He aha te Kai Parenteral Katoa? Te Whāinga, te Hātepe me te Whakahaere

Ko te kai parenteral katoa (TPN) he huarahi motuhake ki te tuku kai katoa ki roto i tō toto mā te uaua. Ko tēnei tikanga whāngai rongoā e karo ana i tō pūnaha kūnatu katoa, e whakarato ana i ngā kārohi katoa, pūmua, ngako, huaora, me ngā kohuke e hiahia ana tō tinana ki te whakaora me te mahi tika i te wā e kore ai e taea e koe te kai, te ngongo rānei i te kai.

He aha te Kai Parenteral Katoa?

Ko te kai parenteral katoa he pūmua wai e mau ana i ngā mea katoa e hiahia ana tō tinana ki te ora me te pūremu. Ko te kupu "parenteral" te tikanga "waho o ngā whekau," nō reira ka haere tēnei kai ki roto i tō toto, kaua mā tō puku me ngā whekau.

Whakaarohia te TPN hei kai katoa i roto i te āhua wai i hangaia mō ngā hiahia tika o tō tinana. He rōpū o ngā tāngata ngaio hauora, tae atu ki ngā tākuta, ngā kai rongoā, me ngā kaiwhakarato kai, e mahi ngātahi ana ki te waihanga i tētahi pūmua ritenga e ōrite ana ki ō hiahia kai motuhake, te āhua rongoā, me te taumaha o te tinana.

Ko te otinga te tikanga he taurite tōtika o ngā pūmua (waikawa amino), warowaihā (te tikanga te kūkū), ngako (ngā lipid), ngā hiko pēnei i te konutai me te pāhare pāporo, huaora, me ngā kohuke tohu. Ko tēnei huarahi whānui e whakarite ana ka whiwhi tō tinana i ngā mea katoa e hiahia ana ki te pupuri i te papatipu uaua, te tautoko i te mahi okana, me te whakatairanga i te whakaora.

He aha te take ka mahia te Kai Parenteral Katoa?

Ka tūtohu pea tō tākuta i te TPN i te wā e hiahia ana tō pūnaha kūnatu kia okioki katoa, e kore rānei e taea te ngongo tika i ngā matūkai. Ka puta tēnei āhuatanga mō ngā take rongoā rerekē, ā, ka mahi te TPN hei piriti rangitahi hei pupuri i tō tinana kia whāngai ana i te wā e whakaora ana.

Ko ngā take tino nui mō te TPN ko ngā āhuatanga mumura nui o te puku me te whekau pēnei i te mate a Crohn, te mumura rānei o te whekau i ngā wā e kaha ana, ngā pokanga nui o te puku e hiahia ana kia okioki ō whekau, ētahi maimoatanga mate pukupuku e pā ana ki tō kaha ki te kai, ki te keri rānei i te kai, me te mumura nui o te puku e taea ai e te kai te whakapōrearea i te āhua.

E hiahia ana ētahi tāngata ki te TPN mō ngā wā poto, pēnei i te whakaora mai i ngā pokanga uaua, i te whakahaere rānei i ngā raruraru mai i ngā maimoatanga rongoā. Ko ētahi atu pea e hiahia ana ki te TPN mō ngā wā roa ake mēnā he āhuatanga tawhito ō rātou e aukati ana i te kai me te keri kai.

He maha ngā pēpi tōmua e whiwhi ana i te TPN nā te mea kāore anō kia tino whanake ō rātou pūnaha keri kai. I tua atu, ko ngā tāngata e whara ana i te wera nui, ētahi āhuatanga ira e pā ana ki te urunga o te matūkai, ērā rānei e pā ana ki te whakapairuaki me te ruaki roa, ka whai hua pea mai i tēnei tautoko kai.

He aha te Hātepe mō te Kai Parenteral Katoa?

Ka tīmata te hātepe TPN mā te whakatau a tō rōpū hauora i ō hiahia kai motuhake mā ngā whakamātautau toto me te arotake hauora tupato. Ka tātaihia e rātou te nui o ngā kārohi, ngā pūmua, me ētahi atu matūkai e hiahiatia ana e tō tinana i runga i tō taumaha, tō āhua hauora, me te taumata mahi.

Muri iho, ka hiahia koe ki tētahi momo rārangi IV motuhake e kīia ana he katetere uaua pokapū. Ko tēnei ngongo angiangi, ngāwari te pōkaia ki roto i tētahi uaua nui i tō uma, tō kaki, i tō ringa rānei. Ka mahia te hātepe i raro i ngā tikanga horoi, i te hōhipera tonu, ā, ka whiwhi koe i te rongoā ā-rohe hei whakaiti i te raruraru.

