IC7 Nutritional Support Flashcards

Question

disadvantages of post pyloric feeding

Answer 1

1) high risk of tube clogging due to smaller size

Answer 2

1) continuous - need pump - better tolerated (spread over longer hours = trickle feeding = less distension) - lower aspiration risk 2) bolus - more physiologic (mimic oral intake) - no pump needed - more freedom for ambulation (IMPT!)

Answer 3

1) modular = single nutrient = fortifier to enhance specific nutritional component 2) semi elemental = partially hydrolysed or completely hydrolysed = for patients with impaired GI function (surgical resection) / tolerance to standard feeds 3) polymeric = macronutrient = need sufficiently functional GIT 4) immune modulation/disease specific = addition/restriction of certain nutrients to meet disease management needs

Answer 4

peptamen - powdered peptides

Answer 5

1) MCT oil = for patient with chyles leakage 2) myotin = protein

Answer 6

BOOST - isotonic feed to reduce diarrhoea (not high osmolarity to draw water) RESOURCE FRUIT - clear feed without lipids so more easily digestible = see if gut has resumed function GLUCERNA

Answer 7

diabetes = glucerna (low GI) increased protein needs = fresubin protein energy about 20g of protein per serving CKD (dialysis) = nephro HP (18g/per serving) also suitable for patients on fluid restriction due to cardiac failure or poor heart function as it is caloric dense (no dialysis) = nephro LP (low protein, k, phosphate) inflammatory disease/cancer = nutrifriend high in omega 3 fatty acids EPA/DHA

Answer 8

1) binding of medication on tube = phenytoin bind irreversibly to tube 2) medication feed interaction = eg fluroquinolones to space apart 3) alteration of dosage form = tablet fed through tube needs to be crushed, affecting dosage forms with enteric coating or sustained release

Answer 9

1) sufficient flushing between feeds - stop feed and flush access device before and after drug administration 2) use therapeutic alternatives in appropriate dosage form - eg SR = IR formulation

Answer 10

1) refeeding syndrome 2) occlusion of feeding tube - jeju > gastro - meds - high fibre / high protein / concentrated feeds may adhere to tube = need to flus 3) tube displacement - vigorous cough = increase intra abdo pressure 4) aspiration 5) infections secondary to microbial contamination (of the feed eg adding water) 6) n/v, diarrhoea, constiaption - constiapiton = lack of fibre - diarrhoea = jeju feeds because stomach acts as a holding site

Answer 11

1) signs of intolerance (N/V/D) 2) gastric residual volume = indicator for ability to process food normally, taken 30-60min after = pH, color, consistency of aspirate also noted (pH of gastric contents usually 1-2, higher pH = more mixing with feeds = unable to tolerate) 3) BG 4) electrolytes (refeeding syndrome) 5) fluid balance (renal/cardiac pt) 6) weight (LONG TERM) - SHORT TERM = fluid retention (no)

Answer 12

1) continuous > bolus 2) pro kinetic agents (meto, domperidone, IV erythromycin) 3) post pyloric if intolerant to gastric feed 4) use of isotonic formula (boost isocal) 5) semi elemental for pts with malabsorption (short bowel syndrome)

Answer 13

1) maintain functional integrity of the gut (prevent gut atrophy) 2) undergo first pass metabolism and promote efficient nutrient utilisation - glucose > glycogen - conversion of inactive --> active vit D (vs giving activated vitD = risk of hypercalcaemia) 3) maintain normal gall bladder function 4) maintain gut associated and mucosal associated lymphoid tissues 5) less complications vs parenteral 6) less expensive

Answer 14

for patients who cannot tolerate adequate nutrition via enteral feeds examples 1) paralytic ileus (gut dysmotilty due to trauma or surgery) 2) small bowel obstruction 3) high output/proximal fistula (food will come out of the hole) 4) mesenteric ischemia (insufficient oxygen = necrosis)

Answer 15

1) peripheral - requires frequent re-site (72h or when inflammation) - delivery limited by osmolarity and concentration = cannot be used long term because cannot meet demands 2) central - for longer term care (tolerate higher osmolarity due to larger volume of blood

