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Flashcards in Home Nutrition Support Deck (78)
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1

What is considered as short term feeding in home NS? Long-term feeding?

Short term: < 2 years
Long term: > 2 years

2

Name examples of conditions that require short term home NS.

- Cancer patients undergoing chemotherapy +/- radiotherapy tx
Usually present dysphagia or odynophagia secondary to cancer tx which will resolve with time

3

Name examples of conditions that require long-term home NS

- Cancer patients who have permanent dysphagia 2/2 cancer tx or surgery (e.g. partial or total removal of esophagus or stomach)
- Degenerative diseases (Parkinson's, SLA, MS, PSP)
- Dementia (alzheimer's, others)
- Trisomy
- Cerebral palsy
- Oculopharyngeal muscular dystrophy
-Stroke
- Some cancer patients

4

Which pump is provided for short term nutrition support by the Ministerial Enteral Nutrition Program (MENP)?

The feeding pump provided is the Connect pump

5

Which pump is provided for long term nutrition support by the Ministerial Enteral Nutrition Program (MENP)?

Kids: Joey pump
Adults: ePump

6

What are the 4 MNEP forms for professionals?

 Practical guide for Short term feeding
 Practical guide for Long term feeding
 Practical guide
 Request form

7

What are the 2 MNEP forms for patients?

 Practical guide for Short term feeding
 Practical guide for Long term feeding

8

Who usually fills the request form?

Hospital dietitian

9

What does the practical guide for clinicians include?

• Explains how to fill the request form
• Explains the quotas of material
• Examples of material request forms
• Explains how it works for patient with private insurance
• Cleaning process

10

What is the RAMQ form to fill our? Who usually fills it?

Exception medication form, usually filled by hospital
Dietitians might need to fill this form if there is a change in the EN solution or if the solution was only authorized for a certain period of time (e.g. short-term patients)

11

What does private insurance usually cover? What does government insurance usually cover?

Private:
- Enteral solution
- PARTIALLY: Feeding material
The portion of the material that is not covered by private insurance can be claimed to the MENP after

If patient is covered by the government: everything is covered (material, formula etc.)

12

Which part of the population is usually more on open systems? Why?

Kids, they need less kcals and protein

13

Name 1 benefit of open systems.

Open system less expensive than closed system; MENP considers that everybody should be on an open system as the material (feeding bag) is less expensive than for closed system (feeding tube)

14

Name 3 drawbacks of open systems

– More risks of infection/contamination
--> Need to wash hands and wash container before you open it; More manipulation involved
– Bag needs to be washed often
Intermittent feeding: Bag has to be rinsed after each feeding and washed once a day
Continuous feeding: Bag has to be washed after each feeding

15

Which part of the population is usually more on closed systems? Why?

Adults (after justifications for MNEP to accept)

16

Name 2 benefits of closed systems

– Less risks of infection/contamination
– Bag can be in suspension for up to 48 hours

17

Who should be using NG and NJ tubes at home?

Kids
Short-term feeding (4-6 weeks)

18

Name 4 drawbacks of NG/NJ tubes

More at risk of nasal infections, uncomfortable, visible, can move/be removed easily

19

How can we make sure a NG/NJ tube is still in place?

Have to measure the length of the tube that is coming out of the nose and/or use a black marker to identify the exit point of the tube. This will allow you and/or the nurses to see if the tube is still in place.

20

How to know if a tube is well placed in the stomach?

Insert air in it while you listen to the stomach noises. If you hear the air come in, the tube is in the right place and you can start the feeding, this should be done at the hospital when they place the tube but it can also be done at home when in doubt

21

How to know if a tube is well placed in the jejunum?

Via radiology

22

Who places NG/NJ tubes?

The nurse

23

What type of feeding should we give patients on these tubes?

Continuous feedings only as these tubes are really narrow (12 Fr, 14 Fr)

24

What are the 3 types of PEG tubes? Which is the most common?

1. Balloor tube (most common)
Ponsky non-balloon tube
3. Gastric button

25

How much time do we have to put a balloon tube back in place in cases of pulling? Ponsky non-balloon tubes?

Balloon tubes: 2h
Ponsky: Cannot put it back except if we have an obturator in hand and nurse comfortable to do it.

26

Where is usually placed a PEG on the belly?

Right side

27

How often does a balloon tube need to be checked?

The balloon PEG has to be verified once a week (q 2-3 days ASPEN = unrealistic) by a nurse to make sure that the balloon is still inflated at its maximal capacity. If the balloon deflates, it has to be inflated again to see if it’s leaking water. If the balloon is perforated (filled too much, too old or too much acidity), it has to be changed. This could be done by a certified nurse with a PEG of the same or bigger caliber (Fr)

28

How is a Ponsky non-balloon tube inserted?

Use obturator to push on the dome and then remove it to open the dome inside of the stomach

29

Name 1 benefit of ponsky tubes vs balloon tubes

Eliminates the weekly verification and refill of water needed for the balloon tube

30

What is a gastric button made of?

Can be dome but usually balloon filled with water

Separate: extension tube