Adult Enteral Nutrition Flashcards
First rule to enteral nutrition=
If the gut works, USE IT!
Enteral nutrition benefits
- Decrease in infectious complication and improved outcomes
- Plays a role in maintaining gut mucosal growth and development to preserve gut function
- Prevent stress related damage/ulcers
- Fewer metabolic complications
- reduced risk of developing cholestasis, gallbladder sludge and gallstones
- Avoids complications with placement
- Less costly
***Contraindication for Enteral nutrition
Mechanical obstruction Diffuse peritonitis Severe diarrhea Severe GI hemorrhage Intractable vomiting Chronic intestinal pseudo-obstruction Severe malabsorption
Functionality of the GI Tract
Got to have enough jejunum and ileum to absorb food
Decreased transit time due to removal of a valve
Reduced gastric emptying (risk of N/V and pulmonary aspiration)
Most common carbohydrate source is
corn syrup
Most common fat source is
Corn oil or palm kernel oil
Most common protein source is
Milk protein
Elemental is only used in those that:
have poor absorption
Partially hydrolyzed =
Rarely every used
Amino Acids that are not normally essential but in disease states they are:
Glutamine and arginine due to in high physiologic stress they become deficient
Glutamine function
Fuel for enterocyte
Helps maintain integrity of gut mucosa
Supplemental arginine does what:
Decrease protein catabolims
Enhance
nitrogen retention
Accelerate wound healing
Sufficient linoleic acid is required to
prevent essential fatty acid deficiency and should be 1-3% of daily total calories
Fiber functions
Decrease bacteria
Reduce incidence of diarrhea and helps keep the colon clean
Standard Polymeric:
Used 90% of the time
Jevity is most common
1-1.2 kcal/mL
Typically have to add water
High protein use
> 1.5 g/kg/day requirement
Trauma pts with burns, pressure sores, or wounds
High caloric density use
Typically in fluid restricted pts
Elemental and peptide based use
Pts who have absorption problems: short bowel, colon removed
Pulmonary and diabetic use
Low carbs
EN Regimen Considerations
- Evaluate risk of aspiration
- Flush feeding tube with at least 30 mL of sterile water every 4 hours during continuous feeding
- Schedules of progression and advancement should be individualized
- Do not dilute formulas bit add free water as boluses intermittently
- If GRV is >250 mL after second residual check, add a promotility agent
- GRV > 500 mLshould result in holding EN and evaluate tolerance
Electrolytes, BUN/SCr, glucose monitoring
Daily during initiation
Every 1-3 months during stable
Ca, Mg, P monitoring
3-7 per week during initiation
Every 1-3 months during stable
Liver function test monitoring
Weekly during initiation
Every 1-3 months during stable
Trace elements and vitamins monitoring
If deficiency or toxicity is suspected
