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NUTR 406 > Exam 2: Enteral Nutrition > Flashcards

Exam 2: Enteral Nutrition Flashcards

(45 cards)

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1
Q

Explain the steps in the decision making process for if, when, and how to provide nutrition support

A

(1) anticipated length of time enteral feeding will be required, (2) degree of risk for aspiration or tube dis- placement, (3) patient’s clinical status, (4) adequacy of digestion and absorption, (5) patient’s anatomy (e.g., after previous surgical resection or in extreme obesity), and (6) whether future surgical intervention is planned.

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2
Q

Identify 4 conditions that my require enteral nutrition

A
  1. impaired nutrient intake
  2. inability to consume adequate nutrition orally
  3. impaired digestion, absorption, metabolism
  4. severe wasting or depressed growth
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3
Q

What situations do patients have impaired nutrient intake?

A

neurological disorders, trauma, congenital anomalies, respiratory failure, traumatic brain/spinal cord injury

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4
Q

In what situations do patients have the inability to consume adequate nutrition orally?

A

Hyperemesis of pregnancy; hypermetabolic = burns; anorexia in
congestive heart failure, cancer, COPD

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5
Q

In what situations do patients have impaired digestion, absorption, or metabolism?

A

Severe gastroparesis, inborn errors of metabolism (GI), Crohn’s
disease, short bowel syndrome

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6
Q

In what situations do patients have severe wasting or depressed growth?

A

Cancer
Cerebral palsy
Cystic fibrosis
FTT
Myasthenia gravis
Sepsis

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7
Q

Describe proposed benefits of enteral nutrition vs. parenteral nutrition

A

Better gastrointestinal barrier function
 More “physiologic”
 Preserved gastrointestinal immunity
 Preserved gut-associated lymphoid
tissue (GALT) activity
 Microbiome support
 Decreased rates of infection

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8
Q

Distinguish between the tubes used for enteral nutrition

A
  • Nasogastric
  • Nasoenteric
  • Gastrostomy
  • Gastrojejunal
  • Jejunostomy
  • Transgastric Jejunostomy
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9
Q

Nasoenteric complications

A

Esophageal strictures
Gastroesophageal reflux resulting in aspiration pneumonia Tracheoesophageal fistula
Incorrect position of the tube leading to pulmonary injury
Mucosal damage at the insertion site
Nasal irritation and erosion
Pharyngeal or vocal cord paralysis
Rhinorrhea, sinusitis, otitis media
Ruptured gastroesophageal varices in hepatic disease
Ulcerations or perforations of the upper gastrointestinal tract and airway

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10
Q

Nasogastric patients

A

-nose to stomach
- medication or feeding
- than 3 to 4 weeks

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11
Q

Nasoduodenal or Nasojejunal patients

A
  • Patients who do not tolerate gastric feedings
  • ## short term
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12
Q

What are the 3 access sites for EN?

A

Nasal
Oral
Abdominal

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13
Q

patient feeding tube if less than 4 week/

A
  • naso enteric
  • oral enteric
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14
Q

patient feeding tube if greater than 4 week?

A
  • gastrostomy
  • jejunostomy
  • transgastric jejunostomy
  • gastric/jejunostomy
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15
Q

What are the 5 feeding schedules for EN?

A
  • Continuous
  • Intermittent and Cyclic
  • Gravity Drip or Bolus
  • Low Dose “trophic feeding”
  • Initiate “Full Strength”
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16
Q

What is Continuous feeding schedule?

A
  • duration of 224 hours
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17
Q

Typical patients receive Continuous feeding

A

Critical care, ICU patients

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18
Q

What is intermittent and Cyclic feeds?

A
  • duration of 8-20 hours
  • depend on medication, procedures, and weaning
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19
Q

What is Gravity Drip or Bolus Feeding?

Study These Flashcards
A
  • used to assimilate normal feeding pattern
  • 500mL/feeding
20
Q

What is low dose “trophic feeding”

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A
  • ICU
  • determine how patient tolerates feeding
21
Q

What is initiate full strength?

