EN Overview Flashcards
what are major risk factors for aspiration in critically ill patients
- decreased levels of consciousness
- previous history of aspiration
- vomiting
- tracheal intubation
- neuromuscular disease
- persistent high gastric residual volume
- prolonged supine positioning
- large diameter feeding tube
what is the most appropriate management of hyperagranulation around a PEG tube site
cauterize with silver nitrate
_______ forms within the tract of a PEG tube and may grow on the surface of the skin. It is a source of moisture underneath the bolster causing breakdown of the skin
granulation tissue
A tube feeding schedule where formula is provided as 240mL administered over 45 mins 5x/day is known as a __________
intermittent schedule
Tube feeding provided in a volume between 240-480mL given over 45minutes several times a day with or without a pump is called _____ feeding
intermittent feeding
What is the benefit of using an electromagnetic replacement device for NGT placement?
it provides a 3 dimensional localization, displayed in real life. A receiver is placed on the patient at the xiphoid process, therefore the magnet follows the tip placement relative to the LES, not the pylorus.
In a patient with a newly placed gastrostomy or jejunostomy tube, observation of which conditions at the tube exit site would signal a possible peristomal infection?
foul smelling drainage
The most common complication soon after PEG or PEJ placement is a
peristomal infection
what type of feeding schedule would be the most appropriate for a critically ill patient with poorly controlled blood glucose
continuous (consistency stabilizes blood sugars)
Continuous tube feeding is most appropriate in the critically ill and poorly controlled diabetic TF patient as intermittent schedules may cause fluctuations in blood glucose concentrations, placing patients at risk for ______ or ______ complications
hypo or hyperglycemia
A terminally ill patient at home on hospice complains of nausea during enteral feedings. A decision is made to discontinue the enteral feeding because
- EN feeding and hydration don’t always ensure comfort
- During starvation the body produces ketones which are euphoric
- The most common symptom when nutrition/hydration are withheld is dry mouth, which is alleviated with good oral mouth care
- IV hydration in the terminally ill patient can raise the risk of patient discomfort and respiratory distress
The most common symptom when withholding hydration or nutrition from a terminally ill patient would be _____ and can be alleviated by ________
dry mouth
good oral mouth care
One method of minimizing the complications associated with refeeding syndrome is to initiate an electrolyte replacement protocol before nutrition therapy begins. This should also be done on patients that
are not considered to be at risk to also be added on the protocol
when refeeding, electrolytes should be replete via which route
IV, oral or feeding tube depending on appropriateness
when a patient is at risk for refeeding syndrome, feedings should ________ be delayed but instead __________
don’t delay nutrition feedings
initiate slowly, advance slowly per electrolyte levels and clinical response
Bacterial contamination during enteral feeding can originate from the patients throat, stomach, lungs, feeding equipment, and retrograde contamination from the patient’s own
secretions
the longer an enteral product is hung the _______ the chance of bacterial contamination
higher
A male patient suffered from a stroke 2 wks ago and has significant dysphagia. An isotonic EN formula has been infusing continuously at a goal rate for 2 days, along with an ordered 30mL water flush per hour. The pt begins to complain of bloating and his abd becomes mildly distended to 4 cm from baseline. He denies nausea, bad cramping or abd pain. His last 2 gastric residual volumes were measured at 100mL. What is the best strategy to reduce his symptoms?
check when his last bowel movement was and if the patient is found to be constipated, initiate a bowel regimen
abdominal distention from enteral feeding can be caused by _______ administration from bolus schedules, _________ solutions, pain medications that slow ______, tube migration from the stomach to the _________, cold temperature formula inadequate fluid causing constipation, and fat/fiber/lactose intolerance.
- rapid administration
- hyper-osmolar solutions
- peristalsis
Only hold a tube feeding if a patient’s abdominal girth has extended beyond ____ to ___ cm
8-10
Patients who are alert and cooperative are at the ____ risk of pulmonary injury from small bore feeding tube misplacement
lowest risk
Oral or nasogastric feeding tubes used for EN should only be indicated for use less than ____ weeks
4 weeks
Placement of feeding tubes is complicated in uncooperative patients with anatomic abnormalities and critically ill patients in which ______ is inhibited
swallowing
a patient with oral cancer who has gained 10 lbs since starting home bolus EN feedings via gastrostomy tube complains of pain and pressure on the “inside of his stomach.” but no redness or drainage at the exterior gastrostomy site. What is the most appropriate response for the clinician?
refer the patient to the gastroenterologist or enterostomal nurse
a new occurrence of pain at or near the tube feeding site of a patient should be promptly evaluated by
the patient’s GI doctor or enterostomal nurse
Constipation in the enterally fed patient may be associated with
obstruction lack of adequate hydration prolonged best rest / lack of activity long term fiber free feedings narcotics
what is most likely the cause of watery diarrhea and bloating in the enterally fed adult
sorbitol content of liquid medications
An enterally fed patient reports nausea and vomiting. If delayed gastric emptying is the suspected cause, what can be done to improve the patient’s symptoms
decrease or discontinue narcotic meds
use low fat. low fiber formulas
administer TF at room temp
decrease the rate or volume of the feeding
the initiation of enteral tube feeding should be delayed in the ICU when the patient is _________, and not ______ to decrease the risk of intestinal ischemia
hemodynamically unstable
fully volume resuscitated
evidence of bowel sounds is _______ required prior to the initiation of EN
NOT required
Patients at risk for refeeding syndrome should _____ delay EN
NOT delay
how should EN feeding be initiated and advanced in the hospitalized patient
use a full strength formula, start at 10-40mL/hr and advance to goal rate within 1-2 days
while a patient is receiving SLP therapy, oral foods are provided during daytime hours. To meet the patient’s nutrition requirements, polymeric tube feeding is required during the night at a rate of 75mL/hr over 10 hours. This night feeding is an example of
cyclic feeding
