client’s dietary habits to determine if all of the necessary nutrients are being consumed and if there are any health issues related to the client’s nutritional intake. Reviewing a client’s daily intake of food, including the quality and quantity, will give the nurse a better understanding of the client’s overall nutritional intake. A 24-hour recall is performed to see what the client has consumed in the last 24 hours, including different foods and portion sizes. A food frequency questionnaire aims to determine the client’s typical food consumption based on a list of foods. Nurses can use these kinds of tools to obtain a better understanding of clients’ daily intake and to identify gaps in their nutrition. Along with reviewing the client’s dietary habits, the nurse should inspect the client’s teeth, hair, and skin while checking the client’s weight and note any conditions that do not match the expected findings. Height and weight measurements will be used to determine the client’s BMI. The nurse should also ask the client if they are experiencing any digestion issues that may indicate a need for dietary changes. Obtaining blood pressure levels and reviewing the results of laboratory reports, including cholesterol levels, will assist the nurse in determining if dietary recommendations are required. Reviewing the client’s medical history will inform the nurse of any risk factors the client may have that will affect their nutritional status. In particular, lack of appetite, decreased hunger, illness, or medications can impact a client’s nutritional status. Eating disorders will also affect a client’s nutritional status, including anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant or restrictive food intake disorder. After gathering the information regarding the client’s nutritional status, the nurse should report unexpected findings to the provider. Depending on a client’s health, eating, chewing, and swallowing abilities, a specific diet geared toward meeting any deficits may be required. Special diets include NPO (an abbreviation of a Latin term meaning “nothing by mouth”), regular, soft, pureed, liquid, cardiovascular, and renal. The provider will determine which diet is appropriate for the client. Part of the nurse’s responsibility is to ensure that the client receives the correct diet based on the provider’s prescription and to promote adequate nutritional intake. The nurse’s role may include helping feed the client or preparing the client to eat. NPO diets can be prescribed for various reasons. An NPO diet restricts the client from eating or drinking anything until the diet is advanced. Such a diet may be prescribed due to the client’s inability to safely eat and drink, a scheduled surgery, or an upcoming diagnostic test that requires fasting or for the stomach and intestines to be empty. Nurses should clarify with the provider if the NPO status extends to medications as well. Maintaining NPO status prior to surgery or procedures helps to protect the client from aspirating while under sedation. Aspiration occurs when food contents or fluids accidentally enter the lungs. A client may also be placed on an NPO diet due to dysphagia, or the inability to safely swallow food. This will protect the client from aspiration and associated complications, but other choices of nourishment must be prescribed. If a client is NPO before a procedure, the provider should determine the specific time frame for how long the client needs to remain NPO. The provider will also specify when the client may resume eating and which diet is to be prescribed. A regular diet consists of healthy foods coming from all of the food groups, such as fruits, vegetables, grains, protein, and dairy sources. When a regular diet is ordered, the client should not have any significant health concerns, and have no restrictions on salt and sugar. A client eating a regular diet should also have no issues with chewing and swallowing, as all foods are allowed. The nurse should help guide the client in making healthy food choices. This includes increasing water intake and limiting sugar, alcohol, saturated fats, and trans fats. Another diet that may be prescribed for a client is a soft diet. A soft diet contains foods that are soft, easy to digest, low in fiber, and can be swallowed without difficulty. This type of diet can be maintained for the short or long term, depending on the client’s medical condition. A soft diet may be prescribed for clients recovering from surgeries on particular areas of the body, such as the jaw, mouth, or abdomen. It may be necessary for a client who is having swallowing difficulty due to use of medications such as narcotics, muscle relaxants, and medications for anxiety. Clients who have dysphagia may be placed on a soft diet for the long term. Soft diets include foods that are typically bland without a lot of seasoning, such as well-cooked vegetables, low-fiber cereals, and easy-to-chew proteins. Examples include plain cake, fruit juices without pulp, tender cuts of beef, creamy nut butters, and cooked fruit without the skin or seeds. If a client has difficulty chewing or swallowing, has had recent oral surgery, or is experiencing numbness in the mouth, a pureed diet may be