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A
  • introduce all formulas at full strength, meaning that it is not diluted
22
Q

What is isotonic

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A
  • 1 to 1.2 formulas
23
Q

What is hypertonic

Study These Flashcards
A
  • more particles per volume
24
Q

what is normal osmo of GI

25
What are open system feeding?
feeding bag with cans Higher risk of contamination o More frequent bag and tubing changes o No more than 8 hours of hang time
26
What are closed system feeing?
* Closed System: “Ready to hang” o Decreased risk of contamination o Room temperature, stable up to 36-48 hrs
27
Hang time
Hang time is the length of time an enteral formula hanging at room temperature is considered safe for delivery to the patient. Most facili- ties allow a 4-hour hang time for a product in an open system and 24 to 48 hours for products in a closed system (manufacturer’s directions should always be followed).
28
Describe the nutrient composition of various enteral nutrition formulas
Protein (8-25% of total kcals) * Predominant sources=soy, whey and casein * BCAA’s * Small peptide and AA’s Carbohydrates (40-75% of total kcals) * Predominant sources=hydrolyzed cornstarch, maltodextrin * corn syrup, fructose, glucose oligosaccharides Fat (15-45% of total kcals) * Predominant sources=polyunsaturated fats such as corn, safflower, sunflower, or soybean oil * Medium chain triglycerides (MCT) Note: do not require hydrolysis by bile salts or pancreatic lipase, BUT no EFA. Made from fractionated coconut oil. * Omega 3 fats (ARDS, Immunonutrition, metabolic)
29
What s the Fiber content in EN?
Soluble or Insoluble? Soy Polysaccharide Content ranges from 0-14 gms/liter Consider recommended intake of fiber (20-35 gms/day) Modular: Benefiber, Fibersource. * One packet=1 tbsp., 3 gms fiber
30
What are the 3 disease-specific formulas
Renal hepatic Diabetic
31
Describe Renal Formula
Calorically Dense-2 kcals/mL * Considerations include: * Level of renal function * Non RRT vs RRT
32
Describe Hepatic Formula
BCAA’s (valine, leucine, isoleucine) vs AAA’s (phenylalanine, tyrosine, tryptophan) with Hepatic Encephalopathy * MCT fat source (0-66%), total fat 12-30% * 1.5 kcals/ml
33
Describe Diabetic Formula
Carbohydrate Source: oligosaccharides, fructose, cornstarch * Soluble fiber (guar, pectin) Improved glycemic control via delay of gastric emptying and increased transit time * Kcal distribution: 34-40% CHO, 42-50% FAT (small % of MCT oil) * Avoid overfeeding, appropriate insulin management
34
What is Respiratory Disease "oxepa"
Acute Respiratory Distress Syndrome (ARDS) óFISH OILS/Borage Oil: -Linolenic (GLA) and Eicosapentanoic acids (EPA). ? Favorable conditions for pro- inflammatory mediators ó55% of kcals from fat óVit E, beta-carotene, selenium, Vitamin C “Oxepa”
35
What are the specialty formulas and modulars
Critical Care/Metabolic Formulas Immunonutrition Formulas * Indications-? * Omega 3 PUFA’s, Nucleic Acids, Selenium, Vitamins A, C, E, Zinc, Glutamine, Arginine Glutamine Arginine
36
Identify markers to monitor in patients receiving nutrition support
Body temperature Intake/output Records Glucose Electrolytes: (NA,K,Mg,Ca,PO4,CL) Renal function Albumin/TP Cholesterol/Trigs H/H-iron status Nitrogen balance Prealbumin/CRP WTS!!!!
37
Recognize potential complications of enteral nutrition
Gi complications Mechanical Complications
38
Describe Gi complications
Diarrhea: >3-4 stools per day or > 250-500mL of liquid stool every 8 hours Nausea and/or vomiting Constipation: no stool for >3 days Gastric residuals: > 200-500mL Food/Drug interactions
39
Describe Mechanical Complications
- Pulmonary Aspiration - Tube obstruction - Mucosal damage
40
Nutrition Support Decision if the patient is meeting needs orally?
no further intervention need, cotinue to onitor
41
Nutrition Support Decision if the patient is not meeting needs orally and has nonfuncional GI tract?
Provide Parenteral nutrition
42
Nutrition Support Decision if parenteral nutrition needs are required for greater than 3 weeks
Peripheral extended dwell catheters or Central tunneled catheters and ports PICC
43
Nutrition Support Decision if parenteral nutrition needs are required for less than 3 weeks
Peripheral standard IV catheters or Central standard central lines
44
Nutrition Support Decision if the patient is not meeting needs orally but still requires fortified food and oral supplements >75% of needs
provide enteral gastric feeding
45

NUTR 406 (22 decks)

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