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NUTR 442 > ASPEN ch 13 - comps of EN > Flashcards

ASPEN ch 13 - comps of EN Flashcards

1
Q

vomiting ^ risk of ______

A

pulmonary aspiration, pneumonia, sepsis

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2
Q

most common reason for vomiting

A

delayed gastric emptying

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3
Q

why delayed gastric emptying?

A

diabetic gastropathy, hypotension, sepsis, stress, anesthesia/surgery, neoplasms, autoimmune, opiate, anticholinergics, rapid infusion, cold /fat/fibre

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4
Q

if delayed gastric emptying suspected, interventions include:

A

d/c narcotics, switch to low fibre/low fat/isotonic formula, admin at rm temp, reduce rate of infusion, continuous feed, prokinetic agent

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5
Q

if GRV low but nausea persists, pt may benefit from ___ meds

A

antiemetic

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6
Q

____ or fecal impaction may lead to distention and nausea

A

obstipation

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7
Q

distention caused by:

A

GI ileus, obstruction, obstipation, ascites, diarrheal illness

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8
Q

simple method assess distention?

A

radiology, physical exam, contrast material under x-ray/fluoroscopy

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9
Q

what is maldigestion?

A

impaired breakdown of nutr into absorbable forms

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10
Q

clinical manifestations of maldigestion:

A

diarrhea, ab distention, bloating

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11
Q

what is malabsorption?

A

defective mucosal uptake and transport of nutrients from small intestine

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12
Q

clinical manifestations of malabsorption:

A

unexplained wt loss, steatorrhea, diarrhea, signs of deficiency

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13
Q

methods to screen for malabsorption:

A

gross/microscopic exam of stool, qualitative determination of fat/pro content of stool, serum carotene, serum citrulline, d-xylose absorption, radiologic exam

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14
Q

how to diagnose malabsorption?

A

intake-output, tests for specific nutr, endoscopic small bowel biopsy

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15
Q

most common side effect of EN

A

diarrhea

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16
Q

clinically useful def of diarrhea?

A

any abnormal vol or consistency of stool

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17
Q

diarrhea defined as > ___mL stool output every 24 hours or > ___ stools per day for at least 2 consecutive days

A

500; 3

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18
Q

common causes of diarrhea?

A

bacterial infection, GI disease, meds

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19
Q

meds delivered in liquid form that contain ___ or ____ can cause diarrhea

A

magnesium; sorbitol

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20
Q

_____ diarrhea is common med effect

A

antibiotic-associated

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21
Q

how to get rid of some osmotic load (dumping) of meds?

A

mix with water to dilute

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22
Q

hyperosmolar EN usually don’t cause diarrhea unless infused at _______ or administered by _____ into small bowel

A

very high rate; bolus

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23
Q

why not mix water into formula?

A

suboptimal nutr provision, not improve tolerance, contamination

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24
Q

how to treat diarrhea?

A

med assessment, antidiarrheal agent once c. diff ruled out/treated, change formula type, addition of soluble fibre, continue EN as tolerated or PN

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25
Q

why fibre containing formula better than modular?

A

no clogging

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26
Q

___ is often seen in pt after Roux-en-Y bypass surgery

A

SIBO

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27
Q

prolonged use of ___ ^ incidence of SIBO

A

broad spectrum antibiotics

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28
Q

how to treat SIBO?

A

empiric: nonabsorbable antibiotics and systemic antibiotics

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29
Q

why are liquid more sterile than powder?

A

undergo heat sterilization whereas powdered formulas not required to be sterile

30
Q

contamination v in delivery systems that have ___ spike sets and nutr container seals

A

recessed

31
Q

how can EN formula become contaminated in retrograde way?

A

pt microorgs reproduce in tube and migrate to enteral delivery system

32
Q

____ports of EN delivery system used to deliver meds and water flushes and minimize disconnection of EN

A

Y

33
Q

c diff most common in pt receiving ___ tube feeding

A

post pyloric

34
Q

best clinical definition of constipation:

A

accumulation of excess waste in colon (up to transverse colon or cecum)

35
Q

how to diagnose constipation?

