Instructions

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Resources

Conclusion:    Click on the link at left to go to your desired page:  Introduction  Page 2  Study 1  Study 2  Study 3  Study 4  Conclusion  Post-Test

Home parenteral and enteral nutrition (HPEN) is a viable and cost effective option for patients unable to maintain weight and nutritional status through oral nutrient intake. HPEN may be short or long term depending on the patient’s underlying cause for HPEN dependence. Catheter sepsis and other complications of parenteral nutrition are controllable and can be held at reasonable levels with a well-trained team approach.

 

The first study demonstrated that while HPEN-dependent patients have to adjust to changes in sleep patterns and may make some changes in social activities; their quality of life could be maintained for a period of years. Physical functioning scores were expectedly lower than a healthy population. However, mental function scores were similar to healthy controls. No deaths were related to HPEN-related complications. Clinical stability and underlying disease were the most significant factors in the timing of death.

 

In many cases, the candidate for home parenteral nutrition (HPN) starts out in a significantly malnourished state. The effect of HPN in this population of patients was explored in the second study finding mostly expected results of an initial improvement in weight, fluid status, and fat tissues while lean tissue reconstitution lagged behind in aggressive (but not over) feeding. Efforts to improve lean tissue after the initial effect of HPN will be important to long-term health improvement while HPN-dependent. 

 

The effect of HPN on survival was explored in the third study of patients with radiation enteritis as the reason for HPN-dependence. This study demonstrated that HPN did not have a detrimental effect on survival and that the potential for catheter sepsis in this group was well within expected ranges for other therapies and other conditions. While one patient’s death was related to catheter sepsis, the primary reason for death was the underlying cancer.

 

Improving oral intake and reducing dependence on HPN is a reasonable goal for short-term HPN candidates. In the case of HPN dependence because of short bowel syndrome (SBS), it is more difficult to realize a reduction in HPN dependence. Strategies such as glutamine enhancement, oral fiber intake, and growth hormone inducement of intestinal absorptive capacity have been explored in an effort to reduce dependency. Presumably, the eventual HPN independence could improve quality of life scores affected by HPN, eliminate catheter, metabolic, and other potential complications of long-term and life-long HPN, and potentially reduce related costs. 

 

A team approach is essential to the management of the transition to homecare for HPEN-dependent patients. Reductions in duplications of efforts between institutional and homecare personnel in concert with the prescribing physician can help to maintain the cost effectiveness of HPN. The fourth article reviewed in this series outlines a communication strategy for team members to maintain quality care while controlling costs.

Implications for Social Workers

Click on the link at left to go to your desired page:  Introduction  Page 2  Study 1  Study 2  Study 3  Study 4  Conclusion  Post-Test

Now take the Post-Test