ASPEN Self-Assessment: Intro to EN Flashcards
What is the maximum hang time for closed-system enteral formulas?
48 hours
What are the fluid needs for an adult over the age of 65?
30 mL/day with a minimum of 1500 mL
What percent water are standard enteral formulas?
~84%
What are the benefits of early enteral feeding in critically ill patients?
- Decreases translocation of gut bacteria
- Reduces atrophy of intestinal villae
- Reduces risk for infectious complications.
It does not increase intestinal permeability.
What are the 2 most important factors in assessing the adequacy and efficacy of enteral feedings in pregnancy?
- Maternal weight gain
2. Fetal growth
(TRUE/FALSE)
There is a strong correlation between infant birth weight and maternal weight.
TRUE
Why is serum albumin not recommended for assessing the adequacy and efficacy of EN during pregnancy?
Serum albumin is not recommended due to diluational effects associated with normal plasma expansion and alterations in plasma protein production.
Lactose is a common ingredient in which type of enteral formula?
Standard infant formula
Lactose is used to mimic the carbohydrate found in human milk.
What EN formula is appropriate for patients with chyle leaks? Why?
Elemental
Goal of nutrition mgmt:
- Reduce the quantity and duration of chyle loss
- Determine patient’s response to an elemental, low-fat diet before initiating PN
What are 3 important parameters for predicting tolerance of EN in patients with pancreatitis?
- APACHE II score (disease severity; most important)
- Duration of NPO (Greater than 6 days have shown poor tolerance)
- Increasing abdominal pain
(TRUE/FALSE)
Triglyceride level is an appropriate parameter for EN tolerance in patients with pancreatitis.
FALSE.
Serum TG levels are used to measure tolerance of PN, not EN
When should EN be initiated?
How long should it last?
When patients are expected to (or have) not received adequate oral intake x 7 - 14 days.
Duration of EN should not be less than 5 to 7 days in the malnourished patient or 7 to 9 days in the adequately nourished patient.
(TRUE/FALSE)
It is safe to provide EN in patients with open abdomen.
TRUE.
In patients requiring open abdomen mgmt after laparatomy, PN should be deferred until EN is not tolerated x 7 or more days.
PN should be indicated in patients with high output mid-jejunal fistula, intractable obstipation and vomiting and short bowel syndrome.
Why would placement of a jejunostomy feeding tube NOT be beneficial for patient’s with short bowel syndrome?
What is recommended instead?
Infusion of EN into the jejunum will result in increased stool output and decreased absorption.
Slow continuous infusion into the stomach is recommended to maximize absorption and increase intestinal transit time.
What is the best intervention to assist with the appropriate placement of an NG tube in an alert patient?
Elevate the HOB to a sitting position, having the patient flex their head slightly forward once the tube tip is in the posterior nostril.
Having the patient swallow small sips of water may prevent respiratory misplacement.
IV metoclopramide is a prokinetic agent that may assist with transpyloric tube passage.
(TRUE/FALSE)
Bedside electromagnetic imaging systems have shown greater than 90% success with placement.
TRUE.
Weighted tube tips are the LEAST likely to facilitate transpyloric placement of an NG tube.
What is the primary advantage of a direct PEJ (percutaneous endoscopic placed jejunal tube) VERSUS PEG-J (percutaneous endoscopic transgastric-placed jejunal tube)?
Reduced incidence of migration or flipping back into the stomach in the PEJ.
Although gastric outlet obstruction may occur may in the PEG-J method, that is NOT the primary advantage of using PEJ.
Bleeding risk is no different
The ability to place PEG-J depends on the skill of the endoscopist.
What characteristic of enteral formulas is the MOST likely to increase splanchnic blood flow in a critically ill patient?
Research has shown that blood flow to the bowel is maximized with the use of HIGH FAT formulas over high CHO formulas.
An isotonic, fiber-free formula is ideal for patients at high risk for intestinal ischemia as adequate bowel perfusion is necessary for tolerance of high fiber, high osmolarity feedings.
What two interventions reduce the risk of aspiration with EN?
- Elevate HOB to 30-45 degrees
- Oral hygiene
No benefit to holding the TF during brief periods of supine positioning or elevated gastric residuals.
What is the effect of alpha-2 adrenergic agonist meds in EN?
Alpha-2 adrenergic agonists, such as clonidine, have been shown to have significant antimotility effects and often prolong instead of reducing intestinal transit time.
