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Advanced Medical Nutrition Therapy II > Enteral Nutrition Support (part 2) > Flashcards

Enteral Nutrition Support (part 2) Flashcards

(89 cards)

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1
Q

_____ formulas contain intact macronutrients

A

Polymeric

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2
Q

Polymeric formulas consist of…

A

-Proteins
-Polysaccharides
-Glucose polymers
-LCT

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3
Q

Polymeric formulas require normal _____ and _____

A

Digestion and absorption

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4
Q

Polymeric formulas are nutritionally _____

A

Complete

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5
Q

What are some examples of polymeric formulas?

A

-Standard
-High nitrogen
-Fiber supplemented
-Concentrated

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6
Q

Calorie content of a standard polymeric formula:

A

1-1.2 kcal/mL

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7
Q

Macronutrient breakdown for a standard polymeric formula?

A

-50-60% carbohydrates
-30-35% fat
-15% protein

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8
Q

A high-nitrogen polymeric formula has over ___% of total kcal from protein

A

15%

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9
Q

When would a high nitrogen formula be used?

A

-Infections
-Trauma
-Surgery
-Burns

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10
Q

Fiber-supplemented formulas contain around ____ g/L of fiber

A

15

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11
Q

Concentrated polymeric formulas contain ___-___ kcal/mL

A

1.5-2.0

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12
Q

Concentrated formulas are given to patients who…

A

-Require a fluid restriction
-Have higher kcal needs

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13
Q

Polymeric formulas can also be ____ (homemade or commercial)

A

Blenderized

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14
Q

Blenderized formulas are made from ____ foods and are increasing in popularity by patients and families

A

Whole

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15
Q

Possible advantages of blenderized formulas:

A

-Consuming the same food as family
-Health benefits from phytonutrients

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16
Q

Contraindications to using blenderized food tube feeding:

A

-Immunocompromised patients
-Tube <14 French

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17
Q

If using blenderized diet, the RDN must provide education on safe ____-___ techniques and guidance on recipe/food components

A

Food-handling

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18
Q

What would be included in a renal-disease specific polymeric formula?

A

-Low fluid and electrolytes
-Variable protein

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19
Q

What would be included in a diabetes-specific polymeric formula?

A

-Lower carbohydrates and higher fat
-Contain soluble fiber

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20
Q

What would be included in a pulmonary-specific polymeric formula?

A

-Low carbohydrate, high fat
-May include extra antioxidants

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21
Q

What is included in immune-modulating formulas?

A

-High protein (25% of total kcal)
-Fortified with immune-enhancing nutrients-> omega-3 fatty acids and arginine

