Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MNT II > Ch 5 - EN and PN > Flashcards

Ch 5 - EN and PN Flashcards

(51 cards)

Start Studying
1
Q

EN

A

Feeding provided through the GI tract via a tube, catheter or stoma that delivers nutrients distal to the oral cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PN

A

intravenous administration of nutrients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

EN Advantages

A

o Intake easily/accurately monitored
o Increased compliance with intake
o Provides nutrition when oral is not possible or accurate
o Costs less than parenteral nutrition
o Supplies readily available
o Preserves gut integrity – better GI barrier function
o ↓ likelihood of bacterial translocation
o Preserves immunologic function of gut → preserves gut-associated lymphoid tissue (GALT) activity
o ↓ rates of infection unrelated to GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

EN Disadvantages

A 
o	Potential Complications
•	Tube displacement, obstruction or clog
•	Contamination of formula
•	GI complications
o	Costs more than oral diets
o	Less “palatable / normal”
o	More labor intensive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which Patients Need EN?

A
  • Impaired ingestion
  • inability to consume adequate oral nutrition
  • impaired digestion, absorption, metabolism
  • severe wasting or depressed growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Impaired ingestion (EN)

A
  • Neurologic disorders/comatose state
  • Traumatic brain injury
  • HIV/AIDS
  • Facial trauma
  • Oral or esophageal trauma or cancer
  • Congenital anomalies
  • Respiratory failure
  • Cystic fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Inability to consume enough oral nutrition (EN)

A
  • Hyperemesis of pregnancy
  • Hyermetabolic states such as burns
  • Anorexia in congestive heart failure, cancer, COPD
  • Congenital heart disease
  • After orofacial surgery or injury
  • Spinal cord injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Impaired digestion, absorption, metabolism (EN)

A
  • Severe gastroparesis
  • Crohn’s Disease
  • Short bowel syndrome
  • Pancreatitis
  • Inborn errors of metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Severe wasting or depressed growth

A
  • Cystic fibrosis
  • Failure to thrive
  • Cancer
  • Critical illness, trauma, burn
  • Cerebral palsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nasogastric EN

A

3-4 weeks
Normal GI
Bolus, intermittent or cont.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nasoduodenal or Nasojejunal EN

A

3-4 weeks

gastric motility disorders, esophageal reflux or persistent nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Percutaneous Endoscopic Gastrostomy (PEG) or jejunostomy (PEJ)

A

nonsurgical

>3-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

1F (French unit)

A

1F = 33mm diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Standard Formulas (EN)

A

• Lactose-free, 1kcal/mL
- Over-the-counter supplements
- Formulas designed specifically for tube feeding
• Some have fiber, some don’t
• Concentrated standard formulas: 1.5 – 2 kcal/mL for fluid restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

High-Nitrogen EN Formulas

A

burns, fistulas, sepsis, trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Chemically-defined EN Formulas

A

• Some called “elemental”
• Low in fat, supplemented with MCT
- Long term use → EFA deficiency – need to monitor
• Protein fragments: dipeptides, tripeptides or oligopeptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Disease Specific EN Formulas

A
  • Kidney disease
  • Liver disease
  • Glucose intolerance/diabetes
  • Pulmonary failure
  • Immunosuppression
  • Wound healing
  • Expensive and controversial efficacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Modular Formulas

A
  • Individual macronutrients
  • Protein
  • Carbohydrate
  • Fat
  • Occasionally combination products used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Protein EN

A
  • 10-37% of kcals
  • intact versus hydrolyzed affect osmolality
  • High-protein
  • Glutamine and arginine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Carbohydrates EN

A
  • 30-90% of kcals
  • Source and degree of hydrolysis affect osmolality
  • Lactose is not used
  • Addition of fiber
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Fat EN

Study These Flashcards
A
  • 1.5% - 55% of kcals
  • 2% – 4% as linoleic acid
  • Corn oil, soybean oil, MCT oil, Fish oil
22
Q

