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clinical nutrition > chapter 15 book notes > Flashcards

chapter 15 book notes Flashcards

1
Q

specialized nutrition support:

A
  • the delivery of nutrients using a feeding tube or intravenous infusions,
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2
Q

enteral nutrition:

A
  • the provision of nutrients using the GI tract;
    -“tube feedings”
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3
Q

parenteral nutrition:

A

-the intravenous provision of nutrients that bypasses the GI tract.
-2 types: by peripheral vein & central vein

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4
Q

oral nutrition support:

A

-nutrition care that allows a malnourished patient to meet nutritional requirements by
mouth
-GI function is normal and poor appetite is the primary nutrition problem.

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5
Q

Medical conditions/treatments that may indicate the need for tube feedings: (5)

A

-severe swallowing disorders
-impaired motility in the upper GI tract
-GI obstructions and fistulas
-mechanical ventilation
-certain types of intestinal surgeries

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6
Q

fistulas:

A

-abnormal passages between organs or tissues that permit the passage of secretions

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7
Q

Complications due to tube feedings:

A

-severe GI bleeding
-high output fistulas
-uncontrollable vomiting or diarrhea

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8
Q

The tube feeding route chosen depends on the

A

-patient’s medical condition,
-the expected duration of tube feeding,
-the potential complications of a particular route.

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9
Q

When a patient is expected to be tube fed for less than four
weeks, the feeding tube is generally routed into the GI tract via the ??

A

-nose
-nasogastric (entered in nose and tube stops in stomach) or nasointestinal( tube enter nose and stops in small intestine) routes

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10
Q

Is the patient usually awake during transnasal placement of the feeding tube?

A

-yes

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11
Q

3 different transnasal feeding tube placements:

A

-nasogastric route (nose to stomach)
-nasoduodenal route (nose to duodenum)
-nasojejunal route (nose to jejunum)

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12
Q

If the patient is awake and alert, he or she can swallow ?? to ease the tube’s passage

A

-water

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13
Q

The final position of the feeding tube tip is verified by…

A

-X-ray or by other means

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14
Q

What is the best feeding tube route for infants?

A

-orogastric (through the mouth to the stomach)
-allows infant to breather more normally during feedings

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15
Q

When is direct tube route to the stomach or intestines used?

A

-if patient will be tube fed for longer than 4 weeks or
-if the nasointestinal route is inaccessible due to an obstruction or other medical reasons

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16
Q

2 types of enterostomy:

A

-gastrostomy (opening in abdominal wall that leads to the stomach)
-jejunostomy (opening in abdominal wall that leads to jejunum.

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17
Q

What kind of feeding is always preferred whenever possible and why? Either directly into stomach or intestines?

A

-gastric feedings
-more easily tolerated and less complicated to deliver than intestinal feedings because the stomach controls the rate at which nutrients enter the intestine.

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18
Q

When are gastric feedings not possible? (3)

A

-gastric obstruction
-motility disorders that interfere with stomach emptying
-inadequate stomach volume due to surgery

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19
Q

Gastric feedings are also avoided in patients at high risk of ???

A

-aspiration
-common complication in which substances from the GI tract are drawn into the lungs potentially leading to aspiration pneumonia

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20
Q

What are feeding tubes made of?

A

-soft, flexible materials & come in variety of lengths and diameters
-usually silicone, polyurethane, polyvinyl chloride

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21
Q

The tube selected largely depends on the patient’s

A
  • age and size,
    -the feeding route,
    -the formula viscosity
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22
Q

In many cases, the tube selected is the smallest-??
tube through which the formula will flow without ??

A

-diameter
-clogging

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23
Q

The outer diameter of a feeding tube is measured in ?? units, in which each unit
equals ?? millimeter

A

-french
-⅓

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24
Q

EX: a “12 French” feeding tube has a ?? millimeter diameter
(12 times ⅓ mm = ?? mm)

A

-4

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25
Q

The inner diameter depends on the ?? of the tubing
material.

A

-thickness

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26
Q

double lumen tubes:

A

-a single tube is used for intestinal feedings and gastric decompression

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27
Q

gastric decompression:

A

-stomach contents of patients with motility disorders or obstructions are removed by suction.

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28
Q

main types of enteral formulas include the following:

A

-standard formulas
-elemental formulas
-specialized formulas
-modular formulas

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29
Q

standard formulas

A

-polymeric formulas/ blenderized formulas
-provided to individuals who can digest and absorb nutrients without difficulty

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30
Q

What do standard formulas contain?