Ina whakanohoia te katetere, ka tukuna te otinga TPN mā te pūhi IV e whakahaere ana i te tere rere tika. Ka whakarite te pūhi kia whiwhi koe i te nui tika o te kai i roto i tētahi wā motuhake, te nuinga i roto i te 12 ki te 24 haora i runga i ō hiahia.

Ka tino mātakitaki tō rōpū hauora i a koe puta noa i te tukanga. Ka tirohia e rātou ō taumata huka toto, te tauritenga hiko, me ētahi atu tohu nui i ngā wā katoa. Ka taea te whakatika i te tātai TPN i ia rā i runga i te urupare o tō tinana me ō hiahia kai e huri ana.

Me pēhea te whakarite mō tō Kai Parenteral Katoa?

Ko te whakarite mō te TPN e whai ana i ētahi mahi nui hei āwhina i te haumaru me te whai hua o te rongoā. Ka ārahi tō rōpū hauora i a koe i ia wāhanga whakarite kia pai ai te haere o te tukanga.

Tuatahi, ka whai koe i te mahi toto whānui hei whakatū i tō tūnga kai tōmua. Ka ine ēnei whakamātautau i ō taumata pūmua, te tauritenga hiko, te huka toto, te mahi ate, me ētahi atu tohu nui hei āwhina i tō rōpū ki te hoahoa i te tātai TPN tika mō koe.

Ka arotake anō tō rōpū hauora i ō rongoā me ō taapiri o nāianei. Akene me whakatika ētahi rongoā nā te mea ka pā te TPN ki te āhua o te tukatuka o tō tinana i ētahi rongoā. Kia mōhio ki te kōrero ki ō kaiwhakarato hauora mō ngā huaora, otaota, rongoā rānei e hokona ana e koe.

Mēnā kei te whakanohohia te raina pokapū hei tukanga motuhake, akene me nohopuku koe mō ētahi haora i mua. Ka hoatu e tō nēhi ngā tohutohu motuhake mō te kai, te inu, me ngā rongoā hei tango, hei karo rānei i mua i te whakaurunga o te katita.

He mea whai hua te whakarite i tētahi tangata hei taraiwa i a koe ki te kāinga mēnā kei te mahi koe i te tukanga hei tūroro waho. Ko te whai i tētahi tangata tautoko i a koe ka whai whakamarie aronganui i tēnei wā.

Me pēhea te pānui i ō Hua Kai Parenteral Katoa?

Ko te māramatanga ki ō hua aroturuki TPN ka āwhina i a koe kia mōhio tonu ki tō ahunga whakamua kai. Ka aroturukihia e tō rōpū hauora ētahi inenga matua hei whakarite kia whai hua me te haumaru te rongoā.

He maha ngā wā e tirohia ana ngā taumata huka toto, ina koa i te wā tuatahi ka tīmata koe i te TPN. Ko ngā awhe noa kei waenga i te 80-180 mg/dL, ahakoa he rerekē pea tō whāinga i runga i tō āhua hauora. Ko ngā pānui teitei ake pea te tikanga me whakatika tō tātai TPN.

Ko ngā tohu pūmua pēnei i te albumin me te prealbumin e whakaatu ana i te pai o te whakamahi a tō tinana i te kai. Ko ngā taumata albumin i waenga i te 3.5-5.0 g/dL e kiia ana he noa, i te mea ko ngā taumata prealbumin o te 15-40 mg/dL e tohu ana i te pai o te tūnga kai.

He mea nui te taurite o te hiko mo te mahi tika o tō tinana. E aroturukihia ana e tō rōpū te konutai (135-145 mEq/L), te pāhare pāporo (3.5-5.0 mEq/L), me ētahi atu kohuke hei ārai i ngā tauritenga kore e pāngia ai ngā raruraru.

He tohu nui hoki ngā huringa taumaha. Ko te pikinga taumaha haere, te taumaha pūmau rānei e tohu ana kei te whakarato te TPN i te kai tika, i te mea ko ngā huringa taumaha tere pea e tohu ana i te pupuri wai, i te iti rānei o ngā kārohi.

Me pēhea te whakahaere i tō Kai Parenteral Katoa?

Ko te whakahaere i te TPN i runga i te whai hua ko te mahi tahi me tō rōpū hauora me te whai i ngā aratohu motuhake hei whakarite i tō haumaru me te angitu o te rongoā. Ko tō whai wāhi kaha ki tēnei tukanga he rerekētanga nui ki ō hua.

