12: Nutrition Support Flashcards
What is the most common g-tube complication?
peristomal infection
If a patient was going to do blenderized tube feedings, what size tube do they need?
larger than 14 Fr
What is important to supplement with during refeeding syndrome?
Thiamin — 100 mg/d for 5-7 days
What is a concern with a patient that is malnourished and starting on NS? What are signs/symptoms and how do you manage it?
Refeeding syndrome
S/S: hypophos/K+/Mg, severe glucose ranges, fluid shifts/retention, cardiac dysfunction and respiratory failure
25% of energy needs to start, gradually increase over 3-5 days until labs/clinical signs are resolved
What are some ways to avoid having clogged tube?
larger Fr – common in 8-10 Fr
interactions between meds and formula are common issues — avoid meds down tube if possible
What are some ways to unclog a tube?
5 mL of warm water as near to clog as possible for up to 15 minutes
Use a gentle push/pull motion with 30-60 ml syringe plunger to help dislodge the clog and attempt to aspirate or flush with warm water
Us a solution of pancrelipase mixed with sodium bicarb
commercial unclogging device or things like clog zapper (medical supervision needed)
What are some EN specific concerns with medications for: anti-diarrheals
Cholestyramine isn’t recommended – particularly for small bore tubes
Use loperamide liquid instead or diphenoxylate hydrochloride and atropine sulfate
What are some EN specific concerns with medications for: antiemetics
Concerns with aprepitant and ondansetron orally disintegrating tablet (better to take orally by letting it dissolve on tongue and swallow)
Use liquid versions instead
What are some EN specific concerns with medications for: antibiotics
cirpofloxacin and levofloxacin aren’t recommended to go down a tube but there are no recommended alternatives — oral if possible
What are some EN specific concerns with medications for: appetite stimulants
Dronabinol isn’t recommended
Use other dissolvable tablets or liquids of other options
What are some EN specific concerns with medications for: pain meds
extended release pills are an issue, but a lot have liquid (or patch) form
What are some EN specific concerns with medications for: Laxatives
methycellulose or psyllium, cholestryamine, or biscodyl tablets are not recommended
use liquids, senna, lactulose, or suppositories
What are some EN specific concerns with medications for: PPIs
Pantoprazole and Rabeprazole tablets not recommended (but can do a packet)
Dexlansoprazole capsules and disintegrating table – others have tablets as well
What are some EN specific concerns with medications for: vitamins
Slow Mag, K-Dur, Micro-K not recommended —- can usually get liquid versions of vitamins/minerals no problem
What are some EN specific concerns with medications for: Sucralfate
May bind with protein left in the tube from formula — change to a different PPI or H2 blocker formulation
What are some EN specific concerns with medications for: pancreatic enzymes
open capsule and mix with small amount of applesauce if oral available, otherwise suspend in water or nectar-thick juice NOT something alkaline like yogurt
What is the highest the final concentration of PPN can be?
900 mOsm/L, dextrose of 5-10% and max of 3% amino acids
What is the minimum dose of dextrose you can give daily to avoid ketone production?
50 g/d
What type of lipid can help reduce common PN issues like liver disease?
Change from normal soybean-oil based to SMOFlipid (mixed oil— 30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil)
What are some medications that can be added directly to PN?
H2-receoptor antagonists, insulin, heparin
What is the ASPEN recommendations for initial insulin dosing?
0.05 to 0.1 units per g of dextrose in the PN solution or 0.15-.2 for patients already hyperglycemic
