Exam #3 RQ: Nutritional Support/Enteral Nutrition Flashcards Preview

NUTR 450 Medical Nutrition Therapy I > Exam #3 RQ: Nutritional Support/Enteral Nutrition > Flashcards

Flashcards in Exam #3 RQ: Nutritional Support/Enteral Nutrition Deck (42):

Differentiate between enteral and parenteral nutrition

1) Enteral - usage of the digestive system normal mechanisms of digestion 2) parenteral - administer directly into the blood stream


Identify potential issues with a clear vs a full liquid diet

1) clear diets have minimal digestion and stimulation of the GI tract - may have potential issues with osmolarity of the liquid 2) full liquid diets are the transition between liquid and full solid diets - issues include the consumption of lactose which can cause discomfort


What are some challenges in using appetite stimulants in to boost nutrient uptake?

1) they have side effects 2) they may not increase appetite enough to cause significant weight gain 3) minimal success


List the advantages of enteral nutrition over parenteral nutrition

1) absorption of nutrients by the portal system (portal vein) 2) maintains gut integrity 3) Maintenance gut mucosal lymphoid tissue 4) may protect against the translocation of bacteria into systemic circulation 5) early enteral feeding found to enhance wound healing 6) diminishes the catabolic response and preserves immunologic function 7) decreases incidence of hypoglycemia 8) more convenient and safer than parenteral nutrition 9) less expensive than parenteral nutrition


Tube Feeding is Contraindicated if...

1) ileus or bowel obstruction 2) intractable diarrhea 3) GI bleeding 4) ischemic or perforated gut 5) high output fistula/ostomy 6) aggressive nutrition intervention not warranted


factors of consideration for administering tube feeding route:

1) length of time of feeding 2) risk of aspiration 3) patients ability to absorb and digest food 4) whether or not there is a planned surgery 5) formula viscosity and volume


what is the most used mode of enteral nutrition?

nasogastric tube


Advantages of feeding into the stomach

1) stomach is better able to handle osmotic loads without vomiting, cramping, diarrhea, or fluid or electrolyte shifts 2) large reservoir 3) presence of HCl in the stomach may better prevent infection


advantages of feeding into the intestine

less risk of aspiration


time frame for nasogastric tube

short term 3-4 weeks, used with patients with an intact gag reflex


time frame for nasodudenal or nasojejunal tubes

for short term 3-4 weeks, for patients with risk of aspiration, persistent nausea or vomiting, or gastroparesis


which type of enteral nutrition is used more long term?

ostomy feedings. Long-term mote comfortable and less noticeable


When should a bolus feeding technique be used?

1) long term usage 2) must have normal gastric function 3) rapid uncontrolled administration rates can cause nausea, diarrhea, and cramps 4) people with poor gastroesophageal sphincter competency or limited gastric volume capacity should not use


Characteristics of continuous drips

1) administered over a 18-24 hour period 2) requires an infusion pump


infusion pump

used in continuous administration of nutrients, is associated with smaller residual volumes in the stomach reduces the possibility of pulmonary aspiration, use of pump requires less supervision.


Characteristics of intermittent drips

1) administered at specific intervals throughout the day (300-400 ml of formula are given over 20-30 minutes several times daily)


advantages of intermittent drips

allows freedom from equipment for: home tube feedings and patients undergoing an intense rehabilitation program.


Cyclic infusion

1) formula is infused 8-16 hours/day usually overnight by infusion pump, and then discontinued in the morning 2) supplement oral intake during the day, once the patient meets 2/3 of caloric needs by mouth, enteral feeding can be discontinued


What are the two main enteral product companies?

Nestle and Abbott Nutrition


Polymeric formulas

(POLYMER) contain intact nutrients, composed of complex carbohydrates, proteins, and fats, usually lactose free, considered to be a standard basic tube feeding or general purpose formula, needs functional GI tract


Elemental/semi-elemental formula

contain partial or completely hydrolyzed nutrients which require less digestive and absorptive capacity, protein is provided as short-chain peptides and amino acids, carbohydrates come from oligosaccharides, low to no fat. Has high osmolarity so monitoring needs to occur


Diseased specific formulas or specialized formulas

used in organ dysfunction or specific metabolic conditions, formulas have been developed for renal, hepatic, respiratory disease, glucose intolerance, trauma, and impaired immune function.


Modular formula

increased need for a single nutrient, can be added to a formula or food item to increase calories or protein


What is the maximum amount of enteral formula that can be administered per hr?

125 ml/hr = 3,000 ml/day


High fiber formulas

normalize bowel function, enhance colonic mucosa integrity and normalize intestinal motility, support bowel integrity by supplying polysaccharides which are fermented by colonic bacteria to yield short chain fatty acids



short chain fatty acids ; benefits - have been shown to speed intestinal healing and support mucosal integrity, can correct both constipation and diarrhea.


Why is glutamine added to some amino acids?

1) non -essential amino acid 2) considered essential during illness 3) cells depleted by more than 50% following severe illness 4) preferential fuel source for enterocytes in the gut mucosa, especially during stress ( helps gut barrier, integrity, and enhances GI cell mass and height of mucosal villi


What components are added to formulas to enhance or maintain a patient's immunity?

glutamine, arginine, omega-3- fatty acids, and antioxidants. claim to reduce infection rates and decrease the length of stay, but the results are mixed


French size saying

The smaller the french size, the more narrow the tube


What is the normal osmolarity of the body?

300 mOsm


What is the relationship between osmolarity and flow rate?

The more concentrated or elemental a formula, the higher the osmolarity. rate of distribution is slow at first, but then increased as patient tolerates the formula (50 cc)



the amount of enteral formula present in the stomach. Lets RDs know how much is being digested. residuals greater than 250ml suggest a problem


Why is it important to check that the tube is placed properly in the stomach? What are some techniques to ensure this?

We check to make sure that food does not enter where it does not belong (i.e the lungs leading to aspiration). Gold standard - x ray, presence of coughing, alterations in breathing


Head angle in bed during enteral nutrition

should be 30-45 degrees to prevent aspiration


Why is the tube flushed with water periodically including before and after administering medications

rid of left over substances, reduce rates of clogging, ensure bacteria do not inhabit tube


Tube Feeding Syndrome

hyperosmolar/non-ketoic dehydration; need to monitor patient for hydration or dehydration


Hyperglycemia in the fed patient

hyperglycemia can occur in patients because of the stress state. Hyperglycemia needs to be monitored to monitor the need to provide insulin in enteral nutrition.


How does underfeeding affect patients?

delay of nutrition repletion, wound healing, and lead to unwanted weight loss


How does overfeeding affect patients?

hyperglycemia, hypertryglyceridemia, and hepatic steatosis and can lead to refeeding syndrome.


Renal solute load

The amount of nitrogenous waste and minerals that must be excreted by the kidney


what two populations is RSL important in?

neonatal patients and the elderly


What is the normal adult tolerance of RSL

1200-1400 mOsm

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