Ko te pupuri i te wāhi catheter kia mā, kia maroke te kawenga nui rawa atu. Mā tō nēhi koe e ako i ngā tikanga tiaki tika, tae atu ki te pēhea te huri i ngā kākahu me te mōhio ki ngā tohu o te mate pēnei i te whero, te pūhi, te rere rānei i te wāhi whakauru.

Ko te whai i te hōtaka whakauru kua whakaritea he mea nui ki te pupuri i ngā taumata kai pūmau. Ki te whiwhi koe i te TPN i te kāinga, ka ako koe ki te whakamahi tika i te pūmuha whakauru me te mārama ki te wā hei tīmata me te whakamutu i te rongoā i ia rā.

Ka āwhina ngā whakamātautau toto i tō rōpū ki te aroturuki i tō ahunga whakamua me te whakatika i te tātai TPN i te mea e tika ana. Kaua e ngaro i ēnei whakaritenga, he mea nui kia ārai i ngā raruraru me te whakarite kia whiwhi koe i te kai tika.

Kia pātata te kōrero ki tō rōpū hauora mō ngā tohumate, āwangawanga rānei. Pūrongo i te kirika, te wiri, te ngenge rerekē, ngā huringa rānei i tō āhua, nā te mea pea e tohu ana ēnei i ngā raruraru e hiahia ana kia aro tonu.

He aha te huarahi pai rawa atu mō te Kai Parenteral Katoa?

Ko te huarahi TPN pai rawa atu ko te mea i hangaia motuhake mō ō hiahia takitahi me tō āhuatanga hauora. Kāore he otinga kotahi-rahi-e-pai-ana-mō-te-katoa nā te mea he rerekē ngā whakaritenga kai me ngā āhuatanga hauora o te katoa.

Ka whakaaro tō rōpū hauora i ētahi mea i te wā e hoahoa ana i tō mahere TPN pai rawa atu. Kei roto i ēnei ko tō tau, tō taumaha, tō āhuatanga hauora, te taumata mahi, me te roa e tūmanakohia ana kia hiahia koe ki te tautoko kai.

Ko te whāinga kia whakarato i te kai katoa i te wā e whakaiti ana i ngā raruraru. Ko te tikanga o tēnei ko te tīmata ki te tātai whakatūpato me te whakatika haere i runga i te urupare o tō tinana. Ka taurite tō rōpū i te whakarato i ngā kārohi me ngā matūkai e tika ana me te karo i te whāngai nui, ka taea e tērā te pā mai i ōna ake raruraru.

Ko ētahi tāngata e pai ana ki te whakauru TPN tonu i te 24 haora, i te mea e whai hua ana ētahi atu i te huringa i te 12-16 haora kia taea ai ngā mahi o ia rā. Mā tō oranga me ō hiahia hauora e āwhina i te whakatau i te hōtaka pai rawa atu mōu.

He aha ngā āhuatanga tūpono mō ngā raruraru TPN?

Ko te māramatanga ki ngā āhuatanga tūpono mō ngā raruraru TPN ka āwhina i a koe me tō rōpū hauora ki te whai i ngā whakatūpato e tika ana. Ahakoa te haumaru o te TPN i te wā e whakahaere tika ana, ka taea e ētahi āhuatanga te whakanui i tō tūponotanga ki ngā raruraru.

Ki te ngoikore te pūnaha ārai mate, ka nui ake te tūponotanga ki ngā mate e pā ana ki te rārangi pokapū. Kei roto i tēnei ko ngā tāngata e mate huka ana, e mate pāwera ana, e tango rongoā ārai mate ana rānei. Ka whai ngā tō rōpū i ngā whakatūpato anō hei pupuri i ngā tikanga horoi.

Ka pā te mate ate, te mate whatukuhu rānei ki te āhua o tō tinana e tukatuka ana i ngā matūkai i roto i te TPN. Ko ngā tāngata e pāngia ana e ēnei āhuatanga e hiahia ana ki te aroturuki auau, ā, tērā pea ka hiahiatia ngā tātai kua whakarerekētia kia kore ai e puta ngā raruraru.

Ko te wheako o mua ki ngā rārangi pokapū, ki ngā katetā IV rānei, ka nui ake te tūponotanga ki ngā raruraru mēnā i pā koe i ngā mate, i ētahi atu raruraru rānei i mua. Ka whakaaro tō rōpū hauora ki tēnei hītori i te wā e whakamahere ana i tō manaakitanga.

Ko te tamariki rawa, te kaumātua rānei ka nui ake te tūponotanga ki ngā raruraru. Ko ngā pēpi tōmua me ngā pakeke ka nui ake te āta aroturuki, ā, tērā pea ka hiahiatia ngā tātai kua whakatikatikaina hei whakaaro ki ō rātou hiahia kai motuhake.