A

-intact proteins extracted from milk or soybeans (protein isolates)
-carb sources include hydrolyzed cornstarch, glucose polymers and sugars

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31
Q

Elemental formulas

A

-hydrolyzed/ chemically defined formulas
-prescribed to patients who have compromised digestive or absorptive functions

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32
Q

What do elemental formulas contain?

A

-proteins and carbs that have been partially or fully broken down to fragments that require little digestion.
-low in fat and may provide fat from medium chain triglycerides

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33
Q

Specialized formulas

A

-disease specific/ specialty formulas
-meet the nutrients needs of patients with particular diseases (kidney, liver, and lung)
-very expensive and effectiveness is controversial

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34
Q

Modular formulas

A

-created from individual macronutrient preparations called modules,
-sometimes prepared for patients who require specific nutrient combinations.
-vitamins and minerals preparations can be included.

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35
Q

Macronutrient composition of eternal formulas: (fat, carbs, protein)

A

-protein= 15 to 20% of total kcals
-carbs= 45 to 60% of total kcals
-fat= 30 to 40% kcals

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36
Q

what patients benefit from high energy density formulas and which benefit from low energy density?

A

-low=patients with average fluid requirements
-high=patients with high nutrient needs/ fluid restrictions

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37
Q

osmolality:

A

-the concentration of osmotically active solutes in a solution
-Osmotically active solutes affect osmosis, the movement of water across semipermeable
membranes.

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38
Q

An enteral formula with an osmolality similar to that of blood serum (about 300 milliosmoles per kilogram) is an ?? formula, whereas a ?? formula has an osmolality greater than that of blood serum

A

-isotonic
-hypertonic
-MOST PEOPLE CAN TOLERATE BOTH FEEDINGS W/O DIFFICULTY

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39
Q

Most enteral formulas have osmolalities between ?? and ?? milliosmoles per
kilogram

A

-280 to 875

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40
Q

When ?? are infused along with
enteral feedings, however, the osmotic load ?? substantially and may contribute
to the ?? experienced by many tube-fed patients.

A

-medications
-increases
-diarrhea

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41
Q

Factors that influence formula selection include: (5)

A

-GI function
-nutrient and energy needs
-fluid requirements
-need for fiber modifications
-individual tolerances (food allergies and sensitivities)

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42
Q

Nearly all formulas are:

A

-lactose-free and gluten-free

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43
Q

Before starting a tube feeding, health practitioners can ease fears by fully

A

-discussing the procedure with the patient and family members

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44
Q

To minimize the risk of incorrect tube placement, clinicians verify the position of the feeding tube,

A

-usually with an X-ray, before a feeding is initiated

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45
Q

After the tube’s placement has been confirmed, the nurse often secures the tube to the patient’s

A

-nose and cheek with tape and monitors the position of the tubing throughout the day

46
Q

Tube placement can also be monitored by testing the ?? of a sample of bodily fluid drawn into the feeding tube, as the pH in the stomach (?? or ?? ) is lower than the pH in the small intestine or respiratory tract (?? or ??).

A

-Ph
-5 or lower
-6 or higher

47
Q

To reduce the risk of aspiration, the patient’s upper body is elevated to a ??- to
??-degree angle during the feeding and for ??to ??minutes after the feeding whenever possible

A

-30 to 45 degree angle
-30 to 60 minutes

48
Q

the personnel involved with preparing or delivering formula must follow the
specific protocols at their facility that prevent formula contamination, referred to as

A

-Hazard Analysis and Critical Control Points (HACCP) systems.

49
Q

Formulas may be delivered using either an:

A

–open feeding system or a closed feeding system

50
Q

Open system

A

-formula needs to be transferred from its original packaging to a feeding container

51
Q

Closed system

A

-lees likely to become contaminated, require less nursing time, and can hang for longer periods of time
-more costly, but in long run will save money from preventing bacterial contamination.

52
Q

Clinicians should carefully ??? and put on ??? before handling formulas and feeding containers

A

-wash hands
-disposable gloves

53
Q

The following steps can reduce the risk of formula contamination when using open
feeding systems:

A

-clean the lid of can with disposable alcohol wipe and wash can opener with detergent and hot water
-hang no more than 8hr supply of formula (4hr for newborn) when using liquid formula.(formulas from powders or modules hang no longer than 4 hours)
-if not whole can is used label it with date and time and refrigerate right away.
-discard all opened containers not used in 24 hours

54
Q

A new feeding container and
tubing (except for the feeding tube itself) is necessary every ?? hours

A

-24

55
Q

Nutrient needs may be met by delivering relatively large
amounts of formula several times per day called?? or
smaller amounts continuously ??