Water EN

23
Q

Adult Water Requirements

Study These Flashcards
A

1 mL/kcal or 35 mL/kg

24
Q

Infant Water Requirements

Study These Flashcards
A

1.5 mL/kcal or 150 mL/kg

25
Elderly Water Requirements
25 mL/kg for renal, liver or cardiac failure | 35 mL/kg for hx of dehydration
26
Vit/Min Supplement EN
If not meeting 100% of RDI’s → 15 mL/day multivit/mineral elixer via feeding tube If pt should not get minerals → 5 mL multivitamin elixer
27
Residue
Fat, fiber, lactose
28
Osmolality EN
Concentration of particles in a solution (mOsm/kg of water) EN Blood = 285 - 290 mOsm/kg
29
Lower Osmolality EN
Large (intact) proteins - soy isolates, sodium or calcium casein, lactalbumin Large starch molecules Better tolerated
30
Higher Osmolality EN
Hydrolyzed proteins or amino acids Disaccharides May cause diarrhea if infused too quickly
31
Osmolarity (PN)
unit of measure is mOsm/L of entire solution | Includes liquids and solids
32
Bolus EN
Normal method Best for ambulatory pts 4-6 "meals"/day, 250-500 mL rapid infusion (<10 mins) Order by # cans/day Syringe or gravity drip Start with .25 - .5 goal then work up to goal Only stomach because reservoir capacity Check nausea, vomit or excessive bloating
33
Intermittent EN
Everything is the same as bolus except 250-500 mL formula over 20-40 mins via gravity drip bag only
34
Continuous EN
24 hour pump Gastric or SI 30-50 mL/hour start → increase by 20 mL/hour every 4-8 hours as tolerated until goal rate is reached Most common hospital feeding
35
Cyclic EN
``` Pump over night 150 mL/hour max Compress over a few days - Day 1: 20 hours - Day 2: 16 hours - Day 3: 12 hours Always for jejunum Controls overflow ```
36
GI Tolerance Symptoms
``` Nausea vomiting diarrhea constipation, cramps abdominal distention esophageal reflux high gastric residual volumes - stomach is not emptying properly ```
37
Pulmonary complications
Respiratory distress - reflux of GI residue - decrease vol | aspiration
38
Hydration status
monitor urine output, weight change and output vs. input daily
39
Lab Symptoms
Dehydration = High Na, High BUN:creatinine ratio Hyper/hypoglycemic before Electrolyte imbalances - monitor K, Mg and P daily Nutritional Parameters
40
Access Complications
Tube Displacement breakage/malfunciton leakage obstruction
41
Tube obstruction
Meds not crushed inadequate flushing viscous formula used in small tube
42
GI Complications
``` Nausea/vomiting delayed gastric emptying with sedatives or pain meds high gastric residuals malabsorption diarrhea constipation ```
43
Diarrhea
Number one complication with EN 1. Is stool output quantified? 2. What meds? Mg can cause diarrhea 3. Is the patient receiving antibiotics? 4. C. difficile? 5. More or less fiber? 6. Need isotonic formula? Hyperosmolar formula used with severe heart failure for fluid restricted diet causes diarrhea 7. Need antidiarrheals? 8. Need probiotics? 9. Need pancreatic enzymes or an elemental formula?
44
Constipation
Monitor meds, EN formulation (concentration, fiber), adequate water Consider "bowel regimen" - stool softeners/laxatives
45
Microbial contamination
Max 8 hour hang time | change En feed bags/tubing every 24 hours
46
Aspiration
Reflux of EN - inhales formula into lungs - pneumonia - death High risk patients: poor gag reflex, depressed mental status, esophageal reflux disease
47
Reducing Aspiration Risk
Check gastric residual volume if receiving gastric feedings - hold feed if >250-500 mL - may need prokinetic to stimulate GI motility Head >30 degrees while feeding Postpyloric feeding
48
Gastric Residual Volume
60 mL syringe used to feed and withdraw contents - attach syringe to withdraw and then refeed into stomach to preserve acid
49
Hyperglycemia Risk
Diabetes, obese, metabolic stress, steroid rx every 6 hours with finger stick establish monitoring plan before patient goes home
50
Refeeding Syndrome
Hypokalemia - Heart won't work Hypophosphatemia - muscle/respiratory failure Hypomagnesemia - cardiopulmonary failure Complications from fluid overload Carb intake should be conservative If any levels drop, replete IV if possible Limit to 1000 kcals/day until electrolytes are stable
51
Nutritional Parameters
Weight - 3x/wk S/S of edema and dehydration - daily Fluid intake/output - daily Adequacy of EN intake - 2x/wk Nitrogen balance, 24 hour urine urea nitrogen - weekly Gastric residuals - every 4 hours Serum electrolytes, BUN, creatinine - 2-3x/wk Serum glucose, Ca, Mg, P - weekly or as ordered Stool output and consistency - daily

MNT II (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions