Basic Care Wound Care Diabetic Care Incontinence Care

  • Slides: 96
Download presentation
. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Clinical

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Clinical Nutrition 1 Basics of nutrition Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/1/96 B|BRAUN OPM . Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Please

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Please note: For printing this presentation please choose the here mentioned selection to prevent that some text fields will be printed with frames. Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/2/96 B|BRAUN OPM . Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care Significance of Nutrition energy well-being body mass health Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/3/96 B|BRAUN OPM . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Energy Transfer nutrients O 2 ATP NH 3 chemical energy transfer CO 2 · mechanical energy muscles H 2 O · osmotic energy transport of substances · chemical energy biosynthesis, reactions Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/4/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Energy Units 1 k. Joule: quantity of energy needed to move 1 kg 1 m forward by the power of 1 Newton (1 k. J = 0, 24 kcal) 1 kcal: quantity of energy needed to warm 1 kg water from 14, 5 up to 15, 5 °C (1 kcal = 4, 186 k. J) Energy density of nutrients carbohydrates fat protein Basics of Nutrition 2003 -01 -09/5/96 k. J/g 4 17 9 alcohol Clinical Nutrition 1/OPM Germany/Stand 02 kcal/g 38 4 17 7 29 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Energy Requirement total metabolism = basal metabolism + activity metabolism basal metabolism = energy required in the state of complete resting (fasting 12 h) to maintain body functions activity metabolism metabolic = energy required in addition to basal rate obligat for · musculation · digestion and metabolism · cellular reactions Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/6/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Determination of Energy Requirement 25 - 35 kcal/kg body weight basal metabolic rate (BMR) in kcal according to Harris-Benedict (1919) f = 655, 1 + 9, 56 x body weight (kg) + 1, 85 x height (cm) - 4, 7 x age (years) m = 66, 5 + 13, 75 x body weight (kg) + 5 x height (cm) - 6, 8 x age (years)p female (f), male (m) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/7/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Total Energy Metabolism (in kcal) according to Long et al. 1979 total metabolism = basal metabolism x activity factor x illness factor activity factor illness factor bed rest x 1, 1 serious operation little activity x 1, 3 fever cancer 1, 2 - 1, 5 infections for each increased °C + 13 % example: 38 °C x 1, 13 39 °C x 1, 26 - little - serious (sepsis) - burn not in addition to illness factor Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/8/96 B|BRAUN OPM x 1, 2 x x 1, 3 x 1, 6 x 1, 5 - 2, 0 .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Increased Requirement of Energy • diseases • stress metabolism • convalescence • loss of energy-rich substances • hormone disorders • growth • pregnancy (+ 300 kcal/d) • lactation period (+ 700 kcal/d) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/9/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Digestion mouth • food intake · chewing and insalivation · registration of taste · initiation of digestion of starch · transportation stomach • desinfection of chyme · initiation of digestion of fat and protein · dilution of chyme to decrease osmolarity · deposition in portions into small intestine (functioning as a reservoir) esophagus • transportation · esophageal sphincter prevents reflux Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/10/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Digestion pancreas gall bladder • excretion of enzymes into small intestine • storage of bile acids - -amylase ( digestion of carbohydrates) · of bile acids into duodenum - pancreas-lipase ( digestion of fat) (emulsification of fats) - peptidase ( digestion of protein) • excretion of hormones into blood - insulin - glucagon Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/11/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Digestion small intestine large intestine • reabsorption of water - duodenum (0, 3 m) - jejunum (1, 3 m) - ileum (1, 6 m) - ileocecal valve • resorption of electrolytes • bacterial fermentation of • enzymatic decomposition of nutrients • resorption of nutrients and water • reabsorption of bile acids Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/12/96 - not digested carbohydrates and proteins - dietary fibers ( short-chain fatty acids and gases) B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Location of Resorption for Different Nutrients pancreatic enzymes bile peptides, fat amino acids water magnesium bile salts electrolytes, short-chain fatty acids water colon stomach vitamines calcium ferrum monosaccharid es Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/13/96 B|BRAUN OPM vitamin B 12