prescribed. A pureed diet consists of foods that are soft and smooth and do not need to be chewed. Foods that can be eaten on a pureed diet include pudding, mashed potatoes, yogurt, juices without pulp, baby food, pureed meats, broths, and ice cream. A full liquid diet is a diet that contains only fluids, foods that are liquids, and foods that are liquids at room temperature, such as ice cream. Other examples include juices, pudding, milkshakes, tea, strained soups, protein shakes, and gelatin. Solid foods are not allowed on a full liquid diet. This diet may be prescribed if a client is postoperative from abdominal surgery, is experiencing dysphagia, or prior to undergoing certain procedures. A clear liquid diet contains only clear liquids, such as broth, gelatin, and water. Foods that can be seen through, such as gelatin, can be included on a clear liquid diet, as well as foods that partly or completely melt at room temperature. Other acceptable foods include tea, fruit juices without pulp, and sports drinks. In essence, this diet consists of easily digestible foods that do not leave undigested residue in the intestinal tract. It is intended to decrease the strain on the digestive system while keeping the body adequately hydrated. Solid foods should not be eaten while on a clear liquid diet. A clear liquid diet may be required before or after certain procedures, following surgery, or due to digestive issues. It should be restricted to no more than a few days due to the limited amount of calories and nutrients that it offers. Liquids or gelatin with red coloring need to be avoided for colon procedures and tonsillectomies to avoid any confusion with possible bleeding. A clear liquid diet is also appropriate for clients who are experiencing nausea, vomiting, and diarrhea. A diet plan designed to improve or maintain cardiovascular health is known as a heart-healthy diet. A heart-healthy diet focuses on controlling portions, consuming more fruits and vegetables, increasing whole grains, limiting unhealthy fats, eating low-fat protein sources, and decreasing sodium intake. Such a diet is beneficial for everyone, but it is especially critical for clients who have a history of cardiovascular disease and other related ailments. Portion control is utilized to control calorie intake and promote weight loss if needed. While portions of nutrient-rich foods such as fruits and vegetables should be increased, decreasing portions of high-calorie and high-sodium foods is key to maintaining good cardiovascular health. Fast foods and foods that are processed should also be limited. Whole-grain foods such as wheat bread and pastas contain fiber and other nutrients that can promote heart health and blood pressure regulation. Thus, whole grains should be included in the diet instead of their refined counterparts, such as white bread. To decrease cholesterol levels and the risk for heart disease, consumption of saturated fats should be limited and trans fats avoided. Low-fat protein options such as lean meats, skim milk, and fish also promote heart health. Controlling sodium intake is a key element of a heart-healthy diet. High sodium intake can lead to hypertension and an increased risk for heart disease. A healthy adult should consume no more than 2,300 mg of sodium, or a teaspoon of salt, per day. This amount is decreased for clients with preexisting heart disease. Strategies to decrease the intake of sodium include not adding salt to foods while cooking or at the table. Clients should be reminded to pay attention to nutritional labels and avoid purchasing foods with high sodium content. If purchasing canned foods, clients should substitute no-salt-added versions of soups and vegetables. The kidneys play an important role in the body by removing extra fluid and wastes. The kidneys also maintain the balance of water and minerals in the blood. When kidney disease is present, this balance is disrupted. In turn, it is important for clients who have kidney disease to monitor and limit their intake of minerals such as potassium, phosphorus, and sodium. A renal diet offers guidance to clients who have kidney disease in controlling the intake of these minerals. Methods of limiting sodium intake include: Avoiding table salt Not adding salt to foods while cooking them Avoiding processed meats such as lunch meats, hot dogs, bacon, and sausage Consuming “no salt added” foods Avoiding soups unless they are low sodium and eating only one serving Reading food labels to determine the amount of sodium per serving Clients who have kidney disease should also limit their intake of potassium, as high potassium levels can lead to heart dysrhythmias and increase the risk of myocardial infarction. Thus, limiting, and if possible avoiding, potassium-rich foods may become necessary for a client who has kidney disease. Nurses should educate clients on which foods contain high amounts of potassium, such as the following: Bananas Grapefruit juice Honeydew melons Cantaloupe Dried beans Prune juice Tomatoes Tomato sauce Tomato juice Oranges Orange juice Greens such as spinach, collards, kale, and Swiss chard Potatoes and sweet potatoes may be eaten in small amounts. Granola, bran cereals, and molasses should be limited