Enteral nutrition Flashcards
(38 cards)
Malnutrition definition
Not meeting the metabolic demands of the body/nutrition imbalance
typically associated with weight loss (undernutrition)
but also applies to obesity (overnutrition)
populations susceptible to malnutrition
Age: elderly, infants
GI conditions (IBD, bariatric surgery, pancreatitis)
Cancer
AIDS
Developmental disabilities (CP, swallow reflex)
Hospitalized patients
How long before most patients require nutritional support (inpatient, hospitalized)
Most go 7 days before starting nutrition support
Critically ill / ICU patients can start enteral nutrition _____
earlier than the 7 days due to mortality benefit
When do outpatients require nutritional support?
patients with malnutrition or at risk of developing malnutrition
If the gut works – use it
When to use enteral vs parenteral
If the gut is functioning, use it. TPN has lots of AE
Must use gut to maintain integrity
Why do we want to maintain gut integrity?
Keeps bile flowing (bacteriostatic flow) = prevent infection
Prevents stones (cholestasis/cholelithiasis)
Immune defense: GALT, stomach acid, protective mucosal layer, peristalsis, healthy microbiota
Enteral nutrition tubes (3)
Nasal tubes (NG, ND, NJ)
Abdominal wall placement (G, J)
Nasogastric tubes
easy to place
highest aspiration risk into lung
Can push large volume
Stomach decompression possible (if intestinal block, can such material out of stomach)
Naso -jejunal/-duodenal tubes
more difficult to place
reduced aspiration risk
More likely to clog (smaller tube)
Can’t push large volume
Abdominal wall G tube
Can give larger volume bolus feeds that mimic meals (push 15min-1hr)
OK to crush and flush meds
Abdominal wall J tube
Can’t give large volumes
Must give medications as a liquid
Can’t crush/flush meds
Abdominal wall J tube
Can’t give large volumes
Must give medications as a liquid
Can’t crush/flush meds
Crushing/Flushing medications
Flush with 15-30 mL sterile water before and after
NOT FOR JEJUNAL TUBES (gastric and duodenal OK)
Do each medication separately
Do not crush SR, ER, or enteric coated
Giving liquid medications
Check osmolality
>600 mOsm = dilute with sterile water or else may cause diarrhea
If viscous - dilute or it could stick to the tubing
Enteral feeding interactions
Must stop enteral feed to give med
Medications that require feed hold 1-2 hrs before/after
Phenytoin
Fluoroquinolones abx
Levothyroxine (give IV if need adjust dose)
Warfarin (PO only)
Calculate caloric requirement for enteral nutrition
20-30 kcal/kg/day
Do patients usually require specialized enteral preps?
No, generally use standard prep
Which patients require specialized EN?
Renal/heart failure (fluid restrict)
End stage renal disease
Diabetes
Burn/trauma
Pancreatitis
Renal/HF EN adjustment
Less volume – use more concentrated formula
ESRD EN adjustment
Reduce potassium and phosphate
Diabetes EN adjustment
Calories – more fat and fiber, less sugar
Burn/trauma EN adjustment
High protein
