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Pharmacology > Chapter 17-Nutritional Support > Flashcards

Chapter 17-Nutritional Support Flashcards

1
Q

What are nutrients needed for?

A

cell growth, cellular function, enzyme activity, carb-fat-protein synthesis, muscular contraction, wound healing, immune competence, GI integrity.

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2
Q

For how many days can a well nourished patient tolerate a lack of nutrients? (until major health problems will occur)

A

14 days

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3
Q

Patients who are critically ill can only tolerate a lack of nutrient support for how long?

A

A few days to a week

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4
Q

If nutritional support is started within ____ of an injury, recovery is more rapid.

A

hours

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5
Q

“Early fed” injured patients have a _________ _______ ___________ and less chance for bacterial infections.

A

positive nitrogen balance

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6
Q

A patient requires how many calories a day?

A

2000 calories/day

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7
Q

Critically ill patients may require ____ to ____ calories per day.

A

3000-5000 calories/day

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8
Q

If nutritional support is delayed by as little as _ days for a patient w/ trauma or neuro damage this can delay healing, and increase risk for infection.

A

5

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9
Q

What are the 2 routes for administering nutritional support?

A
  1. Enteral nutrition

2. Parenteral nutrition (TPN)

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10
Q

Enteral nutrition involves the GI tract and can be given by which two routes?

A
  1. orally

2. feeding tubes

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11
Q

If the PT can swallow nutrition is taken orally, and if not a tube is inserted where?

A

Into the stomach or small intestine

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12
Q

What does Parenteral nutrition involve?

A

administering high caloric nutrients through large veins

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13
Q

Parental nutrition is __ times more expensive than enteral nutrition.

A

3

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14
Q

Which of the two nutritional support options (enteral or TPN) has a higher infection rate?

A

TPN

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15
Q

Enteral feedings require a functioning __ tract.

A

GI

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16
Q

When does TPN become necessary?

A

when the GI tract is incapacitated due to uncontrolled vomiting, malabsorption, or intestinal obstruction.

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17
Q

TPN can also be used for GI rest in which two diseases?

A

Crohn’s Disease and Ulcerative Colitis

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18
Q

What main things are included in solutions for enteral and parenteral nutrition?

A

amino acids, carbs, electrolytes, fats, trace elements, and vitamins

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19
Q

Enteral nutrition requires small bowel function with….

A

digestion, absorption, and GI motility

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20
Q

What should the nurse assess to determine whether there is a lack of GI motility?

A

abdominal distention, a decrease or absence of bowel sounds, if the patient has a bowel movement.

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21
Q

What are the 4 types of GI tubes used for enteral feedings?

A
  1. Nasogastric (nose to stomach)
  2. Nasoduodenal/nasojejunal (nose to duodenum/jejunum)
  3. Gastrostomy (from stoma into stomach)
  4. Jejunostomy (stoma to jejunum)
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22
Q

What is the most common route for short-term enteral feedings?

A

NG tube through mouth or nose.

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23
Q

Which tubes are used for long term enteral feedings?

A

gastrostomy, nasoduodenal/nasojejunal, jejunostomy

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24
Q

Which enteral feeding route is suggested if aspiration is a concern?

A

small intestinal route

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25
Q

What are the 3 types of preparations for enteral feeding?

A
  1. Blenderized
  2. Polymeric, Milk-based, Lactose-free
  3. Elemental (monomeric)
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26
Q

What are the 3 components of enteral solutions?

A
  1. carbs
  2. protein
  3. fat
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27
Q

Most milk-based polymeric preparations come in what form? What are they to be mixed with?

A

Powdered form, milk or water

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28
Q

Lactose-free polymeric solutions come in what form?

A

liquid form

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29
Q

Between milk-based and Lactose-free solutions which is frequently used more as a supplement and which is more often used as a replacement feeding?

A

Milk-based is frequently used only as a supplement.

Lactose-free solutions are often used for replacement feedings.

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30
Q

Many of the lactose-free solutions are _______.

A

Isotonic (300-340 mOsm/kg water)

31
Q

What is the breakdown of nutrients in the lactose-free solutions? (by percentage of carbs, protein, fat, and other nutrients)

A

50% carbs, 15% protein, 15% fat, 20% other nutrients.

32
Q

What are some polymeric solutions that are commonly used?

A

Ensure, Isocal, Boost

33
Q

The polymeric solutions provide __ calorie per mL of feeding.

A

1

34
Q

Patients with diabetes mellitus often use which formulas?

A

Glucerna and Diabetic Resource

35
Q

What is a solution recommended to treat hepatic disorders?

A

NutriHep

36
Q

What are some solutions used for people with pulmonary disorders?

A

Pulmocare or Respalor

37
Q

What are some solutions used to treat patients with renal disorders?

