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?
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
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.
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
(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
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.
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?
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