Jesus lord of glory help me Flashcards
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how to get fat mls from kcals
divide by 1.1
Osmolarity
dextose grams x 5 + protien grams x 10 / volume if given
dextrose load
dextrose grams x 1000/ weight in kg/ min in a day 1440
fat load
fat grams / weight in kg
normal range of fat load
1 - 2.5
normal range of dextrose load
2-5
3.5 for diabetes
Enteral versus parenteral characteristics
Enteral nutrition: provision of nutrients into the GI tract through a tube or catheter when oral intake is inadequate (may include formulas as oral supplements or meal replacements)
Parenteral nutrition: provision of nutrients intravenously
Enteral formula characteristics/types
Standard polymeric formulas
Lactose-free, 1 kcal/mL with a balanced CHO, fat, and protein
Concentrated standard formulas: 1.5 to 2 kcal/mL for fluid restriction
High-nitrogen formulas (18%‒25% of calories
Increased protein requirements: burns, fistulas, sepsis, trauma
Elemental or predigested formulas
When the GI tract is compromised and polymeric formula is not tolerated
Specialized or disease-specific formulas
Aimed at a specific disease associated problem (e.g., renal products)
Predigested formulas
Fat is primarily MCT
Protein fragments: dipeptides, tripeptides, or oligopeptides
Disease specific (can be polymeric or predigested)
Modular components
Protein Intact vs. hydrolyzed affect osmolarity High protein Glutamine and arginine Carbohydrate 30% to 90% of kilocalories Source and degree of hydrolysis affect osmolarity Lactose is not used Addition of fiber lipid 1.5% to 55% of kilocalories 2% to 4% as linoleic acid Vitamins, minerals, and electrolytes DRIs; modified for specific formulas Fluid 1 kcal/mL formulas are about 80% water Amount of water depends on calorie density Provide additional water via tube as needed
When to use parenteral over enteral nutrition and vice versa
Enteral nutrition
For those who can’t eat or can’t eat enough
Should be first consideration
Parenteral nutrition
Reserved for nonfunctional or severely diminished small bowel
RQ
Over feeding intake of carbon dioxide over outtake
Common causes of TF intolerance
High residual
Abdominal dissention
Pain
Diarrhea
When is elemental formulas recommended?
Elemental or predigested formulas
When the GI tract is compromised and polymeric formula is not tolerated
300-500mOsm = isotonic know the difference between iso & hypertonic (which is
better tolerated?)
iso
Enteral tube options, and their characteristics
NGT: normal digestive, hormonal and bactericidal processes of stomach. Less risk complications
Tubing: soft, flexible and well-tomerated polyurethan or silicone tubes
Placed at bedside by nursing or possibly trained RD. Check placement by aspirating GI contents or XR confirmation.
Post-pyloric tube (NDT or NJT) = more complicated to insert (intraoperative, endoscopic or fluroscopic guidance, spontaneous placement via peristalsis, bedside with computer guidance)
Indicated if problems with gastric feeding: abdominal distention/discomfort, vomiting, persistent high gastric residuals (>400 ml). ? Higher risk for aspiration pnemonia
How you can maintain the patency of enteral access devices?
Flushing
No food
Nothing that’s not reccomened
When is the post-pyloric TF recommended?
Gastric motility disorders, esophageal reflux, or persistent nausea and vomiting Gastric pyres is Stomach not emptying High residuals or nausea Unable to be elevated
Labs for monitoring enteral and parenteral complications
weight
Signs and symptoms of edema (daily)
Signs and symptoms of dehydration (daily)
Fluid intake and output (daily)
Adequacy of enteral intake (at least two times/wk)
Abdominal distension and discomfort
Gastric residuals (every 4 hr) if appropriate
Serum glucose, Calcium, electrolytes, blood urea nitrogen, creatinine (two or three times/wk)
Stool output and consistency (daily)
Peripheral vs. central catheters for parenteral feeding.
Central parenteral nutrition ( CPN): catheter in large, high-blood-flow vein such as superior vena cava
Peripheral parenteral nutrition (PPN): catheter in small vein, typically the arm
Short term
Cannot tolerate concentrated solutions
Explain the complications of feeding excess fat to a patient on parenteral feeding
Fatty liver
What are some strategies to avoid aspiration?
Nevertheless, to minimize the risk of aspiration, patients should be posi- tioned with their heads and shoulders above their chests during and immediately after feeding.
How many days a patient can be NPO or inadequate oral intake before ASPEN
recommends to initiate nutrition support?
5-10 days
24-48 critical ICUs
How you will taper a TF to oral intake? (starting and stopping guidelines)
Parenteral to enteral Takes 2 to 3 days Stop parenteral when enteral reaches 75% Parenteral to oral Stop parenteral when oral reaches 75% Enteral to oral Reduce enteral to night only to reestablish hunger or satiety cues
Know when bolus feeding or continuous feeding is recommended?
bolus is the _feeding modality of choice when patients are clinically stablewith a functional stomach is the syringe bolus method.
continuous drip infusion of formula requiresa pump. This method is appropriate for patients who do not tolerate large-volume infusions during a given feeding such asthose occurring with bolus or intermittent methods.
Reefeding syndrome
Caused by overly aggressive parenteral nutrition, specifically carbohydrate
Potentially lethal
Cardiac and pulmonary complications from fluid overload
Monitor serum magnesium, potassium, and phosphorus
Start with 25% to 50% of goal parenteral nutrition in those at risk
refeedingsyndromelowserumlevelsofpotassiumm,agne- sium, and phosphoruswirh severe,potentially lethal out- c o m e t h a t r e s u l t sf r o m t h e t o o - r a p i d i n f u s i o n o f s u b s t r a t e s , particularlycarbohydrate,into the plasmawith the conse- quent releaseof insulin and shift of electrolytesinto the intracellularspaceasglucosemovesinto the cellsfor oxida- tion andthereis reductionin saltandwaterexcretio