He Pai Anei te TPN Wā-poto, te TPN Wā-roa rānei?

Ko te roa o te TPN e whakawhirinaki ana ki tō āhuatanga hauora me te ahunga whakamua o te whakaora, ehara i te mea e pai ana. Ka tūtohu tō rōpū hauora i te roa poto rawa e whai hua ana hei whakatutuki i ō hiahia kai i te wā e ora ana tō tinana.

Ko te TPN wā-poto, e mau ana i ngā rā ki ētahi wiki, ka whakamahia i muri i te pokanga, i ngā mate koi rānei. Ko tēnei huarahi e whakaiti ana i te tūponotanga ki ngā raruraru i te wā e whakarato ana i ngā kai nui i ngā wā whakaora nui.

Ko te TPN wā-roa, e mau ana i ngā marama, i ngā tau rānei, i ētahi wā e tika ana mō ngā āhuatanga mau tonu e aukati ana i te kai me te keri kai noa. Ahakoa e hiahia ana tēnei ki te aroturuki āta, ka taea e ia te whakaora i te ora mō ngā tāngata e pāngia ana e ētahi āhuatanga hauora.

Ko te mea nui ko te hoki ki te kai noa i te wā e haumaru ana, e tika ana hoki i te taha hauora. Ka arotake auau tō rōpū hauora mēnā ka taea e koe te tīmata ki te kai anō, ahakoa he iti noa i te tīmatanga.

He aha ngā raruraru ka puta mai i te Kai Whakawhāiti Katoa?

Ahakoa te nuinga he haumaru te TPN ina tika te whakahaere, he mea nui kia mōhio ki ngā raruraru ka puta mai kia mōhio ai koe ki ngā tohu whakatūpato me te rapu awhina wawe. Ko te nuinga o ngā raruraru ka taea te ārai mā te manaaki me te aroturuki tika.

Ko te mate huakita tētahi o ngā raruraru tino nui nā te mea he ara tika te raina matua ki tō toto. Ko ngā tohu ko te kirika, te wiri, te whero, te pūpū rānei i te wāhi o te kātere, me te kore pai te tū. E hiahia ana ēnei tohu kia āta tirohia e te tākuta.

Ka puta mai ngā raruraru huka toto nā te mea kei roto i te TPN te kūkō. Ka piki te huka toto o ētahi tāngata, ina koa i te tīmatanga o te rongoā. Ka āta aroturukihia tēnei e tō rōpū, ā, ka whakatika pea i tō tātai, ka tūtohu rānei i ngā rongoā ki te hiahiatia.

Ka puta mai ngā raruraru ate i te whakamahi TPN mō te wā roa. Ka aroturukihia e tō rōpū hauora ngā whakamātautau mahi ate i ngā wā katoa, ā, ka whakarerekē pea i tō tātai TPN ki te puta mai ētahi raruraru. Ko te nuinga o ngā huringa ate ka taea te whakatika ina kitea wawe.

Ka taea e ngā tauritenga hiko te pā ki ngā momo tohu i runga i ngā kohuke e pā ana. Ko ēnei pea ko te ngoikore o te uaua, te ngākau pōrearea, te rangirua rānei. Ka ārai ngā whakamātautau toto i ngā wā katoa i ēnei raruraru.

Ko ngā raruraru miihini e pā ana ki te raina matua he iti noa iho, engari ka uru pea te kātere ki te aukati, ki te neke rānei. Ka whakaako tō rōpū hauora i a koe ki ngā tohu whakatūpato hei mātakitaki me te pēhea te urupare.

Āhea ahau e kite ai i te tākuta mō ngā āwangawanga e pā ana ki te TPN?

He mea nui kia mōhio ki te wā ki te whakapā atu ki tō rōpū hauora mō tō haumaru i te wā e whiwhi ana koe i te TPN. Ko ētahi āhuatanga e hiahia ana kia āta tirohia e te tākuta, ā, ko ētahi atu ka taea te tatari mō tō tūāki kua whakaritea.

Whakapā atu ki tō kaiwhakarato hauora tonu mēnā ka pā te kirika, te wiri, tōna tū rānei te kore pai. Ko ēnei tohu ka tohu pea i te mate, e hiahia ana ki te rongoā wawe. Kaua e tatari kia kite mēnā ka pai ake ngā tohu i a rātou anō.