(TRUE/FALSE)
Metoprolol administration requires changing TF schedules.
FALSE, does NOT.
(TRUE/FALSE)
The bioavailability of warfarin, phenytoin, carbamazepine, and fluoroquinolones, such as ciprofloxacin, may be altered with EN and the EN feeding is often held for up to 2 hours, before and after administration to reduce interactions.
TRUE, but there is controversy surrounding holding TF
Many practitioners do not recommend holding TF around medication administration due to suboptimal nutrition delivery and lack of evidence. Many will justify continuing EN around medications that could potentially interact, and for adjustment of meds to help maintain therapeutic serum drug levels.
(TRUE/FALSE)
An acidic juice such as OJ can reduce the risk of microencapsulated beads/pellets sticking to the tube.
TRUE.
The tube should be flushed with 30 mL water before and after administration of the drug-juice mixture to avoid physical interactions between the acidic juice and the EN formulation.
Mixing drugs with carbonated beverages may be problematic due to the physical drug-nutrient interaction with the EN formulation.
The use of water or an oral electrolyte solution to administer granules may cause them to become sticky and adhere to the tube, thereby increasing the risk for feeding tube occlusion.
What is the hang time for blenderized formulas?
2 to 8 hours depending on if it’s homemade or commercial
What is the hang time for reconstituted enteral formulas?
Hang-time for powdered formula is limited to 4 hours (at room temperature)
Hang-time for canned or bottled sterile, liquid formulas is 8 hours.
Must be prepared aseptically and by trained personnel
What is the hang time for closed system EN?
24 to 48 hours, depending on the connection set.
What is the best method to assess protein requirement and adequacy?
The gold standard for assessing adequacy of protein intake in the hospitalized patient is NITROGEN OUTPUT.
-Derived using UUN and requires a 24-hour urine collection.
N balance = N intake (intake in nutrition support divided by 6.25) - N output (UUN x urinary volume / 100 + 20% urinary urea losses + 2g)
Example: EN provides 136g protein
N balance = 21.8g - [16+3.2(20%) +2] = 0.6 or N equilibrium
(TRUE/FALSE)
Elemental and semi-elemental formulas are designed for patients with GI dysfunction, including patients with known malabsorptive disorders or those having difficulty absorbing or digesting standard polymeric formulas.
TRUE.
Polymeric formulas may also have more benefits than elemental formulas in patients with intestinal failure as these formulas are more isotonic and may better enhance intestinal adaptation.
Immune-modulating EN formulas should be reserved for which patients?
Trauma, TBI and, surgical ICU patients.
(TRUE/FALSE)
Immune-modulating EN formulas are contraindicated in septic patients.
TRUE.
Due to adverse effects are seen with arginine supplementation in these individuals.
(TRUE/FALSE)
Immune-modulating EN formulas are recommended for routine use in the medical ICU.
FALSE, are NOT recommended
Which of the following are modular products?
Safflower oil Protein Glucose Selenium MCT oil Fiber Glutamine Cholecalciferol
MCT oil, glucose, fiber, and protein
Modular products are commonly used to fortify enteral nutrition regimes or meals served
-Are typically single-nutrient products and are available for use in addition to the selected oral or enteral products.
(TRUE/FALSE)
There is believed to be an increased ratio of AAA (aromatic AA) to BCAAs in patients experiencing hepatic encephalopathy.
TRUE, therefore, the use of EN enriched with BCAAs may benefit patients with refractory encephalopathy.
But the use of these hepatic formulas be limited to patients with encephalopathy that is unresponsive to standard medical therapy (lactulose, non-absorbed abx)
Why may EN be contraindicated in the early post-transplant period with hematopoietic cell transplants?
Because of potential mucosal toxicities related to the conditioning regime.
GI toxicities such as: N/V/D/delayed gastric emptying seen in the 2-3 weeks post-stem cell transplant may preclude EN.
Which type of medications can be crushed for administration via EN tube?
Only immediate-release tablets
(TRUE/FALSE)
Modified release dosage (such as XL, XR, SR, CD) are inappropriate crush and give via EN tube because crushing these dosage forms destroys their modified releasing properties.
TRUE. This may lead to an excessive dose of the drug being released at one time (instead of slowly over a longer period of time), which can lead to adverse effects and has even been reported as a cause of death.
