Nutritional support for the shock patient

In the past, patients were indescriminately fed until they began to gain weight; however, this should not be the philosophy today. With the specialized solutions and laboratory tests available today, precise tailoring of a patient's nutritional needs can be achieved. Nutritional support has been devised to maintain the energy, vitamins, and minerals necessary to supply amino acids for protein synthesis and to reduce the loss of amino acids from the periphery. Providing patients with early nutritional supplementation either by the parenteral or enteral route decreases the incidence of septic complications by improving overall nutritional status and maintaining immune competence and wound healing. Careful determination of the patient's nutritional needs and close monitoring during therapy are important nursing interventions. As the patient recovers from the shock state, the catabolic phase gradually gives way to an anabolic phase. There is a decrease in urinary nitrogen excretion that reflects a decrease in protein catabolism. The stress hormones of catabolism change to the growth hormones of anabolism. The state of convalescence can continue for weeks to months depending on the body protein and fat lost during the stressed state. As the nurse prepares to administer enteral or parenteral nutrition, a thorough assessment is obtained, including history of current illness, recent weight changes, and food allergies or intolerances. Solutions are administered according to institutional policies. Patients are evaluated to ensure that nutritional support is effective. Visceral protein status and fluid and electrolyte balances should improve. Nutritional support is not static, but requires ongoing assessment and reevaluation. The route, composition, and quantity of the formula are adjusted to meet the changing requirements of the patient.