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . . Nutrition Care Stoma Care . Areas of Resorption of Fats, Proteins and Carbohydrates stomach duodenum ileum jejunum fat protein carbohydrates resorption in reserve Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/14/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Metabolism Liver • synthesis of fatty acids, ketone bodies, some proteins (for instance albumin, transferrin, acute-phase proteins) • regulation of amino acid pool in the blood · production of bile acids · storage organ for glycogen, vitamines · detoxification of alcohol, drugs, ammonia Blood · transport of nutrients, oxygen and decomposition products • transport of nutrients to organs Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/15/96 B|BRAUN OPM Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Body Composition 1 kg ~ 1, 5 % carbohydrates 9 kg ~ 13, 8 % fat 11 kg ~ 17, 0 % protein 40 kg ~ 61, 6 % water 4 kg = 65 kg Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/16/96 B|BRAUN OPM ~ 6, 1 % minerals

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care Nutrients Macronutrients Micronutrients • water • vitamines • protein • minerals • carbohydrates • trace elements • fat • phytochemicals • dietary fibers Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/17/96 B|BRAUN OPM . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Carbohydrates Monosaccharides = simple sugars Polysaccharides • glucose (grape sugar; glc) · fructose (fruit sugar; fru) · galactose (gal) · xylose • starch (glc-reserve in plants) • dextrins (fragments of starch) • glycogen (glc-reserve in animals) • dietary fibers Disaccharides = dual sugars Glucose-substitutes • saccharose (glc-fru) = unrefined sugar · sorbitol (alcohol of glucose) · maltose (glc-glc) = starch hydrolysate · xylitol (alcohol of xylose) · lactose (glc-gal) = milk sugar Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/18/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Digestion of Carbohydrates organ enzyme reaction -amylase mouth dextrin starch maltose stomach --- --- pancreas -amylase starch dextrin maltose small intestine fru saccharose glc + saccharase maltase lactase maltose glc + glc lactose glc + gal B|BRAUN large intestine OPM bacterial degradation of indigestible carbohydrates Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/19/96

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Function of Carbohydrates • energy substrate • energy storage 1 g glucose = 4 kcal in form of glycogen in liver and muscels • component of membranes and intercellular substance Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/20/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Significance of Glucose • the only energy source utilized by all body cells • obligatory fuel for: 1. central nervous system (supply with energy after long periods of fasting also by ketone bodies) 2. erythrocytes 3. renal medulla 4. bone marrow 5. granulation tissue • daily minimum requirements: ca. 150 g Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/21/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Glycemic Index example: glycemic index of oranges (53 %) 25 g glucose = 25 g carbohydrate 280 g oranges = 25 g carbohydrate time (minutes) glycemic index = comparison of blood glucose above the fasting value after administrating glucose and after test meal. Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/22/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Glycemic

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Glycemic Index Substrate specific: • quantity and quality of dietary fibers • amount of indigestible starch • processing of foods • composition of meal Subject specific: • individual metabolism • individual digestion • medication (e. g. insulin) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/23/96 B|BRAUN OPM . Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Digestion of Long-Chain Triglycerides (LCT) organ release of stomach acidic lipase cholecystis bile acid pancreas-lipases reaction/function TG 1 FFA (free fatty acid) + diacylglycerol emulsification of fats TG 2 FFA + monoacylglycerol 1 FFA + glycerol small intestine - intestinal lumen --- intestinal cell Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/24/96 --- resorption of FFA, mono- and diacylglycerol, glycerol resynthesis to TG in chylomicrons, release into lymphatic system B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Cellular Metabolism of Triglycerides LCT MCT transport lipoprotein-bound as free triglycerides hydrolysis in blood and in liver slowly fast transport liver as triglycerides as remnants of chylomicrons and VLDL transport into mitochondrions activation by coenzyme A carnitine-dependent transport Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/25/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Cellular Metabolism of Triglycerides LCT MCT rate of oxidation low high hepatic stress high low stress of RES* high low tissue-pexis high low protein-saving effect low high immune system immuno-modulation immunological neutral * reticuloendothelial system Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/26/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Advantages of MCT-Fats compared to LCT-Fats • fast resorption • direct transport via portal vein into liver • more efficient oxidation • immunological neutral Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/27/96 low liver burden protein-saving effect maintenance of immune-functions B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Functions