Ko ngā huringa katoa huri noa i tō wāhi kātere e hiahia ana ki te aro. Kei roto i tēnei ko te whero, te pūpū, te mamae, te rere ke, mēnā rānei te ahua o te kātere e wewete ana, e nekehia ana rānei. Ko ēnei huringa ka tohu pea i te mate, i ngā raruraru miihini rānei.

Ko te uaua ki te manawa, te mamae o te uma, te pūpū rānei i ō ringa, i tō kaki rānei me aki tonu te arotake hauora tonu. Ko ēnei tohu ka tohu pea i ngā raruraru nui e pā ana ki te rārangi pokapū.

Whakapā atu ki tō rōpū hauora mēnā ka pā te whakapairuaki tonu, te ruaki, te ngenge ke, ngā huringa rānei i tō māramatanga hinengaro. Ko ēnei tohu ka tohu pea i ngā raruraru pūkoro e hiahia ana ki te arotake.

Ko ngā raruraru ki ō taputapu TPN, pērā i ngā whakaoho papu e kore e whakawātea, ngā āwangawanga rānei mō te ahua o te otinga, me pūrongo tonu. Ka taea e tō rōpū hauora te whakarato aratohu me te whakarite i tō haumaru.

Ngā Pātai Auau mō te Kai Parenteral Katoa

Q1. He pai te Kai Parenteral Katoa mō te whakanui i te taumaha?

Ka taea e te TPN te tautoko i te whakanui i te taumaha hauora ina whakamahia tika ana i raro i te tirotiro hauora. Ko te whāinga tuatahi o te TPN ko te whakarato i te kai katoa ina kore e taea e koe te kai noa, ā, ka puta pea te whakanui i te taumaha hei hua māori o te whakatutuki i ngā hiahia kai o tō tinana. Heoi, kāore te TPN e whakamahia ana mō te whakanui i te taumaha i roto i ngā tāngata hauora nā te mea he mōrearea e nui ake ana i ngā painga ina taea te kai noa.

Q2. Ka pā te TPN wā-roa ki ngā raruraru ate?

Ka pānga pea te TPN wā-roa ki te mahi ate, inā koa ki ngā pēpi tōmua me ngā tāngata e whiwhi ana i te TPN mō ngā wā roa. Heoi, nā te hanganga TPN hou me te aroturuki tupato kua tino whakaiti i tēnei tūponotanga. Ka tirohia e tō rōpū hauora ngā whakamātautau mahi ate i ngā wā katoa, ā, ka taea te whakatika i tō tātai mēnā ka puta he raruraru. Ko te nuinga o ngā huringa ate e pā ana ki te TPN ka taea te whakatika ina kitea wawe, ā, ka whakahaerehia tika.

Q3. Ka taea e au te kai i te kai i te wā e whiwhi ana i te TPN?

Ko te mea ka taea e koe te kai i te wā e whiwhi ana i te TPN kei runga i tō āhuatanga hauora me ngā tohutohu a te tākuta. Ko ētahi tāngata e whiwhi ana i te TPN i te wā e whakahoki ana i ngā rahinga iti o te kai, i te wā e hiahia ana ētahi atu ki te okioki puku katoa. Mā tō rōpū hauora koe e ārahi mō te wā me te aha ka taea e koe te kai i runga i tō āhuatanga motuhake me te ahunga whakamua o te whakaora.

Q4. Kia pēhea te roa ka taea e tētahi te whiwhi TPN i runga i te haumaru?

He rerekē te roa o te TPN i runga i ngā hiahia hauora takitahi. Ko ētahi tāngata e whiwhi ana i te TPN mō ngā rā torutoru i muri i te pokanga, i te wā e hiahia ana ētahi atu me ngā āhuatanga mau tonu mō ngā marama, tau rānei. Ka arotakehia e tō rōpū hauora i ngā wā katoa mēnā kei te hiahia tonu koe i te TPN, ā, ka mahi ki te whakahoki i a koe ki te kai noa i te wā e tika ana, e haumaru ana hoki.

Q5. He huarahi kē atu anō ki te Kai Parenteral Katoa?

Āe, he huarahi kē atu anō kei runga i tō āhuatanga. Ko te kai enteral (te whāngai ngongo) mā tō pūnaha kūnatu te mea e pai ana ina taea e ō whekau te mahi engari kāore e taea e koe te kai noa. Ka whakarato te kai parenteral wāhanga i ētahi matūkai mā te IV i te wā e kai ana koe i ngā rahinga iti o te kai. Mā tō rōpū hauora e whiriwhiri te kōwhiringa pai rawa atu i runga i tō āhuatanga hauora motuhake me te kaha o tō pūnaha kūnatu ki te mahi.