Ch. 20 Enteral Nutrition Support Flashcards
What are the 3 strategies of nutrition support?
Strategy #1: enhance oral intake
Strategy #2: enteral nutrition
Strategy #3: parenteral nutrition
Strategy #1: Enhance oral intake
Feeding by mouth
ex: Person has unintentionally lost a fair amount of weight and eating regular, everyday, foods aren’t cutting it. Could be elderly person, no interest in eating, lost a spouse, limited mobility.
Think about ways to enhance oral intake.
–how can you get more PRO in a person? More calories?
Strategy #2: Enteral nutrition
Tube feeding (TF)
- person has functional GI tract
- feeding directly into stomach or small intestines
Strategy #3: Parenteral Nutrition
Feeding directly into veins
Indications for TF
Include people with:
- -severe swallowing disorders/not safe to swallow (ex: stroke patients)
- -impaired motility in upper GI tract
- -GI obstructions and fistulas that can be bypassed with a feeding tube
- -Certain types of intestinal surgeries
- -Mechanical ventilators
- -Extremely high nutrient requirements (can’t get enough orally)
- -Little or no appetite for extended periods, especially in malnourished (tried everything else by oral intake yet they continue to decline; over extended period of time, not a couple of days)
- -Mental incapacitation due to confusion, neurological disorders, or coma (later states of Alzheimer’s: weight loss)
- -> if the gut works, use it!
What is TPN?
Total Parenteral Nutrition
Is the preferred route a TF or TPN?
TF is the preferred route over TPN
What are some contraindications for TF?
Severe GI bleeding (can aggravate bleeding by inserting tube)
High-Output fistulas
Intractable vomiting or diarrhea (“uncontrolled”)
Complete intestinal obstruction (nutrients absorbed in small intestine…you’ve got to them them to the person somehow)
Severe malabsorption
Paralytic Ileus
–Ileus: they don’t really have motility/decreased motility through bowels
What are the 2 categories of Feeding Tube Routes?
- Transnasal feeding tube placements
- Enterostomies
- -creating a stoma and putting the tube right into the stomach/jejunum so that you can feed directly through that tube to the organ
Transnasal feeding tube placements
Nasogastric (NG)
Nasoduodenal (ND)
Nasojejunal (NJ)
–>long term issue: sepsis (increased risk of infection)
Enterostomies
Gastronomy (PEG/G tube)
–directly into stomach
Jejunostomy (J tube)
–directly into jejunum
Enterostomy does give a lot of quality of life options
What nutrients go through a feeding tube?
Macronutrient composition -->PRO, CHO, fat Energy density Fiber Osmolality Cost
What should you consider when selecting a formula for a feeding tube?
Nutrient and energy needs Fluid requirements Need for fiber modifications Individual tolerance --food allergies and sensitivities -->ex: lactose intolerance -->ex: food preference (vegetarian...)
What are the 4 types of standard enteral formulas?
- Standard
- Elemental - CHO and PRO that are partially/fully hydrolyzed
- Specialized formulas - specific disease state (ex: diabetes)
Bolus TF delivery
Large amount in short period of time (“rapid infusion”)
ex: 1 can q 4º (1 can every 4 hours)
