ASPEN ch 10 - EN Flashcards
nutr provided via enteral route undergo ____ metabolism, promoting efficient nutr utilization
first-pass
risk of cholecystitis if kept ___
NPO
____ which is secreted in GI tract in response to intraluminal nutr can prevent _____
IgA; bacterial adherence and translocation
contraindications for EN
severe SBS, severe malabsorption, severe GI bleed, distal high output GI fistula, paralytic ileus, intractable vomiting/diarrhea, mech obstruction, GI can’t be accessed
factors to assess before initiate EN
duration, modality, aspiration/refeeding risk, primary diagnosis, comorbidities
small bore flexible tubes good for:
ppl awake/alert, limit discomfort, lower risk upper GI bleed
why modulars typically not mixed directly with EN formulas?
may clog feeding tube
why abnormalities in refeeding?
increased use of specific nutr for cho metabolism
s/s of refeeding
electrolyte abnormalities, cardiovasc conditions, thiamin v , fluid retention, hyperglycemia, neurologic, resp
risks for refeeding?
severe malnutrition, prolonged NPO, GI/renal conditions (electrolyte losses), meds like diuretics
inhalation of GI or oropharyngeal contents into lungs is called ____
aspiration
type of aspiration that can occur with EN?
regurgitation or reflux in aspiration of stomach contents
risk factors for aspiration?
inability protect airway, delayed gastric emptying, presence of feeding tube, gerd, poor positioning, vomit, bolus feed, mech ventilation, >70yrs, poor oral care, inadequate nurse-pt ratio
traditional key strategy to decrease incidence of aspiration in pt with EN?
postpyloric feeding tube placement
when is gastric feeding preferable?
if waiting for migration of a feeding tube tip past pylorus will delay early initiation
what classifies as early initiation of EN?
within 24-48 hrs of initial insult
why early initiation?
lower mortality and infection
continuous drip infusions preferred for these pts:
critically ill, mech ventilated in throat, risk of refeeding, poor glycemic control, fed via jejunostomy, intolerance to intermittent/bolus
__method can be used to provide continuous drip feed to noncritically ill pt living outside hospital
gravity drip
___ feeding provides EN over time period < 24 hr
cyclic
intermittent feeding more common in feeding tubes terminating in ___
stomach
___ feedings involves provision of volume of formula at specific time intervals over very short period of time ((usually with syringe)
bolus
benefits of bolus feed:
mimic normal meals, freedom of mvmt, admin more convenient, least expensive
why not delay EN even if absence of overt signs of GI contractility (eg. bowel sounds/mvmts)?
because delay ^ risk of compromising GI mucosal barrier and immune function
____based feeding instead of ____ is more recent feeding method for critically ill
volume; volume per hour
EN should be delayed in these pts:
hemodynamically unstable, starting vasopressor meds (prevent ischemic bowel)
critically ill obese pt may benefit from ____ EN to minimize metabolic complications of feeding, preserve LBM and mobilize fat stores
hypocaloric high protein
^ risk of clogging when:
fibre, small diameter, silicone tubes, checking GRV, improper med admin
why water superior choice for fluid?
maintain best patency and keep hydrated
probs with liquid meds?
hyperosmotic, leading to diarrhea
one of the major causes of contamination in EN
improper hand washing
how to monitor EN?
physical assessment, lab data, anthro, vital signs, measure intake/output
things that compromise GRV checks:
feeding tube type/diameter/position; viscosity , technique, position of pt
why GRV no longer recommended?
no correlation with incidence of pneumonia/aspiration, can ^ episodes of tube occlusion and reduce total vol. EN delivered, waste of time
holding EN for long/repeated times can ^ risk of developing ___
ileus
methods other than GRVs for assessing GI fxn?
passage of flatus/stool, stool frequency and consistency, physical exam, ab radiographs
excess fluid losses occur in these conditions:
high vol GI output from diarrhea, colostomies, ileostomies, fistulas, high fever, burns, wounds
how can EN itself contribute to dehydration?
hyperosmolarity
s/s of dehydration:
poor skin turgor, dry mucous mem, ^ serum BUN/creatinine/sodium
target BG range for pt:
140-180mg/dL
BG control can be achieved via ____ drips, EN not postponed
continuous insulin
with poor BG control, why not recommend high fat content low CHO?
high fat may delay gastric emptying, affecting tolerance (limit ability achieve goal volumes)
this can be used as a tool to assess adequacy of protein provision
nitrogen balance
accuracy of NB is limited by:
impaired renal fxn, incomplete collection of GI losses from fistulas/stool/ostomies
