ASPEN ch 13 - comps of EN Flashcards
vomiting ^ risk of ______
pulmonary aspiration, pneumonia, sepsis
most common reason for vomiting
delayed gastric emptying
why delayed gastric emptying?
diabetic gastropathy, hypotension, sepsis, stress, anesthesia/surgery, neoplasms, autoimmune, opiate, anticholinergics, rapid infusion, cold /fat/fibre
if delayed gastric emptying suspected, interventions include:
d/c narcotics, switch to low fibre/low fat/isotonic formula, admin at rm temp, reduce rate of infusion, continuous feed, prokinetic agent
if GRV low but nausea persists, pt may benefit from ___ meds
antiemetic
____ or fecal impaction may lead to distention and nausea
obstipation
distention caused by:
GI ileus, obstruction, obstipation, ascites, diarrheal illness
simple method assess distention?
radiology, physical exam, contrast material under x-ray/fluoroscopy
what is maldigestion?
impaired breakdown of nutr into absorbable forms
clinical manifestations of maldigestion:
diarrhea, ab distention, bloating
what is malabsorption?
defective mucosal uptake and transport of nutrients from small intestine
clinical manifestations of malabsorption:
unexplained wt loss, steatorrhea, diarrhea, signs of deficiency
methods to screen for malabsorption:
gross/microscopic exam of stool, qualitative determination of fat/pro content of stool, serum carotene, serum citrulline, d-xylose absorption, radiologic exam
how to diagnose malabsorption?
intake-output, tests for specific nutr, endoscopic small bowel biopsy
most common side effect of EN
diarrhea
clinically useful def of diarrhea?
any abnormal vol or consistency of stool
diarrhea defined as > ___mL stool output every 24 hours or > ___ stools per day for at least 2 consecutive days
500; 3
common causes of diarrhea?
bacterial infection, GI disease, meds
meds delivered in liquid form that contain ___ or ____ can cause diarrhea
magnesium; sorbitol
_____ diarrhea is common med effect
antibiotic-associated
how to get rid of some osmotic load (dumping) of meds?
mix with water to dilute
hyperosmolar EN usually don’t cause diarrhea unless infused at _______ or administered by _____ into small bowel
very high rate; bolus
why not mix water into formula?
suboptimal nutr provision, not improve tolerance, contamination
how to treat diarrhea?
med assessment, antidiarrheal agent once c. diff ruled out/treated, change formula type, addition of soluble fibre, continue EN as tolerated or PN
why fibre containing formula better than modular?
no clogging
___ is often seen in pt after Roux-en-Y bypass surgery
SIBO
prolonged use of ___ ^ incidence of SIBO
broad spectrum antibiotics
how to treat SIBO?
empiric: nonabsorbable antibiotics and systemic antibiotics
why are liquid more sterile than powder?
undergo heat sterilization whereas powdered formulas not required to be sterile
contamination v in delivery systems that have ___ spike sets and nutr container seals
recessed
how can EN formula become contaminated in retrograde way?
pt microorgs reproduce in tube and migrate to enteral delivery system
____ports of EN delivery system used to deliver meds and water flushes and minimize disconnection of EN
Y
c diff most common in pt receiving ___ tube feeding
post pyloric
best clinical definition of constipation:
accumulation of excess waste in colon (up to transverse colon or cecum)
how to diagnose constipation?
rectal exam and plain ab x-ray
common cause of constipation:
dehydration and inadequate/excess fibre
if not dehydrated, constipation can be treated with addition of _____
stool softener and laxative
variant of constipation where there is a firm collection of stool in distal colon, liquid stool seep around impaction
impaction
rare life-threatening complication associated with tube feeds w/ fibre:
intestinal bezoar
what is NOBN?
nonocclusive bowel necrosis
factors associated w/ NOBN?
jejunal feed, hyperosmolar formula, feeding in presence of hypotension, disordered peristalsi
best way to prevent NOBN:
wait initiate EN after fluid resuscitated
aspiration can –> pneumonia when ____ and ___ of formula overwhelm pt natural defense mechanisms
quantity; acidity
acute symptoms of clinically significant aspiration:
dyspnea, wheezing, sputum that is frothy/purulent, hypoxia, cyanosis, anxiety, agitation
when pneumonia develops in ventilated pt, labelled _____
VAP
risk factors for aspiration?
low HOB, vomiting, gastric tube feedings, low glasgow coma score, GI reflux disease
emergency measures for aspiration:
sitting upright, orotracheal suctioning, O2, antibiotics
how to measure GRV?
suction fluid intermittently from EN access devices by syringe or gravity drain
GRV influenced by many factors, like:
diameter/position of tip, number/location of openings, pt position, skill of clinician
when should GRV checks be considered?
initial days of feeding and in pt at risk for intolerance
raise HOB _____ degrees to reduce aspiration risk
30-45
ASPEN recommendation that clinicians avoid holding EN for GRVs < ___mL
500
Canadian guidelines about GRVs?
threshold of 250-500mL
tube fed pt should be assessed for signs of intolerance at ____ hr intervals
4
pt at ^ risk of refeeding:
diarrhea, high output fistulas, vomiting
risk factors for refeeding syndrome?
malnutrition, inadequate intake >2 wks, poorly controlled diabetes, cancer, anorexia nervosa, SBS, IBD, older adult living alone, low birth weight and premature birth, chronic infection
ASPEN recommend EN for pt at risk for refeeding should provide only ___ % of nrg goal on first day
25
hyperglycemia more commonly associated with __ than ___
PN; EN
absorption of glucose from continuous feed is more affected by ___ than ____
rate of CHO delivery; glycemic index
glycemic index refers to rate of glucose increase after a ___
bolus
dehydration associated with ^ risk for ___
falls, pressure ulcers, constipation, UTIs, resp infections, med toxicities
why dehydration risk > in older adults?
lower water reserves cuz v in LBM occuring with aging , altered sense of thirst, diminished cognition, dysphagia, dysgeusia, hyposmia, reduced kidney fxn, impaired hormonal modulators of Na/H2o balance
s/s of dehydration:
dry mouth/eyes, thirst, light headed, headache, fatigue, loss of appetite, flushed skin, heat intolerance, dark urine with strong odour
simple quick and reliable costeffective way identify dehydration in older adults?
tongue dryness
dehydrated pt usually develop ___ hypotension and rise in __ rate
orthostatic; pulse
signs of progressive dehydration:
dysphagia, clumsiness, poor skin turgor, sunken eyes with dim vision, painful urination, cramps, delirium
lab values for dehydration:
^ in BUN, plasma osmolality and Hct
fluid status can be tracked by:
strict intake/output measurements and daily wts
1 kg wt change = __ kg of fluid
1
fluids should be ^ for pt who have:
fever, emesis, diarrhea, high fistula/ostomy outputs, hyperclycemia
