Chapter 16: Nutrition Support Flashcards
the delivery of formulated enteral or parenteral nutrients to appropriate patients for the purpose of maintaining or restoring nutritional status
nutrition support
2 modes of nutrition support employed by practitioners for the nutritional care of a patient
enteral nutrition; parenteral nutrition
refers to the provision of nutrients both orally and via tube directly into the git
enteral nutrition
administer if preferred mode is:
-oral feeding, normal route og ingesting nutrients
-individual is not able to eat the adequate amounts required by the body either due to oral and swallowing problems, or a very high nutritional requirements
administering enteral feeding
in administering tube feeding (enteral nutrition), these are important consideration (3)
-functioning git
-length of feeding
-presence or risk of aspiration
patients with functional git but unable to orally ingest adequate nutrients to meet nutritional requirements can benefit from tube feeding
enteral feeing/tube feeding
indications for enteral feeding
_____ with inadequate oral intake of nutrients for the previous 5 days or normal nutritional status but with inadequate oral intake for the previous 7-10 days
protein-calorie-malnutrition
indications for enteral feeding
_____, such as comatose state, CVA, and parkinson’s disease
central nervous system disorders
indications for enteral feeding
_____, such as crohn’s disease, gastroparesis, short bowel syndrome, and chronic pancreatitis
git diseases
indications for enteral feeding
_____, such as severe depression and anorexia nervosa
psychiatric disorders
indication when nutritional requirements are still not met through oral nutrition supplements or tube feeding
parenteral nutrition
enteral nutrition preferred over parenteral nutrition because it is _____ (3)
safer, economical, and maintains gut structure and integrity
tube feeding routes of access depends on consideration upon assessment
nasogastric/nasoduodenal/nasojejunal, jejunostomy or percutaneous endoscopic gastronomy, or multiple lumen tubes
-
contraindications to enteral feeding
-complete intestinal or colonic obstruction
-intractable vomiting
-active git bleeding and shock
enteral nutrition formulas
are often classified to their (2)
protein content
overall macronutrient content
enteral nutrition formulas
composed of chon, cho, and fat in high molecular weight form and therefore have lower osmolality
formula require normal digestive and lipolytic activity
polymeric formula (nutritionally complete)
enteral nutrition formulas
have a low residue and use free amino acids or peptides as a protein source
oligosaccharides or monosaccharides provide the cho source and most contain medium as well as long chain triglycerides
elemental formula (chemically defined)
enteral nutrition formulas
not nutritionally complete because they contain single nutrients, such as cho, fat, or chon
can be added to standard enteral products
modular formula
enteral nutrition formulas
available for use in patients with a variety of clinical conditions including renal, respiratory, hepatic insufficiency, diabetes, immunocompromised states, and fat or cho malabsorption
specialty/disease-specific formula
tube feedings could also be prepared by liquefying regular foods that are selected from the soft diet using a blender
blenderized tube feeding
advantages of this type of feeding:
-cost effectiveness
-health benefits from using whole foods
-ability to tailor the formula exactly to patient needs
blenderized tube feeding
btf are contraindicated for patients who are immunocompromised, for infusion tubes smaller than _____, for continuous feeding (unless formula hangs for less than 2 hrs)
10 french
btf
if fluid restriction of less than _____ is requires, in cases of multiple food allergies, and if a jejunostomy tube (jt) is used
900 ml/day
enteral feeding for acute pancreatitis requires
very low fat-containing formula
btf considerations
may have a direct effect on git side effects and therapy tolerance to enteral therapy
formula osmolality
btf considerations
mineral contents of the formula (4)
Mg, Na, P, K
fluid requirements
recommended daily water requirement in the absence of hepatic, renal, or cardiac disease is _____
1ml/kcal
most 1 ml/kcal formulas contain approx. _____ of water
patients w/o fluid restriction should receive additional free water to at least 25% of the total formula volume which can be a
75%
most 1 ml/kcal formulas contain approx. 75% of water
patients w/o fluid restriction should receive additional free water to at least 25% of the total formula volume which can be administered into _____ or _____ separate doses
2-3
an ideal formula is
isotonic
isotonic: ideal formula (ideal nutrient density)
for adults
1 kcal per 1 ml
isotonic: ideal formula (ideal nutrient density)
for infants
2/3 kcal per 1 ml
fluid requirements
the more _____ the formula, the higher the osmolality
concentrated
fluid requirements
is the size and number of the nutrient particles in a solution
osmolality
fluid requirements
ideal enteral formula should be characterized by their (2)
bacteriological safety; ease of administration
necessary to detect and prevent complications
monitoring
monitoring
make sure that the patients head and neck are elevated at _____ degrees always and for 1 hour after feeding to prevent aspiration
30-45
enteral feeding - complications