or avoided. The nurse should teach clients to avoid salt substitutes or foods labeled as containing “lite salt,” as these often contain potassium. As with potassium, excess phosphorus can accumulate in the blood when the kidneys do not function properly. High phosphorus levels can increase the risk for bone disease, as calcium is pulled from the bones. This increases a client’s risk for fractures. To prevent excess levels of phosphorus from building up in the blood, the nurse should instruct clients on which foods should be avoided or limited. These include the following foods: Dairy: Limit to 1 cup of milk per day or 1 ounce of another dairy product such as yogurt or cheese. Dried beans: Limit to 1 cup per week. Mushrooms: Limit to 1 cup per week. Broccoli: Limit to 1 cup per week. Brussels sprouts: Limit to 1 cup per week. Eat white bread versus whole-grain bread. Bran, wheat cereals, granola, and oatmeal: Limit to 1 serving per week. Beer: Avoid. Soft drinks: Drink clear drinks, but avoid colas, root beers, and similar beverages. Many different nutritional supplements are available on the market today. However, clients should seek guidance from their provider before adding supplements to their daily regimen. While vitamins are readily available, some supplements contain herbs, amino acids, minerals, enzymes, and other components. Supplements are also available in many forms, such as capsules, gummies, powders, drinks, food, and tablets. Each supplement should have a nutritional label containing information such as serving size, active ingredients, and other ingredients including fillers and flavorings. These products can be used to provide essential nutrients if deficiencies exist, but they should not be used to replace a healthy diet. While supplements cannot replace a varied, nutritious diet, some are known to improve health. Folic acid helps to decrease the risk of birth defects in neonates, while calcium and vitamin D help maintain bone strength and reduce bone loss. Omega-3 fatty acids may increase heart health by reducing triglycerides and blood pressure. Vision loss can be slowed by taking a combination of vitamin C, E, zinc, lutein, copper, and zeaxanthin. It is important to note that the FDA does not approve or regulate dietary supplements before they are made available for sale. Some supplements may potentially interact with other medications a client may be prescribed. To guard against this possibility, clients should always speak with their provider before beginning any supplement regimen. Examples of supplement interactions with medications include the following: St. John’s wort can decrease the effectiveness of medications including birth control, cardiac medications, and antidepressants. Vitamin K reduces the effectiveness of warfarin, an anticoagulant, which can increase the risk of blood clots. Antioxidant supplements, including vitamin C and E, can reduce the effectiveness of chemotherapy. Toxicity can also occur if supplements are taken in excess. For example, increased levels of iron can lead to nausea and vomiting while risking damage to the liver. Excess vitamin A can cause headaches, lead to birth defects, and decrease bone strength. A pregnant or nursing client should not take supplements without first consulting with their provider. Children should also not take supplements unless those products are specifically prescribed by their provider. It is important for nurses to question clients about their use of supplements while conducting a nutritional health assessment, and providers should approve all supplement use to prevent unwanted outcomes. Aspiration occurs when something enters the lungs other than air, including food, liquid, or other materials. Aspiration is prone to happening if a client has difficulty with swallowing—for example if the client has dysphagia or poor swallowing reflexes. Medical conditions that put a client at increased risk for aspiration include stroke, acid reflux, mouth sores, and dental issues. Overt aspiration presents with noticeable symptoms such as sudden cough, wheezing, trouble breathing, congestion, heartburn, throat clearing, or chest discomfort, as the body recognizes a foreign object going into the airway and attempts to clear it. Silent aspiration has no obvious symptoms. There are several ways to help a client prevent aspiration while eating and drinking. Diet modifications can help prevent aspiration in the client who has dysphagia. Providers may prescribe thickening of liquids with gels or powders, as thinner liquids are easier to aspirate. Thickened liquids can be mildly thick, like nectar; moderately thick, like honey; or extremely thick, with a pudding consistency. When adding thickener to liquids, it is important for the liquid to reach the expected consistency before the client consumes it. Thickness can be verified by stirring the liquid after the thickener has been added and then tilting the spoon to see how fast the liquid flows off of it. Examples of liquids that may be thickened to prevent the risk of aspiration include milk, tea, water, coffee, soup, juice, and nutritional supplements. To prevent aspiration, nurses should carefully assess clients who are at risk for dysphagia. If