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Functions of Fats • energy substrate (triglycerides) 1 g fat = 9 kcal • energy storage (triglycerides) • cell structure component of membrane (phospholipids) • bioactive substances (for instance for prostaglandins) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/28/96 B|BRAUN OPM . Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Recommendations for Fat Uptake relation of fatty acids saturated/ monounsaturated/ polyunsaturated fatty acids • w-3 fatty acids: maximum of 3 % kcal • relation of w-6 to w-3 fatty acids: 3 - 5 : 1 • polyunsaturated fatty acids: maximum of 10 % kcal Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/29/96 B|BRAUN OPM Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Recommendations for Linoleic Acid Uptake • requirement of linoleic acid (w-6 FA) : 7 - 10 g/day (healthy subjects) in case of serious stress-metabolism requirement may double • excessive supply of linoleic acid imbalances of the pattern of fatty acids disorders of immune system • deficiency of linoleic acid (essential fatty acid deficiency/EFAD) disorders in wound healing skin alterations: xerosis, redness, incrustation thrombocytopenia Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/30/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . . Infusion Care

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . . Infusion Care Nutrition Care . Stoma Care . Classes of Fatty Acids w-9 example oleic acid C 18: 1 w-6 example linoleic acid C 18: 2 w-3 example -linolenic acid C 18: 3 Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/31/96 B|BRAUN OPM = = COOH = = = COOH

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care Protein Structure · smallest unit: amino acid (AA) · 20 proteinogenous amino acids · peptide bond between acid- and aminogroup · peptides: chain of amino acids - dipeptide: 2 AA - oligopeptide: 3 - 10 AA - polypeptide: > 10 AA · globoid structure of amino acid chain by folding Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/32/96 B|BRAUN OPM . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Proteinogenous Amino Acids essential non essential Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/33/96 valine phenylalanine threonine leucine tryptophan lysin isoleucine methionine glycine aspartic acid alanine cysteine tyrosine proline asparagine arginine serine glutamine histidine B|BRAUN OPM glutamic acid .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Digestion of Proteins organ enzyme reaction stomach denaturation of proteins pepsin by acidic milieu protein trypsin chymotrypsin polypeptides polypeptides oligopeptides pancreas peptidases large intestine bacterial decomposition of not resorbed protein Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/34/96 B|BRAUN OPM peptides amino small intestine acids