A

Nepro and Novasource Renal

38
Q

Elemental solutions provide nutrients that are rapidly absorbed in the small intestine. What are these used for?

A

Partial GI tract dysfunction

39
Q

How can enteral feedings be given?

A

By bolus, intermittent drip or infusion, continuous drip, cyclic infusion.

40
Q

Which was the first method used to deliver enteral feedings?

A

bolus

41
Q

How many mL of solution is rapidly administered with the bolus method?

A

250-400 mL

42
Q

With the bolus method 240-400 mL of solution is administered through a syringe or funnel how many times a day?

A

4-6 times a day

43
Q

How long does the bolus method take with each feeding?

A

10 mins each feeding

44
Q

What adverse effects can be caused by the bolus method?

A

nausea, vomiting, aspiration, abdominal cramping, diarrhea

45
Q

The bolus method is generally reserved for the __________ patient.

A

ambulatory

46
Q

Intermittent enteral feedings are given every _ to _ hours over __ to __ minutes.

A

3-6 hours, 30-60 minutes

47
Q

How much mL of solution is given in an intermittent enteral feeding?

A

300-400 mL

48
Q

Continuous feedings are given at what rate for how many hours?

A

a slow rate for 24 hours

49
Q

With continuous feedings, how many mL of solution is infused per hour?

A

50-125 mL/hr

50
Q

What is the cyclic method?

A

a type of continuous feeding infused over 8-16 hours daily.

51
Q

What can cause dehydration?

A

an insufficient amount of water given with or between feedings

52
Q

Aspiration pneumonitis is a major complication of enteral nutrition. How can the nurse prevent this?

A
  1. Make sure the head of the bed is elevated at least 30-45 degrees.
  2. Check for gastric residual
53
Q

How does the nurse check for gastric residual and how often can it be done?

A

by gently aspirating the stomach contents before giving the next enteral feeding, every 4 hours minimum between feedings.

54
Q

A major problem of enteral feeding is diarrhea, what can this be caused by?

A

rapid administration of feeding, high caloric solutions, malnutrition, C. Diff, drugs (antibacterials, drugs that contain magnesium).

55
Q

How can diarrhea be managed or corrected in enteral feeding?

A

decreasing the rate of infusion of the enteral solution, diluting the solution, changing the solution, discontinuing the drug, increasing pt’s water intake, administering an enteral solution containing fiber.

56
Q

What are recommended parameters to monitor during enteral nutrition?

A

BUN, creatinine, electrolytes, glucose, triglycerides, serum proteins, I&O’s, weight.

57
Q

What does A.L.E.R.T. stand for?

A

A- Aseptic technique.
L- Label enteral equipment.
E- Elevate head of bed at least 30 degrees.
R- Right patient, right formula, right tube.
T- Trace all lines and tubing back to patient.

58
Q

What are two examples of enteral medications used for patients with pancreatic enzyme deficiency?

A

pancreatin (Creon) and pancrelipase (Viokase)

59
Q

What are forms of drugs CAN’T be dissolved for enteral administration?

A

time-release forms, enteric-coated forms, sublingual forms, bulk-forming laxatives.

60
Q

The drug dose is usually given by bolus and followed by what?

A

water

61
Q

Most liquid meds are….

A

hyperosmolar (>1000 mOsm/kg water)

62
Q

Liquid meds should be diluted with water to reduce the osmolality to

A

500 mOsm/kg H2O (mildly hypertonic)

63
Q

Absorption of what drug is significantly reduced by protein and therefore must have 1 hour before and 1 hour after where the feeding is stopped?

A

phenytoin suspension (Dilantin)

64
Q

If the patient is diabetic and requires insulin while on enteral feeding you would not want to stop the feeding to administer phenytoin suspension (Dilantin), so how else could you give it?

A

in an injectable form

65
Q

The feeding should be held for 30 mins after this drug is administered. This drug is a treatment for gastric ulcers.

A

Sucralfate (Carafate)

66
Q

How could you check the tube placement in enteral feedings?

A

by aspirating gastric secretion or injecting air into tube to listen by stethoscope for air movement in the stomach

67
Q

A residual of more than what percent of previous feeding indicates delayed gastric emptying?

A

50%; if residual is more than this stop infusion for 30 mins to an hour and recheck

68
Q

Usual residual is what?

A

0-100 mL

69
Q

If tube obstruction occurs flush with what?

A

warm water or cola

70
Q

Flush feeding tube accordingly:

A

intermittent feeding: 30mL before and after
continuous feeding: every 4 hrs
meds: 30 mL before and after

71
Q

How often should you change the feeding bag in enteral nutrition?

A

daily

72
Q

Nutritional solution should be at what temp?

A

room temperature

73
Q

TPN is indicated for patients w/ severe burns in ________ ________ balance.

A

negative nitrogen

Pharmacology (1 decks)

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