Efficacy of multidisciplinary inpatient treatment of feeding disordered children was sought through retrospective chart review of 40 G-tube dependent children ages 22 months to 7 years. Premature births were 55% of the sample ranging from 23 to 36 weeks gestation. The majority of co-occurring medical conditions included congenital anomalies (50%), gastroesophageal reflux disease (25%) and chronic lung disease (25%). Treatment effect analyzed from pre and post treatment measures of oral and G-tube caloric intakes resulted in a significant difference from admission to discharge for both oral intake, t (39) = 5.76, p < 0.001, d = 1.02, and G-tube dependency, t(39) = 10.94, p < 0.001, d = 2.03 with both showing strong treatment effects. Results indicated a highly reliable and valid method of treating severe pediatric feeding disorders.

The aim of this thesis was to identify and assess the nitrogen balance due to the field of nutritional support, body composition, energy expenditure, utilization of nutritional substrates and their changes during the hospitalization. Nitrogen balance was determined in 12 men and one woman (age 44 ± 16,4 years) with multiple injuries (ISS 40 ± 11) in the ICU based on 2 measurements in the time interval of 1-7 days, as the difference between the received and the ecrected nitrogen. The energy expenditure and nutritional substrate utilization nutritional indirect calorimetry, body composition analysis and blood chemistry laboratory were examined at patients. Correlation analysis revealed dependence between nitrogen balance and other monitored parameters and also dependence on the length of their trauma. Total protein intake averaged 1,40 ± 0,69 g.kg-1 .d-1 . At this dose were recorded negative values of nitrogen balance in the first measurement of the 9-patients and in the second measurement of the whole group. In this work also the results of uptake of parenteral and enteral route were compared. In practice, significant correlations were found between total uptake and energy expenditure (p = 6,31.10-3 ; r = 0,6) in the first measurement, and on the other hand negative correlation during the second...

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Introduktion/Bakgrund:  Nasogastrisk sond [NGS] är en vanlig förekommande behandling för patienter med undernäring som har orsakats av olika sjukdomar. Sonden kan medföra risker och komplikationer, framför allt vid insättningen. Det är viktigt att sjuksköterskan stöttar och uppmuntra patienterna till att vara delaktiga i sin egenvård, men även att hjälpa patienterna att acceptera sig själva. Syfte: Syftet med studien var att belysa patienters erfarenheter av enteral nutritionstillförsel via nasogastrisk sond. Metod: Processen i denna litteraturstudie grundades på nio stegen enligt Polit &amp; Beck (2021) med en induktivt ansats. Databaserna Cinahl och PubMed användes för att utföra litteratursökningen. Studien innehåller 11 vetenskapliga artiklar som är kvalitetsgranskade. Resultat: Utifrån databearbetningen framkom en huvudkategori Påverkan i det dagliga livet med fem underkategorier. Fysisk och psykisk påverkan, Social isolering, Förändrad vardag, Nya möjligheter och Förbättrad mående. Slutsats: I studien framkommer det att patienterna har haft negativa upplevelser, bland annat isolering på grund av det förändrade utseende som till följd orsakade dåligt självbild och självförtroende. Patienterna hade också positiva upplevelser av NGS som förbättrat nutritionstillstånd och vikstabilisering

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The diploma thesis is devoted to complications of enteral nutrition in patients with idiopathic inflammatory bowel diseases. The incidence of these diseases has increased in recent years. Nutritional support is an important part of the treatment and the possibility of improving the nutritional status of patients, which plays an important role in responding to other forms of treatment itself or in pre-operative preparation. All forms of artificial nutrition might also cause certain complications. The subject of this work is to observe the complications of enteral nutrition, their solutions and the possibilities of their prevention.

Syftet med denna systematiska litteraturstudie som inkluderar 18 artiklar, har varit att belysa vilka nutritionsstöd som kan förebygga och behandla malnutrition hos barn med cancer samt vilka omvårdnadsbehov som finns i samband med nutritionsbehandling. Resultatet visade att barn med cancer som behandlas med strålning och/eller cytostatika ofta drabbas av olika biverkningar som påverkar nutritionen. Cirka 46 % av barnen utvecklade malnutrition. Näringsintaget försämrades ofta på grund av biverkningarna vilket fick till följd att behandlingen försämrades samt tillväxt och utveckling påverkades negativt. Olika sätt fanns för att upprätthålla gott nutritionsstatus. Oralt intag förordades för att upprätthålla mag- tarmkanalens struktur och funktion. Alternativ för kostbehandling när barnet inte klarade att inta oral kost var nasogastrisk sond (NS), Perkutan Endoskopisk Gastrostomi (PEG) och Total Parenteral Nutrition (TPN). NS visade sig vara relativt biverkningsfritt och ett alternativ att tillgå under kortare nutritionsbehandlingar. PEG var ett gott alternativ med relativt få biverkningar då barnet behöver nutritionsstöd under längre tid. TPN var ett alternativ enbart då barnet inte kunde äta relaterat till bristande upptag i mag- tarmkanalen. Försämrat näringsintag påverkade barnets livskvalitet. Familjen påverkades genom att ätandet var en stark källa till konflikt mellan barnet och föräldrarna. Det var viktigt att barnet och familjen fick stöd i barnets förmåga att kunna äta samt att erbjudas näringsrik kost. Bedömning av nutritionsstatus och dokumentation av oralt intag, parenteralt intag och effekter av nutritionsbehandlingen var av stor vikt för att kunna ge barnet optimal omvårdnad.