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Functions of Amino Acids and Proteins • component for synthesis (amino acids) muscels structure proteins (organs, connective tissue) hormones transport protein immunoglobulins (antibodies) enzymes membrane proteins • energy substrate in case of malnutrition 1 g protein = 4 kcal Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/35/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nitrogen Balance NBal = Nin - Nout Nin = N-intake (proteins or amino acids) Nout = N-excretion through urine + correction for feces + skin anabolism positive N-balance = Nin > Nout catabolism negative N-balance = Nin < Nout (N= chemical symbol for nitrogen) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/36/96 B|BRAUN OPM Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Metabolic Pathways in Anabolism and Catabolism anabolism catabolism glucose glycogenesis liponeogenesis glycogenolysis fat protein Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/37/96 glycolysis lipogenesis lipolysis protein synthesis B|BRAUN OPM proteolysis gluconeogenesis .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Physiological Significance of Glutamine • most frequent free intra- and extracellular amino acid · non essential proteinogenous amino acid · nitrogen- and carbon-transport molecule · substrate for gluconeogenesis · energy substrate of enteroytes, fibroblasts, lymphocytes · substrate for synthesis of RNA- and DNA-precursors · antioxidative effect (glutathione peroxidase) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/38/96 B|BRAUN OPM Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Glutamine in Critical Illness Trauma • release of glutamine from muscels (and lungs), partly from liver and intestinum. • energy substrate for cells of immune system and fibroblasts around wound area. Sepsis • release of glutamine from muscels (and lungs), partly from intestinum and kidney. • energy substrate for immune system, liver and intestinum. Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/39/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Water Balance out in food 1 L beverages 1, 2 L respiratory air 950 m. L perspiration oxidation water 300 m. L urine 1, 4 L feces 150 m. L Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/40/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care Function of Water • solvent (dilution) • transport medium • temperature regulation (perspiration) survival without fluid intake: maximum of 3 -4 days Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/41/96 B|BRAUN OPM . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Dietary Fibre Carbohydrates, which cannot be broken down by the enzymes in the human intestinal tract (indigestible) as well as lignin Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/42/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Classification of Dietary fibre Indigestible polysaccharides depending on the analyses methods used classified as - NSP = non-starch polysaccharides - TDF = total dietary fibre This definition does not include other indigestible constituents of food, which act similar to dietary fibre in the intestine, e. g. : - Polyalcohols - Polydextroses - indigestible proteins - indigestible lipids, waxes and fat replacement substances - Fructo-oligo-saccharides - Maillard products Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/43/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Indigestible Constituents of Food • are only indigestible for human digestive enzymes • reach the colon virtually unchanged • can be fermented by bacterial enzymes Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/44/96 B|BRAUN OPM Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Dietary Fibre Insoluble Soluble Lignin Gums (gummi arabicum, guar) Cellulose ß-Glucanes (oats, barley) Hemi-cellulose Pectin Resistant starches Mucous substances Inulin Fructo-oligo-saccharides (FOS) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/45/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Dietary

