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NUTR 442 > ASPEN ch 13 - comps of EN > Flashcards

ASPEN ch 13 - comps of EN Flashcards

1
Q

vomiting ^ risk of ______

A

pulmonary aspiration, pneumonia, sepsis

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2
Q

most common reason for vomiting

A

delayed gastric emptying

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3
Q

why delayed gastric emptying?

A

diabetic gastropathy, hypotension, sepsis, stress, anesthesia/surgery, neoplasms, autoimmune, opiate, anticholinergics, rapid infusion, cold /fat/fibre

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4
Q

if delayed gastric emptying suspected, interventions include:

A

d/c narcotics, switch to low fibre/low fat/isotonic formula, admin at rm temp, reduce rate of infusion, continuous feed, prokinetic agent

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5
Q

if GRV low but nausea persists, pt may benefit from ___ meds

A

antiemetic

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6
Q

____ or fecal impaction may lead to distention and nausea

A

obstipation

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7
Q

distention caused by:

A

GI ileus, obstruction, obstipation, ascites, diarrheal illness

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8
Q

simple method assess distention?

A

radiology, physical exam, contrast material under x-ray/fluoroscopy

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9
Q

what is maldigestion?

A

impaired breakdown of nutr into absorbable forms

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10
Q

clinical manifestations of maldigestion:

A

diarrhea, ab distention, bloating

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11
Q

what is malabsorption?

A

defective mucosal uptake and transport of nutrients from small intestine

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12
Q

clinical manifestations of malabsorption:

A

unexplained wt loss, steatorrhea, diarrhea, signs of deficiency

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13
Q

methods to screen for malabsorption:

A

gross/microscopic exam of stool, qualitative determination of fat/pro content of stool, serum carotene, serum citrulline, d-xylose absorption, radiologic exam

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14
Q

how to diagnose malabsorption?

A

intake-output, tests for specific nutr, endoscopic small bowel biopsy

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15
Q

most common side effect of EN

A

diarrhea

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16
Q

clinically useful def of diarrhea?

A

any abnormal vol or consistency of stool

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17
Q

diarrhea defined as > ___mL stool output every 24 hours or > ___ stools per day for at least 2 consecutive days

A

500; 3

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18
Q

common causes of diarrhea?

A

bacterial infection, GI disease, meds

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19
Q

meds delivered in liquid form that contain ___ or ____ can cause diarrhea

A

magnesium; sorbitol

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20
Q

_____ diarrhea is common med effect

A

antibiotic-associated

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21
Q

how to get rid of some osmotic load (dumping) of meds?

A

mix with water to dilute

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22
Q

hyperosmolar EN usually don’t cause diarrhea unless infused at _______ or administered by _____ into small bowel

A

very high rate; bolus

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23
Q

why not mix water into formula?

A

suboptimal nutr provision, not improve tolerance, contamination

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24
Q

how to treat diarrhea?

A

med assessment, antidiarrheal agent once c. diff ruled out/treated, change formula type, addition of soluble fibre, continue EN as tolerated or PN

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25
why fibre containing formula better than modular?
no clogging
26
___ is often seen in pt after Roux-en-Y bypass surgery
SIBO
27
prolonged use of ___ ^ incidence of SIBO
broad spectrum antibiotics
28
how to treat SIBO?
empiric: nonabsorbable antibiotics and systemic antibiotics
29
why are liquid more sterile than powder?
undergo heat sterilization whereas powdered formulas not required to be sterile
30
contamination v in delivery systems that have ___ spike sets and nutr container seals
recessed
31
how can EN formula become contaminated in retrograde way?
pt microorgs reproduce in tube and migrate to enteral delivery system
32
____ports of EN delivery system used to deliver meds and water flushes and minimize disconnection of EN
Y
33
c diff most common in pt receiving ___ tube feeding
post pyloric
34
best clinical definition of constipation:
accumulation of excess waste in colon (up to transverse colon or cecum)
35
how to diagnose constipation?
rectal exam and plain ab x-ray
36
common cause of constipation:
dehydration and inadequate/excess fibre
37
if not dehydrated, constipation can be treated with addition of _____
stool softener and laxative
38
variant of constipation where there is a firm collection of stool in distal colon, liquid stool seep around impaction
impaction
39
rare life-threatening complication associated with tube feeds w/ fibre:
intestinal bezoar
40
what is NOBN?
nonocclusive bowel necrosis
41
factors associated w/ NOBN?
jejunal feed, hyperosmolar formula, feeding in presence of hypotension, disordered peristalsi
42
best way to prevent NOBN:
wait initiate EN after fluid resuscitated
43
aspiration can --> pneumonia when ____ and ___ of formula overwhelm pt natural defense mechanisms
quantity; acidity
44
acute symptoms of clinically significant aspiration:
dyspnea, wheezing, sputum that is frothy/purulent, hypoxia, cyanosis, anxiety, agitation
45
when pneumonia develops in ventilated pt, labelled _____
VAP
46
risk factors for aspiration?
low HOB, vomiting, gastric tube feedings, low glasgow coma score, GI reflux disease
47
emergency measures for aspiration:
sitting upright, orotracheal suctioning, O2, antibiotics
48
how to measure GRV?
suction fluid intermittently from EN access devices by syringe or gravity drain
49
GRV influenced by many factors, like:
diameter/position of tip, number/location of openings, pt position, skill of clinician
50
when should GRV checks be considered?
initial days of feeding and in pt at risk for intolerance
51
raise HOB _____ degrees to reduce aspiration risk
30-45
52
ASPEN recommendation that clinicians avoid holding EN for GRVs < ___mL
500
53
Canadian guidelines about GRVs?
threshold of 250-500mL
54
tube fed pt should be assessed for signs of intolerance at ____ hr intervals
4
55
pt at ^ risk of refeeding:
diarrhea, high output fistulas, vomiting
56
risk factors for refeeding syndrome?
malnutrition, inadequate intake >2 wks, poorly controlled diabetes, cancer, anorexia nervosa, SBS, IBD, older adult living alone, low birth weight and premature birth, chronic infection
57
ASPEN recommend EN for pt at risk for refeeding should provide only ___ % of nrg goal on first day
25
58
hyperglycemia more commonly associated with __ than ___
PN; EN
59
absorption of glucose from continuous feed is more affected by ___ than ____
rate of CHO delivery; glycemic index
60
glycemic index refers to rate of glucose increase after a ___
bolus
61
dehydration associated with ^ risk for ___
falls, pressure ulcers, constipation, UTIs, resp infections, med toxicities
62
why dehydration risk > in older adults?
lower water reserves cuz v in LBM occuring with aging , altered sense of thirst, diminished cognition, dysphagia, dysgeusia, hyposmia, reduced kidney fxn, impaired hormonal modulators of Na/H2o balance
63
s/s of dehydration:
dry mouth/eyes, thirst, light headed, headache, fatigue, loss of appetite, flushed skin, heat intolerance, dark urine with strong odour
64
simple quick and reliable costeffective way identify dehydration in older adults?
tongue dryness
65
dehydrated pt usually develop ___ hypotension and rise in __ rate
orthostatic; pulse
66
signs of progressive dehydration:
dysphagia, clumsiness, poor skin turgor, sunken eyes with dim vision, painful urination, cramps, delirium
67
lab values for dehydration:
^ in BUN, plasma osmolality and Hct
68
fluid status can be tracked by:
strict intake/output measurements and daily wts
69
1 kg wt change = __ kg of fluid
1
70
fluids should be ^ for pt who have:
fever, emesis, diarrhea, high fistula/ostomy outputs, hyperclycemia

NUTR 442 (34 decks)

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