Syfte: Att studera den tillgängliga litteraturen om hur minskad näringstillförsel i form av fasta, Anorexia nervosa (AN), protein-energiundernäring (PEU) och sondmatning påverkar det orala ekosystemet. Material och metod: Det utfördes en narrative review på artiklar som identifierats med hjälp av Pubmed databas. Artiklar som handlar om minskad näringstillförsel och dess konsekvenser för den orala miljön har granskats. Resultat: Fasta hade effekt på salivens sammansättning, flödeshastighet och buffringskapacitet. Personer med svält tillståndet Anorexia nervosa (AN) upplevde bland annat förändringar i slemhinnor, saliv pH-värde och salivflödeshastighet. Personer med protein-energiundernäring (PEU) löpte stor risk för flera orala förändringar som medför bland annat högre kariesförekomst och sämre prognos för inflammatoriska lesioner. Flera av bakterierna som dominerade hos personer med sondmatning var patogena bakterier som kan vara hälsoskadliga. Slutsats: Vid fasta uppstår det förändringar i salivflödeshastighet, sammansättning, mängd och buffringskapacitet. AN kan leda till förändringar i saliven. PEU innebär stor risk för flera orala förändringar som medför bland annat högre kariesförekomst och sämre prognos för inflammatoriska lesioner. Tidig PEU har en fortsatt negativ effekt på salivens funktion även i tonårsåldern. Flera av bakterierna som dominerar hos personer med sondmatning är patogenabakterier som kan vara hälsohotande. Flera orala, mikrobiella och biologiska förändringar manifesterar sig i samband med minskad näringstillförsel. Det behövs fler studier för att få en bättre förståelse av dessa förändringars kliniska betydelse. / Aim: To review the available literature on how reduced nutrient supply in the form of fasting, Anorexia nervosa (AN), protein-energy malnutrition (PEU) as well as tube feeding affect the oral ecosystem. Material and method: A narrative review was performed on articles identified using the Pubmed database. Articles about nutritional deficiencies and their consequences on the oral environment have been reviewed. Results: Fasting influenced saliva composition, flow rate and buffering capacity. People with Anorexia nervosa (AN) experienced, among other things, changes inmucous membranes, saliva pH-value and saliva flow rate. It was shown that people with protein-energy malnutrition are at high risk for several oral changesthat lead to a higher incidence of caries and a worse prognosis for inflammatory lesions etc. Several of the bacteria that dominated in people with enteral nutrition were pathogenic bacteria; that can be damaging to health. Conclusions: During fasting, changes in saliva flow rate, composition, amount, and buffering capacity occur. People with AN experience among other things, changes in mucous membranes, pH value and flow rate of saliva. PEU involves a high risk of several oral changes that lead to, among other things, a higher incidence of caries and a worse prognosis for inflammatory lesions. Early PEU has a continued negative effect on saliva function in adolescence. Several of the bacteria that predominate in people with tube feeding are pathogenic bacteria that can be health-threatening. Several oral, microbial, and biological changes manifest themselves in connection with malnutrition. More studies are needed to gain a better understanding of the clinical significance of these changes.

The overall aim of the thesis was to gain a deeper understanding of nutritional nursing care in municipal care and county council care, with specific focus on enteral nutrition (EN) in intensive care. Quantitative and qualitative methods were used. Telephone interviews regarding assessment of the nutritional status of patients were carried out with special medical nurses (CNs) (n = 14) in municipalities in one county and first line managers (CNs) (n = 27) in one county council. Registered nurses (RNs) in municipalities (n = 74) and county councils (n = 57) answered a questionnaire about nutritional assessment and documentation (I). RNs (n = 44) at three different intensive care units answered a questionnaire about responsibility, knowledge, documentation and nursing interventions regarding EN. Observations (n = 40) on nursing care interventions for patients with EN were carried out (II). RNs (n = 8), enrolled nurses (n = 4) (III) and patients (n = 14) (IV) were interviewed and nutritional nursing care was observed (III-IV) at an intensive care unit. The results showed that assessment of nutritional status was not performed on all patients, according to RNs/CNs. Malnourished patients were estimated to occur to a varied extent. Sixty-six percent of RNs/CNs answered that there were no guidelines for nutritional care and 13% that they did not know if there were any. RNs saw the VIPS model as a guide in nursing care, but also as an obstacle to information exchange (I). A majority of RNs answered that there were guidelines for EN. There were differences between the RNs’ opinions about their responsibility, knowledge and documentation. Deviations from recommended nursing care interventions occurred (II). The developed substantive theory of nurses (RNs and enrolled nurses) concerns and strategies of nutritional nursing care for patients with EN, includes the core category ”to have and to hold nutritional control – balancing between individual care and routine care” and the categories ”knowing the patient”, ”facilitating the patients’ involvement”, ”being a nurse in the team”, ”having professional confidence” and ”having a supportive organization”. In order for RNs and enrolled nurses to have a sense of control over the patients’ care in relation to nutrition, a balance between routine care and individual care was required (III). The developed substantive theory regarding the patients’ experiences of nutritional care includes the core category ”grasping nutrition during the recovery process”.  The core category is reflected in, and dependent on, the categories ”facing nutritional changes”, ”making sense of the nutritional situation” and ”being involved with nutritional care”. The patients alternated emotionally between worry, fear and failure, and relief and hope. The patients experienced a turning point and felt an improvement in their condition when their appetite returned, when the stomach and gut were functioning and when the feeding tube was removed (IV). The conclusion is that quality and safety in relation to nutritional nursing care is dependent on the interactions between the nurse and patient, between the nurse and the team, and the nurse and the organization.