Lecture 8

Question 1

different types of IV fluids?

Answer 1

Ringer’s Lactate, Normal saline, 1/2 normal saline, D5W, D10W, D5W 1/2 NS

Question 2

what does TKVO mean?

Answer 2

to keep vein open

Question 3

what is the purpose of nutrition monitoring?

Answer 3

determine and measure amt of progress made for nutr intervention and whether nutr related goals/expected outcomes are being met

Question 4

enteral nutrition related complications:

Answer 4

GI, metabolic, pulmonary, hydration, mechanical

Question 5

nausea and vomiting happens in ____ % of pt on EN and ^ risk for _____

Answer 5

7-26; aspiration

Question 6

possible etiologies of nausea/vomiting

Answer 6

delayed gastric emptying/gastroparesis, hypotension, hemodynamic instability, stress, sepsis, anesthesia/surgery, meds, very cold formula

Question 7

interventions for nausea/vomiting?

Answer 7

room temp feeds, decrease rate of infusion, go back to continuous, change EN formula, liaise with team re meds

Question 8

drugs that enhance GI motility via various mechanisms of action

Answer 8

prokinetic agents

Question 9

common prokinetic agents

Answer 9

metclopromide, domperidone, erythromycin

Question 10

various mechanisms of action that prokinetics work:

Answer 10

stim gut motility, esophageal peristalsis, strengthen lower esophageal sphincter pressure to promote gastric emptying

Question 11

ab distension caused by:

Answer 11

GI ileus, bowel obstruction, constipation/obstipation, ascites, initial use of high fibre feed

Question 12

interventions for ab distention:

Answer 12

testing to r/o obstruction or ileus (imaging with xray or CT), hold feeds if necessary (not necessary if intestinal appearance/fxn normal, no pain)

Question 13

s/s of malabsorption:

Answer 13

wt loss, steatorrhea, diarrhea

Question 14

interventions for malabsorption:

Answer 14

trial semi elemental formula, supplemental PN if unresponsive to EN

Question 15

disease related malabsorption:

Answer 15

IBD, radiation enteritis, enteric fistulas, pancreatic insufficiency, short bowel syndrome

Question 16

what is the osmolality of blood?

Answer 16

300

Question 17

caused by incomplete absorption of fluid and electrolytes from lumen of GIT

Answer 17

diarrhea

Question 18

sample definitions of diarrhea:

Answer 18

bristol stool chart 5-7, 3 loose stools/day for 2days, >500mL/24h, abnormal volume and consistency

Question 19

etiologies of diarrhea

Answer 19

drugs, disease, infection, feeding formulas (hyperosmolar, lactose containing)

Question 20

what does MOIST stand for?

Answer 20

motility, osmotic, impaction, secretory, trauma

Question 21

decreased motility causes:

Answer 21

areas of stagnation–>bacteria overgrowth–>disrupt bile salt reabsorption, bile salts excessively enter colon

Question 22

increased gut motility causes:

Answer 22

reduced contact time with the gut mucosa–>inadequate absorption of fluid/lytes

Question 23

intraluminal presence of poorly absorbed osmotically active solute causes:

Answer 23

osmotic force pulls water/ions into lumen, exceeding absorptive capacity of bowel

Question 24

the presence of a large amount of hard stool that is too large to pass and is thus retained in rectal vault

Answer 24

impactoin

Question 25

meds that cause impaction:

Answer 25

narcotics/analgesics

Question 26

overstimulation by luminal/circulating secretagogues leads to:

Answer 26

excess GI secretion which overwhelms GI absorptive ability

Question 27

conditions associated with secretory diarrhea:

Answer 27

c difficile infection, intestinal resection, bile acid malabsorption, IBD, chronic infections, celiac sprue, small intestinal lymphoma, villous adenoma of rectum, Zollinger-Ellison syndrome, collagen vascular diseases, congenital defects, malignant carcinoid syndrome

Question 28

how does trauma cause diarrhea?

Answer 28

structural disruption of intestinal epithelium barrier fxn leading to altered hydrostatic pressure in BV/lymphatic's (lumen accumulates blood/pro/water/lytes/mucus)

Question 29

what does CHIME stand for?

Answer 29

constipation, history, infection, meds, equipment

Question 30

how to manage diarrhea nutritionally?

Answer 30

change formula type (intact protein-->peptides), add soluble/insoluble fibre (formula, modular, metamucil/pectin), consider PN

Question 31

common causes of constipation?

Answer 31

dehydration, inadequate/excess fibre, meds, immobilization

Question 32

interventions for constipation?

Answer 32

ensure hydration, switch to fibre rich formula, ensure pt is on bowel routine, mobilize pt, ^ water flushes

Question 33

this is often forgotten in EN, but is very important:

Answer 33

oral care

Question 34

these complications relate to hydration status, electrolyte imbalance, vit. and mineral status, glycemic control

Answer 34

metabolic

Question 35

management strategies for pulmonary complications:

Answer 35

tube placement (chest or abdo xray), HOB 30-45 degrees, manage nausea and vomiting, GRVs

Question 36

what is GRV threshold maximum?

Answer 36

250 mL

Question 37

ins include __ and outs include ___

Answer 37

IVs, EN, free water, meds ; urine, stool, insensible losses, disease (ostomy, fistula, drains, paracentesis)

Question 38

management strategies for hydration:

Answer 38

lab findings, assess ins and outs, physical assessment, include fluids/water in EN calculations

Question 39

tube blockage caused by:

Answer 39

inadequate flushing, large amts of crushed meds and modulars

Question 40

management for blockage:

Answer 40

routine water flushes, tube unclogging protocol (pancrealipase/NaHCO3 mix) , tube change

Question 41

do NOT use these for flushes:

Answer 41

coke, cranberry juice

Question 42

examples of irritation from tube:

Answer 42

sinusitis, nose bleeds, swallowing dysfunction, leakage/wound infection

Question 43

managing irritation:

Answer 43

proper tube/wound care, tube changes as needed