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22
Q

We may consider the use of immune-modulating formulas for patients with…

A

-TBI
-Major surgery
-Severe trauma
-Use caution in patients with severe sepsis

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23
Q

_____ formulas contain partially or fully hydrolyzed nutrients (protein) and decreased amount or alternative fat sources

A

Hydrolyzed

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24
Q

Semi-elemental formulas are partially hydrolyzed and ____-based

A

Peptide

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25
Semi-elemental formulas also usually contain ______
MCT
26
Semi-elemental formulas are used for patients with ______
Malabsorption
27
Examples of conditions where partially-hydrolyzed formulas might be used:
-Pancreatic insufficiency -Crohn's Disease
28
_____ formulas are completely hydrolyzed to free amino acids
Elemental
29
Elemental formulas have minimal ____
Fat
30
Elemental formulas have higher ____ than regular formulas
Osmolality
31
Using an elemental for long-term use puts someone at risk for ____ ____ ____ deficiency
Essential fatty acid
32
For those a risk of essential fatty acid deficiency, provide ____ mL of safflower oil per day via the enteral route
5
33
____ is affected by size and number of nutrient particles in a solution (protein, carbohydrates, and electrolytes)
Osmolality
34
Standard polymeric formulas are about _____ mOsm/kg H2O
300
35
The more nutrient-dense or the more hydrolyzed nutrients in a formula, the _____ the osmolality
Higher
36
If administered directly into the small intestine, hyperosmolar formulas can cause:
-Abdominal distention -Diarrhea
37
Modular products are composed of individual modules such as...
-Protein -Arginine -Glutamine -Fiber -Fat
38
Modular products are used to modify pre-existing ____ formulas or foods
Commercial
39
Factors to consider when selecting enteral nutrition formulas:
-Functional status of the GIT -Nutritional needs of the patient -Physical characteristics of the formula: osmolality, viscosity -Cost of the formula
40
What types of protein are used in polymeric formulas?
-Intact proteins (caseinates, whey protein concentrates, soy protein isolate)
41
What types of proteins are used in semi-elemental formulas?
-Hydrolyzed casein or whey (oligopeptides, dipeptides, tripeptides)
42
What type of protein is used in elemental formulas?
-Crystalline -L-amino acids
43
The amount of protein in formula varies from ___-___% of total kcal
7-25
44
What are things to consider with protein in formulas?
-Food allergies -Maldigestion/malabsorption -Most are gluten-free
45
The amount of carbohydrates in formula varies between ____-____% of kcal
28-90
46
What are sources of starch that are used in formula?
-Maltodextrin, corn syrup solids -Hydrolyzed cornstarch
47
Most formulas are _____ free
Lactose
48
In formulas that contain insoluble fiber, _____ fiber is usually used
Soy
49
What types of soluble fiber are included in formulas with fiber?
-Pectin -Guar gum
50
Soluble fiber has a trophic affect on colon mucosa and may help to decrease ____ and delay gastric emptying
Diarrhea
51
____-____ are prebiotic fibers that are fermented to small-chain fatty acids and play a role in maintaining colonic mucosal integrity
Fructo-oligosaccharides
52
What are sources of fat used in formula?
-Vegetable oils (canola or soy oil) -Fish oil (omega-3 fatty acids) -MCT oil (fat malabsorption)
53
The amount of fat in formula varies from ___-___% of kcal
2-55
54
Lower fat formulas are ____ formulas
Elemental
55
Higher fat formulas are ____ and ____ specific formulas
Pulmonary and diabetic
56
To prevent essential fatty acid deficiency, we must provide at least...
-4% of total kcal needs from linoleic acid OR -10% of total kcal needs from lipid
57
Most enteral nutrition formulas meet the ____ for micronutrients for the healthy population
DRIs
58
Micronutrient adjustments may be necessary with conditions like...
-Wound healing -Increased losses -Electrolytes often need to be restricted in renal failure
59
Free ____ amounts vary with the formula type
Water
60
1.0-1.2 kcal/mL formula contains about ____% free water
85
61
1.5 kcal/mL formula contains about ____% free water
75
62
2.0 kcal/mL formula provides about _____% free water
70
63
A closed feeding system is composed of ____ containers that are pre-filled with formula
Sterile
64
Advantages of closed feeding systems:
-Minimize problems with contamination -Reduced time and labor
65
____ feeding systems require the contents of formula cans to be poured into a bag or container
Open
66
With ____ feeding, the formula is administered at a constant steady rate over a 24 hour period
Continuous
67
Indications of continuous feeding:
-Initiating tube feeding -Critical illness -Small bowel feedings -At risk for refeeding syndrome -Intolerance to bolus or intermittent feedings
68
Continuous feeding is provided using an ____ ____
Infusion pump
69
Advantage of continuous feeding:
-Best tolerated administration method
70
Disadvantages of continuous feeding:
-Continuously being connected to a pump -Not physiological -High cost for people at home
71
____ feeding is continuous tube feeding over 8-20 hours via infusion pump
Cyclic
72
Cyclic feeding is usually _____ tube feedings and then off during the day
Nocturnal
73
Indications of cyclic feeding:
-Patient at home requiring small bowel feeding -Transitioning to an oral diet but with a questionable appetite
74
Advantage of cyclic feeding:
-Physical and physiological freedom from equipment for a period of each day per day
75
Disadvantages of cyclic feeding:
-Requires higher infusion rate over a shorter period of time-> possible GI intolerance due to higher rate -Need calorie and protein-dense formulas (more expensive) -Requires pump
76
____ feeding is administered with a syringe
Bolus
77
Bolus feeding requires ____-____ feedings per day over a short period of time (5-10 minutes)
3-6
78
The max amount per feeding should be ____ mL per feeding
500
79
Indications of bolus feedings:
-Medically stable -Home or rehabilitation patient -Independent patients
80
Bolus feeding can be given if someone gets _____ feeding
Gastric
81
Advantages of bolus feeding:
-Ease of administration; decreased time -Patients can adjust feedings to their schedule -More physiologic -Less expensive
82
Disadvantages of bolus feeding:
-Higher risk of GI intolerance -Higher risk of aspiration -Cannot use with small bowel feeding
83
______ feeding is infused at specific intervals throughout the day by gravity drip or infusion pump
Intermittent
84
Someone on intermittent feeding should get ___-___ feedings throughout the day
4-6
85
Intermittent feeding is usually ____-____ mL administered over 20-60 minutes
240-720
86
Indications for intermittent feeding:
-Medically stable -Home and rehabilitation settings -Gastric feeding only
87
Advantages of intermittent tube feeding:
-More flexible schedule (compared to continuous) -Less expensive than continuous or cyclic (if gravity drip) -More physiologic -May be better tolerated than bolus
88
Disadvantages of intermittent tube feeding:
-Increased risk of GI distress and discomfort (compared to continuous) -Increased risk of aspiration (compared to continuous) -If gravity drip, cannot use a fiber-containing formula
89
Factors to consider to determine administration method of tube feeding:
-Enteral access route -Patient condition -GI function; GI tolerance of tube feeding -Patient's mobility and independence level

Advanced Medical Nutrition Therapy II (19 decks)

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