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Dietary Fibre Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/46/96 B|BRAUN OPM . Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Fermentation of Dietary Fibres by Bacteria in the Colon Dietary Fibre Lignin Cellulose Hemi-cellulose Decomposition Products • Short-chain fatty acids - Butyric acid (butyrate) - Propionic acid (propionate) - Acetic acid (acetate) Pectin Gums Mucous substances Inulin Oligo-fructose Resistant starches Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/47/96 • Gases - Carbon dioxide (CO 2) - Hydrogen (H 2) - Methane (CH 4) B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care Effects of Dietary Fibres • Fermentation products: short-chain fatty acids • Faecal volume - - Water binding - Biomass/bacteria Reduction of diarrheas and obstipation • Gastro-intestinal transit time • Carcinogenesis by diluting carcinogens and toxins in the faeces • Blood sugar levels • Cholesterol Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/48/96 B|BRAUN OPM . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Long-Term Effects of Dietary Fibres • Gall stones • Inflammatory intestinal illnesses • Ulcus duodeni • Haemorrhoids • Irritable intestine • Colon carcinomas Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/49/96 B|BRAUN OPM Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Prebiotics Indigestible constituents of food, which have an effect on the organism (man), which • selectively and specifically promote the growth and/or the activity of one or a limited number of bacteria in the intestine • have the potential to improve health (Gibson & Roberfroid, 1995) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/50/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Probiotics Preparation or product from vital, defined microorganisms • in an adequate number • change the microflora in a section of the host‘s body as a result of implantation or colonisation • exert a favourable effect on the health of the host (Havenaar & Huis In‘t Veld, 1992; Schrezenmeir & de Vrese, 2001) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/51/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Symbiotics Mixture of pre- and probiotica, which favourably affect the host • by implantation of living microorganisms in the gastrointestinal tract • by improving the survival of the probiotica (Gibson & Roberfroid, 1995) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/52/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Intestine: Functional Differences Small intestine Colon • Digestive secretions from: • no human digestive secretions stomach, pancreas, bile & • p. H 6 - 7 intestines • high degree of bacteria • p. H approx. 2 – 6. 5 colonisation • low bacteria colonisation • surface enlargement due to • surface enlargement: Lieberkühn‘s crypts, brush Kerckring‘s folds, villi, border (Lieberkühn‘s crypts), brush border Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/53/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Surface Protection Probiotic bacteria (e. g. lacto-bacillae) Phospholipids Surface protection system Mucous membrane Intestinal epithelium cells Beaker cells Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/54/96 Phospholipids B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Intestinal Flora Totality of all bacteria in the intestines (type and number) • approx. 10 14 (100, 000, 000) cells • approx. 400 - 500 different species • influenced by - regions (Europe, Japan, North America, etc. ) - age - nutrition (breast-feeding/ready-made meals, regions) - diseases - medication (antibiotics, chemo-therapy drugs) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/55/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Bacterial Fermentation Breakdown of nutrients by bacterial enzymes • partial aerobic fermentation in the small intestine • Anaerobic biosis in the colon (lack of oxygen) -> fermentatie only to intermediate products (short-chain fatty acids, lactate, gases, etc. ) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/56/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Bacterial Colonisation of the Intestine Stomach (1) and duodenum (2) Colon (5) (1010 - 1012 KBE/m. L) (101 - 103 KBE/m. L) 1 Lactobacillae Streptococci Yeasts Jejunum (3) and Ileum (4) 2 3 (104 - 108 KBE/m. L) Lactobacillae Coliforms Streptococci Bacteroids Bifidobacterium Fusobacterium 4 5 (KBE=Colony forming units oer ml intestinal content org faeces) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/57/96 B|BRAUN OPM Bacteroids Bifido bacterium Streptococci Eubacterium Fusobacterium Coliforms Clostrides Lactobacillae Proteus Staphylococci Pseudomonades Yeasts Protozoa

