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Clinical 2 EXAM > EN & PN > Flashcards

EN & PN Flashcards

1
Q

what is enteral nutrition?

A

delivery of nutrients distal to the oral cavity of the GI tract via tube, catheter or stoma

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2
Q

Enteral nutrition is indicated for adult pts who have a ….

A

functioning gastrointestinal tract **and **
- Who present with inadequate oral intake for 7-14 days, OR
- In whom inadequate oral intake is expected to continue over 7-14 days

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3
Q

in pediatrics, initiate enteral feeding if:

A
  • Unable to obtain >80% of kcal needs by mouth, OR
  • Requiring >4 hours/day to eat, and/OR
  • Malnutrition or poor growth demonstrated by a ↓ of >2 weight or height growth channels or persistent tricep skinfold thickness <5th percentile
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4
Q

EN may be recommended for adults pts with:

A
  • altered mental status
  • swallowing dysfunction
  • disorders of the upper GI tract that can be bypassed
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5
Q

what are the advantages of EN

over PN or not providing nutrition support

A
  • cost effective
  • decreased length of hospital stay
  • decreased surgical interventions
  • decreased rates of infectious complications in critically-ill pts
  • improved wound healing
  • maintenance of GI function
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6
Q
A
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7
Q

what are the disadvantages of EN?

A
  • potential difficulty of administration
  • difficulty meeting nutritional needs of some pts
  • poor tolerance
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8
Q

how will access to the GI tract be established for EN?

A

access route is often determined by the physician according to
- pts diagnosis
- anticipated time the pt will require support
- pts disease state
- aspiration or tube displacement risk
- GI anatomy
- GI function
- plans for future surgical intervention

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9
Q

when is postpyloric feeding beneficial?

A

when there is:
- gastroparesis
- gastric outlet obstruction
- when previous gastric surgery precludes feeding into the stomach

may minimize aspiration into the lung

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10
Q

what is the main disadvantage of naso and oro-gastric/duodenal/jejunal feeding tubes?

A

patient discomfort

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11
Q

use of smaller tubes for EN increase the changes of..

A

clogging

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12
Q

how long are naso or oro-tubes used for?

A

short term
less than 6 weeks

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13
Q
  1. Naso and oro-gastric/duodenal/jejunal tubes can be used for delivery of _
  2. Nasoduodenal and Nasojejunal require _ administration (vs. gravity feeding)
  3. Gastrostomy and PEG allow for _ feedings
  4. Risk of clogging is highest for _ (which uses a smaller tube)
A
  1. medications
  2. pump
  3. bolus
  4. jejunostomy
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14
Q

what are some of the considerations for formula choice?

A
  • Substrates in the formula
  • Nutrient density
  • osmolality
  • ——As the content of free particles, ions or molecules increases, so does osmolality
  • Viscosity
  • Ability to meet patient’s nutrient requirements
  • Patient’s GI function
  • electrolyte contents (Na, K, Mg, PO4 in particular)
  • Cost effectiveness
  • Patient compliance
  • Cost-to-benefit ratio
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15
Q

as for formula selection, enteral formulas are classified as:

5

A
  1. standard
  2. elemental or semi-elemental
  3. specialty or disease-specific
  4. blenderized
  5. modular
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16
Q

benefits of blenderized tube feeds

A
  • cost effectiveness (commercial fomulas might not be covered by insurance)
  • health benefits of including whole foods
  • ability to tailor the formula exactly to pt needs
  • social bond between caregiver who prepares the feeding and the client
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17
Q

benefits of modular tube feeds

A
  • protein content can be increased through the addition of powdered protein (beneprotein)
  • individual amino acids such as glutamine or arginine are available and can be added via the enteral route if needed
  • more energy can be added with hydrolyzed corn starch and maltodextrin
  • fat content can be increased by adding fish oils, MCTs or safflower oils

often not mixed directly with formula bc they can clog the tube

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18
Q

protein typically ranges from 10-15% of kcal in standard formulas to up to _% for high protein formulas

A

25

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19
Q

polymeric/standard formulas provide _ protein

A

intact

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20
Q

formulas containing peptides are called…

A

hydrolyzed formulas
- these are used for pts with enzyme deficiency, malabsorption or other conditions resulting in protein maldigestion

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21
Q

formulas with specialized amino acid profiles are often used for pts with….

A
  • renal failure
  • hepatic failure
  • stress
  • inborn errors of metabolism
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22
Q

list some of the fibres added to formula

A
  • soy polysaccharides
  • inulin
  • FOS
  • hydrolyzed guar gum
  • gum arabic
  • acacia
  • pectin
  • oat fibers
  • soy fibers
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23
Q

list some of the common sources of fats in formula

A
  • corn
  • soy
  • safflower
  • canola
  • fish oil
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24
Q

nutrient density is measured in kcal/ml and usually ranges between _ and _ kcal/ml
standard feedings contain _ kcal/ml

A

1 and 2 kcal/ml
1 kcal/ml

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25
Q

formulas that are partically hydrolyzed have a higher _

A

osmolality

26
Q

body fluids have an osmolality of _ mOsm/kg

A

300

27
Q

_ feeds were developed to minimize dumping or diarrhea that can result from rapid movements of fluids into the GI tract to dilute hyperosmolar fluids

A

iso-molar

28
Q

in pediatrics, initiate feeding as soon as the child is _

A

hemodynamically stable

29
Q

in pediatrics, progress feedings according to tolerance with the goal of meeting _% of estimated needs on day 1 of enteral support

A

25%

30
Q

in adults, feeding should reach goal rate in - hours of initiation

A

24-48 hours

31
Q

if adult is critically ill, initiate feeding within the first - hours of admission and meet goal rate within _ hours

A

24-48 hours
72 hours

32
Q

how are bolus feedings administered?

