Ch 13: Complications of Enteral Nutrition Flashcards
What is the highest osmolality rate of a TF?
around 750 mOsm/L; in contrast, electrolyte supplements are in the range of 5000-7500 mOsm/L, and are much more likely to cause diarrhea
What are the most common reasons for N/V for a patient receiving EN?
Delayed gastric emptying (Diabetic gastropathy, hypotension, sepsis, stress, surgery, anesthesia, neoplasms, autoimmune diseases, opiates, etc.)
Besides TF, what are some other etiologies of diarrhea?
Hypertonicity of some drugs (lyte replacements, meds in liquid form that contain mg or sorbitol as the vehicle) may cause diarrhea. As little as 10-20 g of sorbitol can lead to GI side effects.
Drugs with direct effects on the gut (ABX, PPI, prokinetics) can also cause diarrhea, and AAD is a common med side effect, occurring in up to 25% of patients treated w/ ABX.
What are some common reasons for distension/bloating/cramping?
GI ileus, obstruction, obstipation, ascites, or diarrheal illness
If delayed gastric emptying is suspected, what are the appropriate interventions?
Interventions may include reducing/discontinuing narcotic meds, switching to low fiber low fat and/or isotonic formula, administering feeding solution at room temp, temporarily reducing the rate by 20-25 mL/hour, changing infusion method and/or administering a prokinetic agent such as metoclopramide or erythromycin
If GRV are checked, unless the patient is vomiting, up to how much of GRV should be re-instilled?
Up to 250 mL should be reinstilled to replace fluid, electrolytes, and feeding formula
When malabsorption is suspected, which tests can be considered?
I/O balance for fecal fat assessment, tests for specific nutrients, such as lactose tolerance tests, schilling test to screen for abnormal absorption of B12, EFA profile for lipid metabolism, etc
To prevent Bezoars, what should be avoided in patients who are not hemodynamically stable?
Fiber
What is the general definition of diarrhea?
Can be defined as > 250 mL stool output every 24 hours or more then 3 stools per day for at least 2 consecutive days
What may the lab result of a dehydrated patient show?
an elevation relative to pre-dehydration levels in BUN, plasma osmolality, and hematocrit whereas serum sodium levels can be elevated, low or normal depending on the etiology of the dehydration.
In dehydration the BUN level usually risks out of proportion to the usual BUN creatinine ratio of 20:1
What diagnosis should be considered in patients who have altered GI anatomy or have been treated with prolonged ABX?
SIBO
When evaluating daily weight changes and I/O, clinicians can assume that 1 kg of weight change = how many liters of fluid?
1 kg of weight change = 1 liter of fluid
What is the minimum UOP required to remove waste?
700 mL
How often should a Lopez valve be changed?
in intervals of 3 days or less and perhaps at each tubing change (high risk of developing biofilms)
What are some signs of a dehydrated patient?
Dehydrated patients usually develop orthostatic hypotension (a drop in systolic blood presume of 20 mm Hg or more upon standing) and rise in pulse rate by at least 10 BPM
What does creatinine usually reflect?
Muscle mass
What are signs and symptoms of malabsorption?
Symptoms include weight loss, steatorrhea, diarrhea, and signs of vitamin, mineral, or essential macro deficiency
What are some risk factors for aspiration?
Low HOB elevation, gastric tube feeds (compared to small bowel), low GCS, GI reflux disease, a mispositioned tube, transportation within the hospital, and inadequate nursing staff
What does BUN usually reflect?
Protein intake as well as hydration and renal function.
What should be done if an ileus or obstruction is suspected?
It may be confirmed by a flat and upright abdominal xray (often non diagnostic) or CT
During gastric feeding, how high should the HOB be raised?
30-45 degrees during gastric feeding
What should be considered as a differential diagnosis if a patient presents with bloating, abdominal pain, and/or otherwise unexplained catabolism/hypoalbumenia?
SIBO
Treatment often empiric and includes ABX
What is the hang out one for reconstituted powdered formulas?
No more than 4 hours at room temp
If formula left over, excess should be refrigerated immediately and stored per manufacturer’s directions, typically max of 24 hours
What is the hang time for ready to feed formulas?
24-48 hours per manufacturer’s directions
How often should feeding bags be changed?
Every 24 hours
When should sterile water be used?
When powdered formula requires reconstitution or dilution
