ASPEN ch 10 - EN

Question 1

nutr provided via enteral route undergo ____ metabolism, promoting efficient nutr utilization

Answer 1

first-pass

Question 2

risk of cholecystitis if kept ___

Answer 2

NPO

Question 3

____ which is secreted in GI tract in response to intraluminal nutr can prevent _____

Answer 3

IgA; bacterial adherence and translocation

Question 4

contraindications for EN

Answer 4

severe SBS, severe malabsorption, severe GI bleed, distal high output GI fistula, paralytic ileus, intractable vomiting/diarrhea, mech obstruction, GI can’t be accessed

Question 5

factors to assess before initiate EN

Answer 5

duration, modality, aspiration/refeeding risk, primary diagnosis, comorbidities

Question 6

small bore flexible tubes good for:

Answer 6

ppl awake/alert, limit discomfort, lower risk upper GI bleed

Question 7

why modulars typically not mixed directly with EN formulas?

Answer 7

may clog feeding tube

Question 8

why abnormalities in refeeding?

Answer 8

increased use of specific nutr for cho metabolism

Question 9

s/s of refeeding

Answer 9

electrolyte abnormalities, cardiovasc conditions, thiamin v , fluid retention, hyperglycemia, neurologic, resp

Question 10

risks for refeeding?

Answer 10

severe malnutrition, prolonged NPO, GI/renal conditions (electrolyte losses), meds like diuretics

Question 11

inhalation of GI or oropharyngeal contents into lungs is called ____

Answer 11

aspiration

Question 12

type of aspiration that can occur with EN?

Answer 12

regurgitation or reflux in aspiration of stomach contents

Question 13

risk factors for aspiration?

Answer 13

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

Question 14

traditional key strategy to decrease incidence of aspiration in pt with EN?

Answer 14

postpyloric feeding tube placement

Question 15

when is gastric feeding preferable?

Answer 15

if waiting for migration of a feeding tube tip past pylorus will delay early initiation

Question 16

what classifies as early initiation of EN?

Answer 16

within 24-48 hrs of initial insult

Question 17

why early initiation?

Answer 17

lower mortality and infection

Question 18

continuous drip infusions preferred for these pts:

Answer 18

critically ill, mech ventilated in throat, risk of refeeding, poor glycemic control, fed via jejunostomy, intolerance to intermittent/bolus

Question 19

__method can be used to provide continuous drip feed to noncritically ill pt living outside hospital

Answer 19

gravity drip

Question 20

___ feeding provides EN over time period < 24 hr

Answer 20

cyclic

Question 21

intermittent feeding more common in feeding tubes terminating in ___

Answer 21

stomach

Question 22

___ feedings involves provision of volume of formula at specific time intervals over very short period of time ((usually with syringe)

Answer 22

bolus

Question 23

benefits of bolus feed:

Answer 23

mimic normal meals, freedom of mvmt, admin more convenient, least expensive

Question 24

why not delay EN even if absence of overt signs of GI contractility (eg. bowel sounds/mvmts)?

Answer 24

because delay ^ risk of compromising GI mucosal barrier and immune function

Question 25

____based feeding instead of ____ is more recent feeding method for critically ill

Answer 25

volume; volume per hour

Question 26

EN should be delayed in these pts:

Answer 26

hemodynamically unstable, starting vasopressor meds (prevent ischemic bowel)

Question 27

critically ill obese pt may benefit from ____ EN to minimize metabolic complications of feeding, preserve LBM and mobilize fat stores

Answer 27

hypocaloric high protein

Question 28

^ risk of clogging when:

Answer 28

fibre, small diameter, silicone tubes, checking GRV, improper med admin

Question 29

why water superior choice for fluid?

Answer 29

maintain best patency and keep hydrated

Question 30

probs with liquid meds?

Answer 30

hyperosmotic, leading to diarrhea

Question 31

one of the major causes of contamination in EN

Answer 31

improper hand washing

Question 32

how to monitor EN?

Answer 32

physical assessment, lab data, anthro, vital signs, measure intake/output

Question 33

things that compromise GRV checks:

Answer 33

feeding tube type/diameter/position; viscosity , technique, position of pt

Question 34

why GRV no longer recommended?

Answer 34

no correlation with incidence of pneumonia/aspiration, can ^ episodes of tube occlusion and reduce total vol. EN delivered, waste of time

Question 35

holding EN for long/repeated times can ^ risk of developing ___

Answer 35

ileus

Question 36

methods other than GRVs for assessing GI fxn?

Answer 36

passage of flatus/stool, stool frequency and consistency, physical exam, ab radiographs

Question 37

excess fluid losses occur in these conditions:

Answer 37

high vol GI output from diarrhea, colostomies, ileostomies, fistulas, high fever, burns, wounds

Question 38

how can EN itself contribute to dehydration?

Answer 38

hyperosmolarity

Question 39

s/s of dehydration:

Answer 39

poor skin turgor, dry mucous mem, ^ serum BUN/creatinine/sodium

Question 40

target BG range for pt:

Answer 40

140-180mg/dL

Question 41

BG control can be achieved via ____ drips, EN not postponed

Answer 41

continuous insulin

Question 42

with poor BG control, why not recommend high fat content low CHO?

Answer 42

high fat may delay gastric emptying, affecting tolerance (limit ability achieve goal volumes)

Question 43

this can be used as a tool to assess adequacy of protein provision

Answer 43

nitrogen balance

Question 44

accuracy of NB is limited by:

Answer 44

impaired renal fxn, incomplete collection of GI losses from fistulas/stool/ostomies