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Fermentation Substrates Approx. quantity consumed by substrate (g/day) Carbohydrates Resistant starch Non-starch polysaccharides – 18 Unabsorbed sugar and sugar alcohols – 10 Oligo-saccharides Chitin and amino sugar Synthetic carbohydrates: Lactulose, lactitol, polydextrose, etc Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/58/96 B|BRAUN OPM 8 – 40 8 2 2 - 8 1 - 2 .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Fermentation

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Fermentation Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/59/96 B|BRAUN OPM . Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Effects Short Chain Fatty Acids • Energy substrate for colonocytes • Promotion of mucosal blood circulation • Anti-diarrhea effect due to coupled absorption with sodium and water • Mucous secretion of the mucosa = surface protection layer • Cell proliferation of the intestinal epithelium • Cell differentiation: mutagenic cells due to butyrate • Post-operative outcome, colitis Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/60/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care The Probiotic Concept Administration of a preparation or a product with probiotic bacteria • Living cultures • Must remain vital under use and storage • Must survive the passage through stomach and small intensive (gastric acids, bile, etc. ) • Shall change microflora in a section of the intestines, through implantation or colonisation • Induce health benefits for the host Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/61/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Probiotic Bacteria Bifido bacteria • Approx. 25 % of the bacteria population in an adult human, up to 95 % in newborn babies • Produce vitamins (mostly B-vitamins) • Saccharolytic bacteria • Metabolic end products: strong acids, mostly acetate and lactate Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/62/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Probiotic Bacteria Bifido-bacteria: potential health-promoting effects • p. H-value, blocks pathogenic microorganims, promotes acidophilic bacteria • Secretion of bacteriocines = block pathogenic microorganisms • Beneficial for intestinal flora during antibiotics therapy • Act as immune modulators against malign cells & pathogenic microorganisms • Acidification promotes detoxification of potential toxic substances (e. g. ammonia) Basics of Nutrition B|BRAUN Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/63/96 OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Probiotic Bacteria Lacto-bacillae • Metabolic end products: short-chain fatty acids • p. H-value, blocks pathogenic microorganisms, promotes acidophilic bacteria • Secretion of bacteriocines = inhibit pathogenic microorganisms • Removal of potential toxic substances • Stimulation of the immune system Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/64/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . . Infusion Care

