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)
Intermittent TF delivery
ex. 70cc/º7pm-7am
Continuous TF delivery
TF is running 24 hr/d OR continuous over night
60 cc/º
Why are water flushes important for TF?
ex. flush with 20-30mL of water before and after formula delivery and every 4 hours
- Needed to keep tube clear and free of debris
- Also helps to give patient extra fluids they need
What are gastric residuals?
- The volume of formula and GI secretions remaining in the stomach after previous feeding
- Many places are no longer checking for these → may not be indicative of the feeding (may be due to other issues)
- -> Textbook vs reality
Open System TF
Administered at the bedside
Hang no more than 8-12 hour supply of formula
Because of risk for infection, you can’t hang open system long.
–ex: cans
Closed System TF
Administered at the bedside
Hang no more than 36-48 hour supply of formula
Formula Strength
Isotonic or hypertonic formulas occasionally diluted when initiating feeding
Formulas (especially hypertonic) are started slowly, and volume is gradually increased
Transition to Table Foods
TF:
- -gradually tapered off - as oral intake increases
- -are discontinued when client is consuming 2/3 of nutrient needs by mouth
- -may need to be continued at home
What is a fistula?
Abnormal passage between organs or tissues (or between an internal organ and the body’s surface) that permits the passage of fluids or secretions