A

-intermittent feedings or bolus feedings)
-(continuous feedings or cyclic feedings)

56
Q

Intermittent feedings:

A

-similar to usual eating pattern and allow patient freedom of movement between meals
-best tolerated when given to stomach
-uses gravity drip method or infusion pump

57
Q

Bolus feeding

A

-given every 3 to 4 hours using a syringe
-convenient for patients and staff because they are rapidly administered
-do not require an infusion pump, and allow greater
independence for patients.

58
Q

Disadvantages to bolus feedings:

A

-abdominal discomfort,
-nausea,
-cramping
-risk of aspiration is greater

59
Q

Continuous feedings

A

-delivered slowly and constant rate over a period of 8 to 24 hours
-preferred method of intestinal feedings
-infusion pump used
-more costly and limit a persons movement

60
Q

What kind of patients are continuous feedings recommended for?

A

-critically ill patients or patients that cannot tolerate intermittent feedings

61
Q

Cyclic feedings

A

-continuous feedings conducted for shorter periods of time
-8 to 18 hours

62
Q

Is diluting formulas recommended?

A

-NO
-formulas are typically provided in full strength

63
Q

gastric residual volume:

A

-the volume of formula and GI secretions remaining in the stomach after a
previous feeding.

64
Q

gastric residual volume is useful in patients who have undergone…

A

-abdominal surgery or who exhibit signs of feeding intolerance (nausea and abdominal distention)

65
Q

In such patients, tube feedings may be withheld
and an evaluation conducted if the gastric residual volume exceeds ??? milliliters on
two consecutive checks.

A

-500

66
Q

If the tendency to accumulate fluids persists, the physician
may recommend intestinal feedings or begin

A

-drug therapy to stimulate gastric emptying.

67
Q

patients require about ?? to ?? milliliters of water per kilogram of body weight daily

A

-30 to 40

68
Q

most enteral formulas contain about ?? to ??percent water, or about 700 to 850 milliliters of water per liter of formula

A

-70 to 85

69
Q

Water can also be administered through…

A

-water flushes
-initially conducted to prevent feeding tubes from clogging and add to patients water intake.

70
Q

some medications may need to be exposed to the ?? stomach environment
and thus cannot be administered via an ?? feeding tube

A

-acidic
-intestinal

71
Q

Medications can also cause feeding tubes to ??

A

-clog

72
Q

Continuous feedings are ordinarily stopped before and after medication administration to prevent

A

-interactions that may clog the feeding tube or interfere with the medication’s absorption

73
Q

Some medications may require a prolonged formula-free interval; for example,

A

-feedings need to be stopped for at least one hour before and after administering phenytoin, a medication that controls seizures

74
Q

Medications are a major cause of ?? that frequently accompanies
tube feedings

A

-diarrhea

75
Q

Common tube feeding complications: (6)

A

-aspiration of formula
-clogged feeding tube
-constipation
-diarrhea
-fluid and electrolyte imbalances
-nausea, vomiting, cramping

76
Q

patients with the following conditions are often considered candidates for
parenteral nutrition:

A

-paralytic ileus (intestinal paralysis)
-short bowel syndrome (part of small intestine has been removed)
-bone marrow transplants

77
Q

The access sites for intravenous nutrition fall into
two main categories

A

-peripheral veins: located in forearm or hand, used in short periods of time
-central veins: located near heart, needed for longer periods of time

78
Q

Peripheral veins can be damaged by overly concentrated solutions, developing …

A

-phlebitis= inflammation of peripheral veins

79
Q

To prevent phlebitis, the osmolarity of
parenteral solutions used for PPN is generally kept below ?? milliosmoles
per liter,

A

-900

80
Q

PPN is used most often in patients who require short-term nutrition support
(less than ?? weeks) and patients who do CPN need…

A

two
-high nutrient needs or fluid restrictions

81
Q

Central parenteral nutrition relies on larger…

A

-central veins where blood volume is greater and nutrient conc. do not need to be limited.