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . . Infusion Care Nutrition Care . Stoma Care . “Colonic Food“ - Prebiotics Carbohydrate Prebiotic Colonic food Resistant starches Non-starch polysaccharides cell wall polysaccharides Hemi-cellulose Pectin Gums Indigestible oligo-saccharides Fructo-oligo-saccharides Galacto-oligo-saccharides Soy – oligo-saccharides Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/65/96 Yes (Yes) Yes No Yes Yes No No Yes Yes ? B|BRAUN OPM No ?

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Resistant Starches • Starches, which reach the colon undigested • 10 % of the starch eaten is resistant starch • uptake per day: 8 - 40 g • Different types of resistant starches (RS) - RS 1: physically resistant starches - RS 2: granular starch - RS 3: retrograded starch • Digestibility depends on - the structure of the starch (amylose, amylopectin) - the preparation (raw, cooked, cooled, water content) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/66/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Resistant Starches • bacterial fermentation to short-chain fatty acids, especially butyrate • energy supply for the colon • in animal trials - bifidogenic - promotion of lactobacillae • reduces increase in blood sugar levels • probably anti-carcinogenic - detoxification of carcinogens e. g. sec. bile acids • promoted mineral absorption by RS 2 Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/67/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Prebiotics (fructo-oligo-saccharides) - Oligo-fructose (GP 2 - 20) - Inulin (GP 2 - 60) Potential prebiotics - resistant starch - Galacto-oligo saccharides - Soy oligo-saccharides - Raffinose - Lacto-sucrose - Lactulose (GP 3 -6) (GP 3) (GP 2) GP = Degree of polymerisation Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/68/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Occurrence of Prebiotics Oligo-fructose and inulin Bananas Chicory Garlic Leeks Rye Asparagus Topinambour Wheat Onions Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/69/96 Resistant starches Maize Rice Barley Wheat Leguminous plants Potatoes Bananas B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care Structure of Prebiotics Saccharose structure of oligo-fructose and inulin Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/70/96 B|BRAUN OPM . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Definition of Prebiotics • Verification of indigestibility in the small intestine - treatment with human digestion secretions - patients with terminal ileal stoma • Verification of the prebiotic effect - in-vitro investigations - in-vivo studies human Oligo-fructose & inulin are bifidogens • Luminal effects - bacteroides, clostridia, enterobacteria - faecal quantity by approx. 1. 5 - 2 g/g OF or inulin - short-chain fatty acids: energy substrate colonocytes - p. H Basics of Nutrition B|BRAUN Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/71/96 OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Effects of the Prebiotics • systemic effects - short-chain fatty acids: acetate, propionate • luminal effects - mineral absorption (Ca, Mg, Fe) - carcinogenics (elimination, detoxification, inhibition of carcinogenic bacterial enzymes) - carcinogenesis due to the effect on cell proliferation and cell differentiation • potential systemic effects - improvement of the glucose and lipid parameters Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/72/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Advantages of Pre- vs Probiotics • No living cultures - manufacture - storage - application • specific nutrition for probiotic bacteria = selective promotion of the bacteria that have already settled • Conditions for the implantation or colonisation with probiotica - Settlement only successful under selective conditions - Competition with the existing flora Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/73/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care Nutricomp Dietary Fibre Concept Inulin 20 % Soya dietary fibre 30 % Gum arabicum Resistant starch 15 % Cellulose 8% Pectin 7% insoluble Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/74/96 20 % 41 % 59 % B|BRAUN OPM . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Basic Principles for Nutrient Intake about 2 liters beverages about 30 g dietary fibers energy substrate distribution protein 15% fat 30% 55% carbohydrates Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/75/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrient Requirement for Children • high energy requirement per kg body weight dependent on age: 100 - 50 kcal/kg body weight · high fluid requirement dependent on age: 140 - 40 ml/kg body weight • recommended relation of nutrients (% kcal) protein : fat : carbohydrates 8 - 12 : 30 - 40 : 50 - 60 Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/76/96 B|BRAUN OPM Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Nutrient Requirement of Elderly People steady or increasing requirement of critical nutrients and reduced energy requirement high nutrient density and low energy intake critical macronutrients • protein • water • dietary fibers critical micronutrients • vitamines: A, D, E, C, B 1, B 2, B 6, folic acid • minerals: K, Ca, Mg • trace elements: Fe, Zn Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/77/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Protein / Amino Acids Requirement in Clinical Nutrition state of metabolism g / kg body weight and day good nutritional status 0, 8 - 1, 0 renal insufficiency 0, 6 - 0, 8 dialysis 1, 2 hepatic insufficiency mild catabolism 1, 0 - 1, 2 catabolism 1, 2 - 1, 5 serious catabolism (sepsis, burn, etc. ) 1, 5 - 2, 5 Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/78/96 0, 5 - 1, 2 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Fluid Requirement in Clinical Nutrition 30 - 40 ml/kg body weight and day body weight 1. - 10. kg 11. - 20. kg 21. - 50. kg each further kg requirement example in case of 70 kg body weight 100 m. L/kg 50 m. L/kg 20 m. L/kg 1000 m. L for 10 kg 500 m. L for further 10 kg 600 m. L for further 30 kg 200 m. L for further 20 kg total 2300 m. L/day additional requirement of fluid in cases of: • fever • diarrhea, vomiting • sweating • polyuria Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/79/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Determination of Requirements (rough calculation) Energy activity of the patient bedfast sedentary mobile 25 kcal/kg body weight 30 kcal/kg body weight 35 kcal/kg body weight total energy requirement (___ kcal x ___ kg body weight) = ___ kcal/d Fluid requirement of the patient normal increased (for instance: sweating) high (for instance: sweating + fever) total requirement Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/80/96 30 m. L/kg body weight 35 m. L/kg body weight 40 m. L/kg body weight (___ ml x ___ kg body weight) = B|BRAUN OPM ___ m. L/d

