Enteral Nutrition Flashcards
Important consideration when assessing patients current weight
dry weight verses wet weight
* consider that changes in weight that exceed 2 kg in a week is outside the ‘normal’ rate of weight gain.
* Should be worried about fluid weight gain → Does the patient have edema (acute/ chronic)?
* What is their urine output like? (mL/kg/hr 1-2 is not great and <1 is seriously low)
consult tip sheet
Why is it important to review medical history of patient?
Need to consider chronic conditions
* Review history for coinciding diseases or presenting symptoms (e.g fever, GI intolerance, respiratory distress, presence of edema)
Why is it important to review laboratory data and medications?
- laboratory data to consider what factors may be important (e.g glucose in a patient with DM is important but may be limited value. Consider the utility of hemoglobin A1C for longer term glycemic control).
- Medications may influence nutrition absorption (and vica versa), nutrient utilization, GI symptoms etc.
What to consider in terms of nutritional needs/ nutrition support regimen
- NPO? (Yes/No?)
- Route of Administration
- Amounts ordered vs amounts received, taking into consideration anytime they will be off support
- Establish adequacy of current nutrition support regimen by determining nutritional requirements (this will be affected by acute illness)
When is oral supplementation indicated?
Oral supplementation (energy boosting) when decreased appetite due to illness, medical treatment
* Need to assess what food it is replacing
Indications for tube feeding
- When feeding efficiency is dramatically
- or when sole source of nutrition (partial and total enteral nutrition support)
- or when unsafe to consume anything orally (e.g dt swallowing issues leading to a high risk for aspiration of oral contents into lungs).
When is tube feeding considered?
Expected need for nutrition support greater than
* 5-10 days for adults
* for children 24-48 hours
Contraindications to EN
- Expected need for nutrition support less than 5-10 days (for adults); for children 24-48 hours (unless severely malnourished)
- When gut experiences significant dysfunction
- Severe coagulopathy leading to ACTIVE bleeding
- Severe portal hypertension
- Abdominal wall infection
- Massive Ascites
Situations for cautious use of EN
- peritoneal dialysis (EN feed carefully)
- Severe-acute pancreatitis; may feed carefully below Ligament of Trietz (chronic pancreatitis can feed higher up in the small bowel).
- with partial bowel obstructions can feed distal to obstruction very carefully
Examples of significant gut dysfunction
- High-output proximal fistulas; where IV replacement of fistula losses may be difficult, ie. the extent of diarrheal losses and problems with fluid hydration put the patient at risk for dehydration
- Intractable diarrhea or vomiting (especially when chemotherapy places patient at high risk for upper GI bleed)
- Complete bowel obstruction
What are the modes of EN delivery?
- Continous (total nutrition support)
- Cycle or altered duration (partial nutrition support)
- Intermittent/ bolus feeds
Describe continuous EN delivery
- Pump assisted (acute care) or gravity drip (home living)
- 24 hour infusion prescribed as a mL/hr rate
- often used to iniate EN in acute care settings
For whome is continuous EN preferred?
- critically/ acutely ill
- refeeding syndrome
- electrolyte or glucose instability
- demonstrated intolerance to other modes of delivery
Advantages and disadvantages of continuous EN
Description of cycled EN
Advantages and disadvantages of cycled EN
Describe intermittent/ bolus feeds
Advantages/ disadvantages of bolus feeds