manifestations of aspiration are noted, nurses should place the client on NPO status and notify the provider immediately. While clients are at risk for aspiration during eating and drinking, those receiving nutrition through tube feedings are also at risk for this complication. Alterations in vital signs such as decreased oxygen saturation and increased heart rate, blood pressure, and respiratory rate, along with audible wheezing, are manifestations of tube feeding aspiration. Indications that a client has experienced tube feeding aspiration include difficulty or painful breathing, wheezing, a productive cough, or a fever of 38°C (100.4°F). If any of these manifestations occur, the nurse should stop the tube feeding and immediately notify the provider. Nurses are responsible for ensuring that clients receive the assistance they need during mealtimes. While some clients are independent during meals, others may need assistance, ranging from setting the meal up to actually feeding the client. The goal for all clients is to provide nutritional support and prevent any complications that may occur. RNs must assess their clients’ ability to safely swallow before delegating the responsibility of feeding to other personnel. The nurse’s role in promoting nutrition for clients includes providing assistance in making food choices based on the particular diet the client is prescribed and their individual food preferences; assessing clients’ ability to chew and swallow; and determining the amount of support clients will need to feed themselves. For clients who can feed themselves, note whether they require assistive devices, such as utensils with easy-to-grip handles. Assistive devices are tools or equipment that help a client perform activities or tasks more easily. Encourage clients to feed themselves if able, so as to promote independence. Before the meal arrives, position the client upright in a chair, sitting at 90°, to prevent aspiration. If the client is unable to sit in a chair, raise the head of the bed to 90° and use pillows as support. After these issues are addressed and the client is correctly positioned, note if they have all of the necessary items within their reach. Once the meal tray has arrived, the nurse or assistive personnel (AP) can help the client remove lids and unwrap packets if necessary. The food should also be cut into bite-sized pieces, which can be done by the client if able. Some clients will need further assistance to eat throughout their meal. Clients may need to use various swallowing techniques to decrease the risk of aspiration while eating and to improve their ability to clear their throat. These techniques should be taught by a speech therapist. Clients who have dysphagia or are at risk for aspiration should receive a referral for an evaluation by a speech therapist. Following a swallowing evaluation, the speech therapist will determine which technique is appropriate for the client. Glucose is the primary sugar found in the blood. It comes from food ingested by the individual and is the body’s major source of energy. Blood glucose monitoring is performed to determine a client’s glucose level. Clients who have diabetes need their glucose checked on a routine basis; however, any client may have their glucose checked at any given time. Glucose monitoring can be done at the bedside by obtaining a capillary blood sample and testing it using a glucose meter. This skill can be performed by an RN, PN, or trained AP, according to facility policy. Blood glucose monitoring is performed to evaluate changes in the client’s blood glucose level, and is an important management tool for clients who have diabetes. Blood glucose levels outside of the expected reference range require intervention. Other reasons to check blood glucose levels include tracking the progress of current treatments, determining how a client’s diet is affecting glucose levels, and monitoring the effect of sickness or stress on the body. Common times to check blood glucose levels include before or after meals or exercise, prior to going to bed, during times of illness, with the start of new medications, or when the client’s daily routine changes. A fasting blood glucose is a blood glucose level that is taken after a client has been NPO for at least 8 hours. The expected reference for a fasting blood glucose level for a client who does not have diabetes is less than 100 mg/dL. A blood glucose level of less than 140 mg/dL after eating 2 hours prior is considered within the expected reference range. Low blood glucose, or hypoglycemia, occurs when the blood glucose level is less than 70 mg/dL. If a client is experiencing hypoglycemia, the goal of treatment is to increase the blood glucose level back to the expected reference range. This is accomplished by providing the client with food that contains at least 15 g of carbohydrates—for example, 4 ounces of soda or juice, 1 tablespoon of honey, or 5 to 6 hard candies. The client’s blood glucose level should then be rechecked 15 minutes later, and this process repeated until the blood glucose level is above 70 mg/dL. The provider should be notified if the interventions to increase the client’s blood glucose level are unsuccessful. Insulin is prescribed