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Micronutrients • vitamines • minerals • trace elements essential nutrients, which have to be supplied daily in a sufficient dose • phytochemicals non essential nutrients with a prophylactic effect for infections, cancer, cardiovascular diseases Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/81/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Vitamines fat-soluble vitamines water-soluble vitamines vit. A vit. D vit. E vit. K vit. C ascorbic acid vit. B 1 thiamine vit. B 2 riboflavin vit. B 6 pyridoxine vit. B 12 cobalamin folic acid biotin pantothenic acid niacin retinol calciferol tocopherol antihemorrhagic factor Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/82/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Biological Significance of B-Vitamines Metabolic cofactors • carbohydrates • fat • protein/amino acids Possible deficiency symptoms • skin alterations (vit. B 2, vit. B 6, biotin, pantothenic acid) • neuritis, lactate-acidosis (vit. B 1) • cramps (vit. B 6) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/83/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Biological Significance of Fat-Soluble Vitamines and Vitam • protective factors antioxidants: vitamines C, E, ß-carotin • mineral metabolism (calcium) vitamin D • visual function, epithelial protection vitamin A • blood coagulation vitamin K Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/84/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Minerals

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care Minerals • sodium • potassium • calcium • magnesium • phosphate • chloride Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/85/96 B|BRAUN OPM . Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Biological Significance of Minerals osmotic function · water and acid-base balance (phosphate, sodium, potassium, chloride) · regulation of osmotic pressure (sodium, potassium, chloride) structural function · construction of bone and dental construction (calcium, phosphate) metabolic function · energetic metabolism (phosphate) · enzyme activation (calcium, magnesium, sulfate) · development of hydrochloric acid in stomach (chloride) signal trransduction · nerves, muscels, heart (calcium, magnesium, potassium, sodium, chloride) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/86/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Trace Elements • iron • manganese • zinc • molybdenum • copper • selenium • iodine • cobalt • chromium • fluorine Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/87/96 B|BRAUN OPM Nutrition Care . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Biological Significance of Trace Elements catalytic function as a complement of enzymes and other proteins · wound healing (zinc) · immune functions (zinc) · hormone functions (iodine) · antioxidative function (selenium) · oxygen transport (iron) · respiration (chromium) dental mineralisation (fluorine) Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/88/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Phytochemicals polyphenols in cereals, green cabbage, artichokes, berries sulfides in onions, garlic, asparagus carotenoids / terpenes phytosterols in many vegetables and fruits cholesterol-like substances from nuts and vegetable seeds glucosinolates in cruciferous plants (cabbages, radish, flavonoids more than 5000 substances, common in most foods phytoestrogens in cereals, legumes, especially in soya saponins lectins protease-inhibitors Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/89/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . . Incontinence Care . Infusion Care

. Basic Care. Wound Care. Diabetic Care . . Incontinence Care . Infusion Care Nutrition Care . Stoma Care . Biological Significance of Phytochemicals Possible effects carotenoids phytosterols saponins glucosinolates polyphenols protease-inhibitors monoterpenes phytoestrogens sulfides lectins A = anticarcinogen B = antimicrobial C = antioxidative Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/90/96 A x x x x x B C D x x E F H I x x x x G x x x x x D = antithrombotic G = influence on blood pressure E = immunomodulating H = anti-cholesteremic F = anti-inflammatory I = influence on blood glucose J = digestive B|BRAUN OPM J

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Nutrients with Antioxidative Effect not-enzymatic antioxidants • water-soluble - glutathione peroxidase (Se, Gln) - superoxide dismutase (Cu, Zn) - protease-inhibitors - ascorbic acid (vitamin C) - cysteine - flavonoids, polyphenols, sulfides • fat-soluble - tocopherol (vitamin E) - carotenoids / terpenes - phytoestrogens Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/91/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care Antioxidants Functions of antioxidants • cofactors of wound healing • stimulators of humoral and cellular immune reaction • prevention of sickness (cancer, cardiovascular diseases) • scavengers of free radicals Characteristics of free radicals • high reactivity because of unpaired electrons low intra- and extracellular concentration short biological half-life period • initiating chain reactions Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/92/96 B|BRAUN OPM . Stoma Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Influence of free Radicals on Cell Metabolism lipid peroxidation lesion of cell membranes denaturation of proteins loss or alteration of enzymatic functions damage of nucleic acids / DNA mutagens or cytotoxic effects stimulation of virus replication Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/93/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care Role of Antioxidants in case of Cancer and AIDS - decreased oral nutrient intake - maldigestion/malabsorption decreased - increased losses because of diarrhea and vomiting antioxidants - lower bioavailability of nutrients because of interactions between nutrients and drugs - radiation- and chemotherapy increased free radicals - radiation- and chemotherapy - immune reactions Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/94/96 B|BRAUN OPM .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Monitoring Anthropometry Bioelectric impedance analysis • body weight (kg) differentiation of body compartments: • height (m) • body fat • body-mass-index (BMI=kg/ m 2) • body cell mass • extracellular mass • circumference of hip, waist, upper arm • skinfold thickness (measure of subcutaneous fat ) • body fluid • muscular strength Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/95/96 B|BRAUN OPM

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care .

. Basic Care. Wound Care. Diabetic Care . Incontinence Care . Infusion Care . Nutrition Care . Stoma Care . Monitoring general data: laboratory data: • basic disease · glucose • gastrointestinal function · albumin (long biological half-live periods) • feces · cholinesterase, retinol-binding protein, transferrin (short biological half-live periods) • temperature • fluid status · triglycerides · urea/creatinine · electrolytes · hepatic enzymes Basics of Nutrition Clinical Nutrition 1/OPM Germany/Stand 02 2003 -01 -09/96/96 B|BRAUN OPM