Enteral Nutrition

Question 1

When can you provide enteral nutrition regarding the GI tract?

Answer 1

If there is an intact, functional, an unobstructed GI tract

Question 2

When should you give enteral nutrition? 3

Answer 2

1. Supplemental nutrition needed for extended period of time
2. Oral nutrition is not indicated
3. Lethargic patients with significant risk of aspiration

Question 3

What are 4 contraindications to enteral nutrition?

Answer 3

1. Severe malabsorption syndromes
2. GI obstruction or ileus
3. Intractable diarrhea
4. Palliative care

Question 4

What are the 3 different types of tube feeding?

Answer 4

1. Nasoenteric tube feeding
2. Orogastric tube feeding
3. Enterostomy tube feeding

Question 5

What is the initial rate for continuous tube feeds?

Answer 5

25 mL/hr and increase slowly

Question 6

What is the goal for continuous and intermittent feeding?

Answer 6

Full replacement over 24 hours

Question 7

What type of feeding is better tolerated?

Answer 7

Continuous

Question 8

What type of feeding is harder to tolerate as an outpatient?

Answer 8

Intermittent

Question 9

What are 3 types of enteral nutrition?

Answer 9

1. Meal replacement
2. Elemental/ peptide
3. Disease specific

Question 10

What products are used for meal replacement enteral nutrition? 3

Answer 10

1. Ensure
2. Osmolite
3. Isosource

Question 11

When can elemental/peptide enteral nutrition be used? 2

Answer 11

1. Patients w malabsorption issues (Crohns, severe IBS)
2. Transition from TPN to enteral

Question 12

What 3 products are used for elemental/peptide enteral nutrition?

Answer 12

1. Vivonex
2. Peptamen
3. Vital

Question 13

What are two specialty feedings used for respiratory insufficiency?

Answer 13

1. Pulmocare
2. Respalor

Question 14

What are 2 specialty feedings used for diarrhea?

Answer 14

1. Jevity
2. Ultracal

Question 15

What are 2 specialty feedings that are used for renal insufficiency?

Answer 15

1. Nepro
2. Suplena

Question 16

What specialty feeding is used for diabetes?

Answer 16

Glucerna

Question 17

How do you maintain hydration when tube feeding?

Answer 17

By administering free water via tube

Question 18

What is a very common issue with tube feeding?

Answer 18

Diarrhea

Question 19

What are 4 ways to manage diarrhea with tube feeding?

Answer 19

1. Decrease amount
2. Decrease rate
3. Add fiber
4. Anti diarrheal agents

Question 20

What should you do if a patient is presenting with nausea and vomiting because of tube feeding?

Answer 20

1. Decrease rate of tube feeds
2. Consider octreotide
3. Can give metoclopramide and erythromycin

Question 21

What formulations of medications should be used when a patient has tube feeds?

Answer 21

Liquid formulations

Question 22

What should you do after administering medications in the tube feed?

Answer 22

Flush with water after every medication

Question 23

What formulation of medications shouldn’t be be used with tube feeding?

Answer 23

Extended release

Question 24

What are 8 medications that are issues with tube feeding?

Answer 24

1. Sucralfate
2. Phenytoin
3. Valproate acid
4. Levothyroxine
5. Quinolones
6. Tetracyclines
7. Griseofulvin
8. Warfarin

Question 25

What is the pH like in the stomach?

Answer 25

Acidic

Question 26

What is the pH like in the duodenum?

Answer 26

Alkaline

Question 27

What two medications have an issue if they are placed in the duodenum instead of the stomach?

Answer 27

1. Ketoconazole 2. Omeprazole

Question 28

What are 2 ways that you can unclog the tube feed?

Answer 28

1. Distilled water 2. Pancreatic enzymes

Question 29

What pancreatic enzyme can be used with sodium bicarbonate to dissolve the clog?

Answer 29

Viokace

Question 30

If there is a need for long term tube feeds, what does nasogastric need to be converted to?

Answer 30

PEG tube