when there is obstruction of tube lumen or tube displacement
mechanical
enteral feeding - complications
when there is esophagitis or ulceration
esophageal complications
enteral feeding - complications
caused by nasal erosions and sloughing of nasal cartilage due to excessive pressure on the nasal cartilage
nasopharyngeal complications
enteral feeding - complications
sudden nausea, vomiting, or diarrhea which may be due to improper formula temperature, irregular or too rapid administration of formula, or bacterial contamination
gastrointestinal complications
enteral feeding - complications
in cases of hypernatremia, hyponatermia, hypercalcemia, and azotemia, which may be prevented by proper monitoring and fluid intake
metabolic complications
modes and rates of feeding
the rapid delivery by syringe of 240-400 ml of formula every 4-6 hrs
simulates normal food intake in terms of gallbladder motility
bolus feeding
modes and rates of feeding
involves provision of 100-400 ml of enteral formula with an interval of 2-4 hrs
can be sued if there has been no history of malabsorption
timed intermittent
modes and rates of feeding
requires infusion of the formula using a pump or gravity drip over a period of 16-24 hrs
continuous drip
modes and rates of feeding
infuses the formula for 8-16 hrs, usually overnight, using an infusion pump
cyclic administration
the delivery of nutrients directly into the blood stream
parenteral nutrition
it is also called intravenous (IV) nutrition, or total parenteral nutrition (TPN), given to patients w/o a functional GIT
given when the condition is expected to continue on a minimum of 7 days
parenteral nutrition
TPN meaning
total parenteral nutrition
TPN - indications
-intractable vomiting (acute pancreatitis)
-severe diarrhea of >_____ ml/day stool, or malabsorption such as in the case of severe acute flare of the inflammatory bowel disease, radiation enteritis with weight loss
-severe trauma or major abdominal surgery
-small bowel or colon obstruction
500 ml/day
TPN - contraindications
_____ unstable patients including those with hypovolemia, cardiogenic, or septic shock
hemodynamically
TPN - contraindications
patients with severe _____ or fluid overload
pulmonary edema
TPN - contraindications
patients with _____ w/o dialysis
anuria
TPN solution - components
fluid volume: fluid intake about about _____ liters per day and should not exceed 4 liters
2-3 liters
TPN solution - components
cho: are given as dextrose or _____
glucose monohydrate
TPN solution - components
cho: are given as dextrose or glucose monohydrate which yields _____ kcal/g
3.4 kcal
TPN solution - components
chon: comes in the form of _____ amino acids available in concentrations of 8.5-15%, although other concentrations can be provided as indicated
the amino acids is diluted with the appropriate amount of dextrose to achieve a desired concentration
crystalline amino acids
TPN solution - components
lipid emulsions: are _____ and are a valuable caloric source if peripheral parenteral nutrition is used
come in 10% and 20% emulsions of soybeans or safflower oil, may be available in 100, 200, 250, and 500 ml bottles
isotonic
TPN solution - components
electrolytes: _____ content must be adjusted according to serum electrolyte concentration
if possible, electrolyte imbalances should be corrected before initiating parenteral nutrition
parenteral electrolyte
TPN solution - components
vitamins and minerals: multivitamins, except vitamin _____, are provided in concentrated formulations based on standard recommendations
some minerals may be supplied using proper dose calculations
vitamin k
TPN solution - components
additives: such as _____ and _____ are used only when necessary
insulin and heparin
TPN nutrition - administration
the site of parenteral infusion of nutrients depends on the (3)
caloric level and source, fluid tolerance, and vascular access
TPN nutrition - administration
are delivered thru a peripheral IV catheter inserted into a small diameter peripheral vein
simple iv infusions
TPN nutrition - administration
is used for patients with mild nutritional deficiencies; uses the small diameter veins that carry blood from the arms and legs
peripheral parenteral nutrition
TPN nutrition - administration
peripheral parenteral nutrition: _____ are commonly used to provide short-term nutrition, usually 1-2 weeks
lipid emulsions
TPN nutrition - administration
refers to the infusion of concentrated solutions delivered thru the central veins for a longer period
central parenteral nutrition
TPN nutrition - complications
refers to the presence of air in the chest
pneumothorax
TPN nutrition - complications
is the presence of the disease-causing microorganisms in the blood
sepsis
TPN nutrition - complications
presence of air in the tube or in the blood vessel that obstructs the parenteral flow
air embolism
TPN nutrition - complications
pertains to the presence of blood in the chest
hemothorax
TPN nutrition - complications
_____ deficiency’s symptoms include: failure to grow, dermal problems, and poor immune system
essential fatty acids
TPN nutrition - complications
characterized by an increase or a decrease of nutrients in the blood
metabolic imbalance
aggressive administration of nutrition, particularly via the intravenous route, can precipitate _____ with severe, potentially lethal electrolyte fluctuations involving metabolic, hemodynamic, and neuromuscular problems
refeeding syndrome
