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Advanced MNT 2 > Enteral Nutrition Part 1 > Flashcards

Enteral Nutrition Part 1 Flashcards

1
Q

the provision of nutrients into the GIT through a tube

A

enteral nutrition

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2
Q

Indications for EN

A

inadequate oral nutrition intake
malnutrition
hyper-metabolic states (burns)
gastroparesis; total gastrectomy (intestines still work)

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3
Q

Relative Contraindications (cant have EN) (need PN)

A

Malfunctioning small bowel
Severe bowel inflammation
Hemodynamically unstable (hypovolemic shock)
Expected short-term duration
Terminal illness

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4
Q

reasons someone would have small bowel malfunction

A

Small bowel obstruction
Small bowel ileus
Severe GI hemorrhage
Intractable vomiting or diarrhea
Severe malabsorption
Severe short bowel syndrome
High output small bowel fistula (>500 mL/day)

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5
Q

benefits of enteral nutrition

A

maintain small bowel function

provides luminal nutrients (glutamine)
- may provide fiber

avoid complications of PN

lower cost than PN

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6
Q

how does enteral nutrition maintain small bowel function

A

digestive and absorptive capacity remains

mucosal barrier function and integrity
- prevention of bacterial translocation

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7
Q

general characteristics of feeding tubes

A

material
lumen
eyelets (where food comes into body)
ports (entrance into feeding tube)

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8
Q

what are different materials of feeding tubes

A

polyurethane or silicone

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9
Q

most tubes have additional ports for _______ and ________

A

irrigation

medication administation

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10
Q

Outer diameter of the tube lumen is designated by _________

Nasoenteric=>For patient comfort, the _______ tube diameter possible should be used

Do not use fiber-containing formulas with tubes ______

A

French units
smallest
<8 Fr

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11
Q

two types of tubes

A

nasoenteric (NG, ND, NJ)
enerostomy (PEG, GT, JT, G-J)

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12
Q

Nasogastric (NG) should be used for ____ term use of ________

NG tube feeding requires a functioning ______

____Fr
______ inches in length

A

short
<4 weeks

stomach

8-12
40-43

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13
Q

____ or lower is small bore

A

12

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14
Q

Nasal insertion at bedside by ___, ____, or ____

placement must be confirmed with _____

there are also NG _____________ tubes

A

MD, RN, PA-C

xray

suction/drainage

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15
Q

Advantages of NG tubes

A

normal digestive and bactericidal processes in stomach

any type of administration method can be used

placement does not require surgery or medical procedure

more cost effective than other tubes

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16
Q

Disadvantages or possible complications of GN tube feeding

A

Increased risk of misplacement on insertion
Easily displaced
Sinusitis & nasal erosion
Increased risk of clogging
Increased risk of GERD leading to aspiration
Cosmetically unappealing

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17
Q

Nasoduodenal Placement

_____ term use of _______
uses include for _______, _______

need to confirm placement with _______
risk?

no ____ or _____ feeding

A

short term <4 weeks
delayed gastric emptying or gastroparesis

xray
tip often coils or pulls up in the stomach

bolus or intermittent feeding

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18
Q

Nasojejunal tubes (NJ)

used for_____ term of ______
_____Fr
_____ inches

A

short term of <4 weeks
8-10 Fr
55-60 in

19
Q

How are Nasojejunal Tubes placed

A

fluoroscopically or endoscopically to confirm tip is past the Ligament of Treitz

Blind bedside placement but this is challenging
- computer guidance systems
- confirm with xray

20
Q

NJ Tubes – Indications for Use

A

Delayed gastric emptying
Persistent nausea
Severe, acute pancreatitis
High aspiration risk

21
Q

NJ Tubes - Advantages

A

May reduce risk of aspiration

Can still feed into the small bowel while providing gastric suction

22
Q

NJ Tubes - Disadvantages

A

Difficult placement
Tube displacement
Sinusitis; nasal necrosis
Cosmetically unappealing
Prone to clogging due to small bore size

23
Q

Potential GI intolerance from NJ tubes because?