A

250-500 ml given several times per day
- 60 ml syringe can be used to inject feedings through the tube
- administered over 5-20 mins

33
Q

how are intermittent feedings administered?

A

administered 4-6 times a day over 20-60 minutes
- a pump may be used to control the flow rate
- if a pump is unavailable, can use gravity feedings

34
Q

how are continuous feedings administered?

A

administered over 8-24 hours/day using a pump to control feeding rate

35
Q

what are the advantages of continuous feedings?

A
  • GI tolerance is maximized
  • easier to administer than bolus/intermittent (for staff)
  • less time consuming to administer than bolus/intermittent (for staff)
36
Q

what are the disadvantages of continuous feedings?

A
  • expense of the pump
  • expense of disposable equipment required for home use
  • restricted mobility
37
Q

stable non-critically ill adult patients either begin feedings at goal rate or….

A

begin at 50ml/hour until goal rate is met

38
Q

explain the 5 steps in nutrition assessment for nutrition support

A
  1. establish dosing weight and protein, energy and fluid requirements
  2. identify an appropriate formula
  3. calculate total energy needs and divide by the caloric density of the formula
  4. divide the total volume by total # of hours over which the formula will be administered. this is the goal rate
  5. determine initial starting rate and recommendations for advancement
39
Q

what issues might arise from tube feeding?

A
  • aspiration
  • tube misplacement
  • leakage from ostomy site
40
Q

proper monitoring of enterally fed pts ensures they are recieving….

A
  • the prescribed feeding
  • at the prescribed feeding
  • —advancing on schedule
41
Q

what should we do to precent clogged tubes?

A

flush with syringe containing 30 ml or more of tap water several time per day

42
Q

clogged tubes often result from…

A

administration of meds or inadequate flushing

43
Q

what are the best methods for reducing aspiration risks?

A
  • elevate head of bed by more than 30 degrees
  • continuous cubglottic suctioning
  • oral decontamination
44
Q

EN and PN electrolyte requirements differ due to …

A

the need for absorption with EN but not IV delivery
- PN electrolytes are measured in mEq or mmol
- oral requirements are stated in mg

45
Q

what is refeeding sydrome?

A

term used to describe several common metabolic alterations that may occur during nutritional repletion of pts who are malnourished or in a state of starvation

results in a drop in serum levels of:
- phosphourous (can result in hemolysis, impaired cardiac function, impaired respiratory function and even death
- Magnesium (can result in tremor, muscle twitching, cardiac arrythmias and paralysis)
- potassium (also associated with cardiac abnormailities)

46
Q

what are the most common refeeding dianosis?

A
  • excessive CHO
  • excessive infusion
  • EN or PN
47
Q

pts at risk for refeeding include those…

A
  • who present with malnutrition
  • those with a history of long term inadequate oral intake
  • those with minimal intake for several days as a result of NPO status or poor appetite
48
Q

it is critical in refeeding to monitor _, _ and _ to provide supplementation as needed

A

phosphorous, magnesium and potassium

49
Q

begin feeding slowly(especially CHO) and avoid _ to prevent refeeding

A

overfeeding

50
Q

what is the difference between pediatric nutrition support and adult?

A

need to consider the dynamic processes of growth and development
- estimated energy, fluid, protein, vitamin and mineral needs must be adjusted frequently as the pt grows or as his/her nutritional needs change in relation to the diagnosis

51
Q

what is parenteral nutrition?

A

IV administration of nutrition outside of the GI tract

52
Q

what is total parenteral nutrition (TPN)?

A

when the IV administered nutrition is the only source of nutrition the patient is receiving

53
Q

what is central venous nutrition (CVN)?

A

parenteral nutrition
delivered through a central vein — usually, the superior vena cava located under your collarbone, which goes directly to your heart

54
Q

what is the distinguishing feature of PN?

A

administration of concentrated macronutrients, vitamins, minerals and electrolytes into a large central vein so that they volume of blood flow is sufficient to immediately dilute the parenteral solution

55
Q

what is peripheral parenteral nutrition (PPN)?

A

administration of large-volume, dilute solutions of nutrients into a vein in the arm or back of the hand
- used infrequently
- requires large volumes to meet nutritional needs which makes this route unacceptable for fluid restricted patients
- high osmolality may cause small veins to collapse; peripheral access is difficult to maintain for more than a few days
- —- max of 900 mOsm/kg

56
Q

what clinical conditions may require PN?

A
  • inability to digest and absorb nutrients
    (such as massive bowel resection or short bowel syndrome)
  • intractable vomiting (as in hypermesis gravidarum)
  • GI tract obstruction
  • Impaired GI motility
  • abdominal trauma, injury or infection
57
Q

PN prescription is based on….

A
  • pts nutrition assessment
  • length of time the pt will require nutrition support
  • pts diagnosis
  • current medical condition
58
Q

what is a central venous catheter (CVC) or central line inserted percutaneously at bedside?

A
  • inserted into large veins such as the subclavian, jugular, or femoral veins
  • cattheters reside in the superior vena cava or inferior vena cava
  • catheters are available in single, -double or triple lumen models
59
Q

explain the use of peripherally inserted central catheter (PICC)

A

need specially trained nurses
- increases availability of the procedure and decreases cost
- inserted into the arm and threated into the subclavain vein to the vena cava

60
Q

an automated compounder is used to combine all nutrients needed for a 24 hour infusion into a single container

A
61
Q
A

Clinical 2 EXAM (2 decks)

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