for some clients with diabetes. Insulin is made in beta cells in the islets of Langerhans, which are located in the pancreas. This hormone helps lower the blood glucose in the body by either using the sugar obtained from food to energize the cells or storing it. The alpha cells located in the islets of Langerhans are responsible for making glucagon, an antagonist to insulin that raises the blood glucose. tissue. Inject the insulin and then remove the needle following safety precautions. Perform hand hygiene and ensure that the client tolerated the medication well. A gastrostomy tube (G-tube) is a tube that delivers nutrition directly into the stomach. It is inserted through the abdomen and is indicated for clients who are unable to consume enough nutrition on their own. The placement of a G-tube is performed by a surgeon, in a procedure that takes about 30 to 45 minutes. Prior to the procedure, x-rays will be taken to provide the surgeon with a view of the client’s digestive tract. The client is required to remain NPO for at least 8 hours prior to the procedure. Three methods are used to insert G-tubes: percutaneous endoscopic gastrostomy (PEG), laparoscopic technique, and open surgery technique. The most common technique used for G-tube placement is the PEG procedure. A G-tube can provide all of a client’s dietary intake, or it can be used to supplement any nutritional deficiencies the client may be experiencing. A nasogastric (NG) tube is a thin plastic tube that is inserted into the nostril and down the esophagus, with the end placed in the stomach. It is primarily used to provide nutrition and medication to a client, but can also be used to remove contents from the stomach in the event of a client ingesting a harmful substance, poison, or too much medication. The removal of stomach contents is facilitated by attaching the NG tube to suction. NG tubes are placed following a prescription by a provider and are inserted by an RN or PN who has demonstrated competency in the skill. Placement of the NG tube must be verified by x-ray prior to its use. The tube is taped to the client’s nose to secure it. A nasoduodenal tube is inserted into the nasal passage, with the tip placed past the stomach and in the duodenum. Nasoduodenal tubes are used primarily for feedings—namely, for clients needing long-term enteral feedings or who require total or supplementary feedings and for whom gastric feeding is not appropriate. Fluoroscopic assistance can aid in achieving appropriate positioning of this tube during insertion, and an abdominal x-ray can confirm placement before the tube is used. Enteral nutrition is dietary intake via a medical device such as a feeding tube. Enteral feedings are prescribed for clients who do not have adequate oral intake or nutrition that can meet their metabolic needs. Such feedings are often used for clients who cannot eat safely due to swallowing impairments or dysphagia. Tube feedings can provide a client’s total sustenance, or they can be used to supplement the diet. For example, a client who consumes a modified diet due to dysphagia, but is unable to meet their daily nutritional needs through their daily diet, would be prescribed enteral nutrition. Enteral nutrition has been associated with improved nutrition, lower incidence of infection, and decreased days in the hospital. It is the preferred mode of feeding versus parenteral nutrition. Nevertheless, enteral nutrition is not ideal for all clients. Some contraindications include gastrointestinal bleeding, small or large bowel obstruction, and bowel ischemia. Enteral nutrition can be given on a short- or long-term basis depending on the individual’s clinical condition. Refer to Skill: Administering Enteral Nutrition. Parenteral nutrition is dietary intake that is administered intravenously (IV). Parenteral nutrition prevents malnutrition in clients or, if the client is already malnourished, can help correct it. This type of feeding provides liquid nutrients such as proteins, fats, carbohydrates, minerals, electrolytes, and vitamins. Clients with a digestive system that cannot absorb or tolerate adequate food eaten by mouth can utilize parenteral nutrition. Parenteral nutrition, in the form of IV fluid, is administered into a large vein through a venous access device. The provider can individualize the nutrition provided for a client by monitoring their serum laboratory results. These lab measurements let the provider know how the client is responding to the parenteral nutrition and allow for evaluation of the fluid balance, catheter site, and client’s ability to move to tube feedings or normal (by mouth) feeding. Refer to Skill: Administering Parenteral Nutrition. Parenteral nutrition can be administered as either partial parenteral nutrition or total parenteral nutrition. Partial parenteral nutrition supplies a client with only part of their nutritional requirements, allowing for supplemental oral intake. In contrast, total parenteral nutrition gives the client their total daily nutritional requirements. For clients without a functioning GI tract, total parenteral nutrition may be the only option. A complication of total parenteral nutrition is abnormalities in glucose, including high blood glucose.