Answer 16

amino acids (4kcal/g) - essential + non essential dextrose (glucose; 3.4kcal/g) - to avoid excessive ketone production lipid (10kcal/g) - source of essential fatty acids (linolenic and alpha linolenic acid)

Answer 17

essential amino acids are provided by external sources conditional EAA = normally non-essential, but become essential under specific circumstances like illness, injury, or infancy, because body cannot produce enough - paediatrics may contain taurine and cysteine because lack enzymatic system to produce them - both are required for fat absorption + bile secretion

Answer 18

1) electrolytes - ca, mg, k, phosphate - acetate, chloride for acid base balance 2) multivitamins - fat soluble (A,D,E, K) - water soluble (B, C) 3) trace elements - zinc, selenium, iron, iodide - copper, manganese

Answer 19

IF patient has liver or gall bladder impairment = impaired bile flow (may be due to lack of CCK) = copper and manganese cannot be properly excreted without bile production intestinal failure associated liver disease (IFALD) is a complication of impaired bile flow.

Answer 20

incompatible drugs = 1) precipitation 2) loss of drug activity 3) phase separation of lipid emulsions (due to pH/electrolyte changes) 4) toxicity

Answer 21

1) administer via separate peripheral IV cannula - if using TPN = can use central line only 2) if needed, pause PN and flush access device before + after drug admin - if pause, may enter hypoglycaemia 3) use access devices with multiple lumens - esp if poor peripheral access 4) avoid admixture or y site

Answer 22

1) OCCLUSION in IV catheter = thrombus/clot = inappropriate flushing = precipitate from drug incompatibility/crystalisation = lipid residues 2) mal positioning (wrong location) 3) catheter related bloodstream infection (CRBSI)

Answer 23

ensure sterile catheter bag hand hygiene when handling catheter enters bloodstream without additional defence from gut

Answer 24

1) refeeding syndrome 2) hyper/hypoglycaemia 3) fluid overload 4) intestinal failure associated with liver disease 5) metabolic bone disease

Answer 25

1) LIPID RESIDUES change administration tubing every 24h and flush out lipids if there is lipid residues 2) CLOT/THROMBOSIS for clotting, can flush with push pause technique

Answer 26

aluminium contamination causing osteomalacia / osteoporosis vit D insufficient supplementation

Answer 27

1) BG 2) electrolytes 3) fluid balance 4) weight 5) renal function test (creatinine, BUN, chloride, O2) 6) LFT 7) triglycerides 8) signs of infection (e.g., differential blood count, fever, redness/pus around access site)

Answer 28

1) starvation / malnutrition = catabolism (break down glycogen, muscle, fats) = decreased insulin, increased glucagon = electrolytes drawn from intracellular stores (k, p, mg) 2) refeeding = switches to anabolism 3) insulin increased = drive glucose uptake for energy production = drive shift of electrolytes into cells = utilisation of thiamine 4) plunge in electrolyte levels = hypo- mg, p, k = edema, fluid retention & potential disruption in electrochemical membrane potential = arrhythmia, cardiac failure, neuromuscular complications + thiamine deficiency

Answer 29

1) identify high risk 2) check serum electrolytes at baseline 3) correct deficiencies prior to feeding OR defer feeding if electrolytes critically low 4) administer thiamine vit B1 supplément 5) initiate feeding slowly (initiate at 50%) and gradually increase to meet nutritional requirements 6) continue monitoring electrolytes and adjust feed as needed

Answer 30

patient has one of the following - bmi <16 - unintentional weight loss > 15% in past 3-6 months - little / no nutrition intake last 10 days - low P, K, Mg before feeding patient has two or more of: - bmi <18.5 - unintentional weight loss > 10% in past 3-6 months - little / no nutrition intake last 5 days - History of alcohol misuse or drugs, including insulin, chemotherapy, antacids, or diuretics

Answer 31

100-200mg per day for 7 to 10 days

Answer 32

autonomy, beneficence (do good), non-maleficence, justice (equality) considerations - end of life patients may nt be able to process feeds/ remove feeds = is it improving QOL or force feeding?

IC7 Nutritional Support Flashcards

(56 cards)