A

rectal exam and plain ab x-ray

36
Q

common cause of constipation:

A

dehydration and inadequate/excess fibre

37
Q

if not dehydrated, constipation can be treated with addition of _____

A

stool softener and laxative

38
Q

variant of constipation where there is a firm collection of stool in distal colon, liquid stool seep around impaction

A

impaction

39
Q

rare life-threatening complication associated with tube feeds w/ fibre:

A

intestinal bezoar

40
Q

what is NOBN?

A

nonocclusive bowel necrosis

41
Q

factors associated w/ NOBN?

A

jejunal feed, hyperosmolar formula, feeding in presence of hypotension, disordered peristalsi

42
Q

best way to prevent NOBN:

A

wait initiate EN after fluid resuscitated

43
Q

aspiration can –> pneumonia when ____ and ___ of formula overwhelm pt natural defense mechanisms

A

quantity; acidity

44
Q

acute symptoms of clinically significant aspiration:

A

dyspnea, wheezing, sputum that is frothy/purulent, hypoxia, cyanosis, anxiety, agitation

45
Q

when pneumonia develops in ventilated pt, labelled _____

A

VAP

46
Q

risk factors for aspiration?

A

low HOB, vomiting, gastric tube feedings, low glasgow coma score, GI reflux disease

47
Q

emergency measures for aspiration:

A

sitting upright, orotracheal suctioning, O2, antibiotics

48
Q

how to measure GRV?

A

suction fluid intermittently from EN access devices by syringe or gravity drain

49
Q

GRV influenced by many factors, like:

A

diameter/position of tip, number/location of openings, pt position, skill of clinician

50
Q

when should GRV checks be considered?

A

initial days of feeding and in pt at risk for intolerance

51
Q

raise HOB _____ degrees to reduce aspiration risk

A

30-45

52
Q

ASPEN recommendation that clinicians avoid holding EN for GRVs < ___mL

A

500

53
Q

Canadian guidelines about GRVs?

A

threshold of 250-500mL

54
Q

tube fed pt should be assessed for signs of intolerance at ____ hr intervals

A

4

55
Q

pt at ^ risk of refeeding:

A

diarrhea, high output fistulas, vomiting

56
Q

risk factors for refeeding syndrome?

A

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

57
Q

ASPEN recommend EN for pt at risk for refeeding should provide only ___ % of nrg goal on first day

A

25

58
Q

hyperglycemia more commonly associated with __ than ___

A

PN; EN

59
Q

absorption of glucose from continuous feed is more affected by ___ than ____

A

rate of CHO delivery; glycemic index

60
Q

glycemic index refers to rate of glucose increase after a ___

A

bolus

61
Q

dehydration associated with ^ risk for ___

A

falls, pressure ulcers, constipation, UTIs, resp infections, med toxicities

62
Q

why dehydration risk > in older adults?

A

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

63
Q

s/s of dehydration:

A

dry mouth/eyes, thirst, light headed, headache, fatigue, loss of appetite, flushed skin, heat intolerance, dark urine with strong odour

64
Q

simple quick and reliable costeffective way identify dehydration in older adults?

A

tongue dryness

65
Q

dehydrated pt usually develop ___ hypotension and rise in __ rate

A

orthostatic; pulse

66
Q

signs of progressive dehydration:

A

dysphagia, clumsiness, poor skin turgor, sunken eyes with dim vision, painful urination, cramps, delirium

67
Q

lab values for dehydration:

A

^ in BUN, plasma osmolality and Hct

68
Q

fluid status can be tracked by:

A

strict intake/output measurements and daily wts

69
Q

1 kg wt change = __ kg of fluid

A

1

70
Q

fluids should be ^ for pt who have:

A

fever, emesis, diarrhea, high fistula/ostomy outputs, hyperclycemia

NUTR 442 (34 decks)

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