A

Jejunum is sensitive to high volume or hyperosmolar feeding

No bolus or intermittent feeding

24
Q

Enterostomy tubes are tubes that are _____ or ______ placed through the _______

A

surgically
endoscopically
abdominal wall

25
Q

indications of use for enterostomy tubes

A

long term >4 weeks

chronic severe dysphagia
oral, esophageal, or gastric cancer
neurologic disease
dementia
chronic poor intake for other reasons

26
Q

Percutaneous Endoscopic Gastrostomy (PEG)

Used for _______ feeding
_______ placement
requires __________
____ Fr

A

long term
endoscopic
functioning stomach
15-28 Fr

27
Q

Contraindication for PEG tubes

A

GI obstruction proximal to the stomach
obesity
ascites
gastric varices

28
Q

Advantages of PEG Tubes

A

No surgery required
More physiologic for digestion & absorption
More comfortable & aesthetic
Can use any administration method
Decreased risk of clogging secondary to larger bore size
May decrease risk of aspiration (compared to NG tube)

29
Q

Disadvantages/Possible Complications of PEG Tubes

A

If dislodges, must be replaced within few hours or tract will close

Site infection

Potential for skin breakdown from leakage of gastric contents

Migration of internal bumper through the gastric wall

30
Q

PEG Migration of internal bumper through the gastric wall can cause __________ which can result in _______

A

Possible leakage of gastric contents internally=>causing peritonitis

31
Q

Gastrostomy Tube (GT) is _______

Used for ______ feeding
________ placed
Need a __________

For patients requiring EN who are either ______________ or __________

_____ Fr

A

Same as PEG but placed surgically

long-term
Surgically
well-functioning stomach

undergoing a surgical procedure
cannot undergo endoscopic placement

15-28 Fr

32
Q

Advantages - GT

A

More physiologic for digestion & absorption

More comfortable & aesthetic

Can use any administration method

Decreased risk of clogging secondary to larger bore size

May reduce risk of aspiration (compared to NG tube)

33
Q

Disadvantages/Possible Complications - GT

A

Requires surgery & general anesthesia

Potential for skin breakdown from leakage of gastric contents

Site infection

Dislodgement of the tube; peritonitis

Migration of internal bumper through the gastric wall

34
Q

Jejunostomy Tube (JT)

_________ placed
_______ use
______ Fr

Use ______________ or ________ only

A

Surgically
Long-term
10-20

pump-controlled continuous infusion
cyclic feeding

35
Q

Indications for a JT

A

Gastroparesis
total gastrectomy
chronic N/V
total esophagectomy

36
Q

Advantage of JT

A

Decreases aspiration risk

37
Q

Disadvantages - JT

A

Dislodgement; Difficult to replace
Occlusion
Wound infection; skin erosion
Potential GI intolerance to goal rates/volume
Bowel obstruction

38
Q

Potential GI intolerance to goal rates/volume with JT because __________

A

No bolus or intermittent feeding

39
Q

Needle Catheter Jejunostomy

bore tube is _____Fr

Disadvantages?

A

5-8 Fr

easily dislodged
clogs easily
fiber containing formulas not recommended

40
Q

Gastrojejunostomy (G-J tube)

These are _______ tubes
__________ placement
______Fr

Used for ___________

A

multi-lumen (gastric suction and feeding into jejunum)

surgical or endoscopic

GT : 15-28
JT : 6-12

long term gastroparesis

41
Q

Advantages of G-J Tube

A

Simultaneous gastric decompression and feeding into small bowel

Reduced aspiration risk

42
Q

Disadvantages of a G-J Tube

A

Risk of bleeding and infection of the abdominal wall

Migration of internal bumper through the gastric wall

Dislodgment

Cannot use bolus or intermittent feeding

43
Q

Factors Used to Determine the Optimal Enteral Access Route

A

Anticipated duration of enteral feeding

Condition/function of the stomach

Risk of aspiration

Planned surgical intervention

44
Q
A

Advanced MNT 2 (17 decks)

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