82
Q

Because the central
veins carry a large volume of blood, the parenteral solutions are rapidly ??
and therefore patients with high nutrient needs or fluid restrictions can receive the
nutrient-dense solutions they require

A

-diluted

83
Q

The ?? located within health care institutions are often responsible for
preparing parenteral solutions

A

-pharmacies

84
Q

Commercial amino acid solutions contain a mix of essential and
nonessential amino acids and are available in concentrations between ?? and ??percent

A

-3 to 20%

85
Q

the more concentrated solutions (??percent and higher) are most
often used for preparing parenteral solutions

A

-8.5

86
Q

What is the main source of energy in parenteral solutions? in the form of??

A

-glucose in the form of dextrose monohydrate where each glucose molecule is associated with a single water molecule

87
Q

Dextrose monohydrate provides ??
kcalories per gram

A

-3.4

88
Q

Lipid emulsions supply essential ?? and are a significant source of
??

A

-fatty acids
-energy

89
Q

Most emulsions available in the United States contain
triglycerides from either

A

-soybean oil or a mixture of olive oil and soybean oil

90
Q

Lipid emulsions are often provided daily and may supply about ?? to ??
percent of total kcalories

A

-20 to 30

91
Q

Including lipids as an energy source reduces the
need for energy from ??and thereby lowers the risk of ??in
glucose-intolerant patients

A

-dextrose
-hyperglycemia

92
Q

lipid emulsions that
supply excessive amounts of ?? acid (such as the amount contained in soybean
oil) may aggravate some ?? conditions

A

-linoleic acid
-inflammatory

93
Q

Daily fluid needs range from ??? to ?? milliliters per kilogram of body weight in stable adult patients, averaging between about ??? and ???
milliliters for most people

A

-30 to 40
-1500 to 2000

94
Q

The electrolytes added to parenteral solutions include (6)

A

-sodium, potassium, chloride,
calcium, magnesium, and phosphate

95
Q

what vitamin is excluded in parenteral solution when warfarin is used?

A

-vitamin K

96
Q

What mineral is excluded from parenteral solution? and why?

A

-iron
-because it can destabilize parenteral solutions that contain lipid emulsions and because some patients have allergic reactions to infused iron

97
Q

piggyback:

A

-the administration of a
second solution using a separate
catheter.

98
Q

Medications that are compatible with parenteral solutions:

A

-insulin
-H2 blockers
-certain antibiotics

99
Q

total nutrient admixture (TNA):

A

-a parenteral solution that contains dextrose, amino acids, and lipids;
-also called a 3-in-1 solution or an all-in-one solution.

100
Q

2-in-1 solution:

A

-a parenteral solution that contains dextrose and amino acids, but not lipids.
-lipid emulsion must be administered separately, often by piggyback administration

101
Q

administration of TNA solutions is simpler because only ?? infusion pump is required, the addition of lipid emulsion to solutions may ?? their stability, potentially resulting
in the formation of

A

-one
-reduce
-enlarged lipid droplets that can obstruct capillaries or have other damaging effects.

102
Q

Thus, lipids are often administered separately when
they are not a major

A

-energy source and are used only to provide essential fatty acids

103
Q

Although skilled nurses
can place catheters into ?? veins, only qualified physicians can
insert catheters directly into ?? veins.

A

-peripheral
-central

104
Q

Ways to reduce complications when inserting catheters:

A

-use aseptic techniques
-change tubing
-change dressing that covers the catheter site

105
Q

Patients who require long-term parenteral nutrition often receive infusions for ?? - to ??-hour periods only called?

A
  • 8 to 14
  • (cyclic parenteral nutrition)
    -allow more freedom of movement for patient
106
Q

metabolic complications that may
result from parenteral nutrition: and efforts to fix them

A

-hyperglycemia (provide insulin with feeding)
-hypertriglyceridemia
-refeeding syndrome
-liver disease (fatty liver results from parenteral nutrition, avoid giving excess energy (dextrose and lipids which promote fat deposit in liver)
-gallbladder disease (medication to stimulate gallbladder contractions or improve bile flow)
-bone disease (medication, weight bearing PA)

107
Q

Most patients prefer what home enteral nutrition access?

A

-gastrostomy or jejunostomy tubes because they allow a more normal lifestyle
-bolus feedings are best

108
Q

Most patients must do what home parenteral nutrition access?

A

-central
-because long term therapy must meet all of a patients nutrient needs and needs access to central vein, usually by chest wall.

109
Q

Because ?? are
required for home parenteral nutrition, sufficient ??? backup is necessary in case
electrical service is interrupted

A

-infusion pumps
-battery

110
Q

What is a good source of current information
and emotional support for individuals who require home nutrition support

A
  • The Oley Foundation (oley.org)

clinical nutrition (26 decks)

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