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NUTR 4040 > ENTERAL > Flashcards

ENTERAL Flashcards

1
Q

what is oral nutr support and its goal

A

pt is able to consume food but not enough to support nutritional needs

Goal: increase kcal and nutrients intake

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2
Q

what do you do in oral nutr support

A

solid or liquid supplements taken orally
not meant to replace food

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3
Q

who would need oral nutr support

A

people losing wt and having trouble eating regularly
- old ppl with decreased apetite
- cancer pt
- diseases with nausea

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4
Q

indications of ETN

A

-dysphagia
-not able to eat via mouth

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5
Q

dysphagia

A

diffculty swallowing

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6
Q

diffuse peronitis

A

inflammation in the perineal muscles/tissues

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7
Q

ileus

A

no peristaltic movement

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8
Q

GI ischemia

A

no 02 in gut

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9
Q

when should you not administer ETN

A

anything that relates to the GI not working
- lower GIT obstruction
- ileus
- GI ishemia
- diffuse peronitis

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10
Q

pt is intractile vomiting. should you use ETN

A

no, sign that GIT is not working

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11
Q

RD responsibilities for ETN

A
  • formula type
  • tube
  • rate
  • method of feeding
  • pt needs
  • monitoring/assessing tolerance
  • manage transition feeding
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12
Q

aspiration

A

food in lungs
= pneumonia

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13
Q

who deternines the access sites for the tube insertion

A

MD

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14
Q

Access sites for ETN

A
  1. NG
  2. ND or NJ
  3. PEG tube
  4. G tube
  5. PEJ tube
  6. J tube

explain start and stop

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15
Q

pros cons of NG tube

A
  • short term
  • flexible
  • uncomfy
  • aspiration risk
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16
Q

pros cons of ND NJ tube

A
  • less risk of aspiration
  • uncomfy
  • no bolus feeding bc dumping syndrome
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17
Q

pros cons of peg/ g tube

A
  • long term, comfier
  • lower aspiration risk
  • lower tube displacement risk
  • less clogs
  • allows all regimen types
  • infection risk
  • gastric leakage
18
Q

pros cons of PEJ /j tube

A
  • comfier
  • long term
  • bypass dysfunc stomach
  • less aspiration risk
  • infection risk
  • continuous feeding only
  • needs semi/ hydolyzed formula
19
Q

formula selection is based on

A
  • condition
  • needs
  • digestuve ability
  • fluid restriction
  • indiv tolerance
20
Q

which formula has no fibre and low fat

A

semi hydrolyzed

21
Q

macros in hydrolyzed

A

pro = broken into aa
cho = usually monosacc
low fat
no fibre

22
Q

types of formula

A
  1. blenderized
  2. polymeric
  3. semi hydrolzyed
  4. modular
  5. disease specific
23
Q

whats the best delivery of ETN for gastric tubes

24
Q

when is continuous feeding ideal?

A

for jejunum/SI insertions

ND.NJ, Pej , j

25
when to not use intermitt or bolus feeding
any insertions in SI
26
protocol for starting ETN prescription
1. continuous at slow rate (10-40 mL/h) 2. if tolerated, start increasing every 4h (10mL if ill, 25 mL if normal) until target rate achieved 3. monitor hang time every 4-8 h 4. flush tubing every few hours, 6x 5. short term = keep on continuous long term = switch to int or bolus
27
target rate for continuous feeding
75-80 ml/hr
27
who would be getting 10mL increment increase instead of 25mL
critically ill GIT impaired malnourished
28
what do we monitor post ETN
1. ins and outs 2. tolerance 3. aspiration 4. site care 5. weight/anthrop 6. bowel movements 7. bloodwork
29
signs of aspiration
inc body temp elevated wBC rattling breath
30
types of ETN complications
1. mechanical 2. gastrointestinal 3. metabolic
31
examples of mechanical complications for ENT
1. clogged blocked tubes 2. tube dislodgment 3. access site irritation
32
how can u avoid clogged tubes
stop feeds 15 mins before and after meds flush with 15-30ml h20 in this time
33
git complications with etn
1. aspiration 2. diarrhea 3. nausea and vomit
34
how to avoid aspiration
raise head lower git placement decrease infusion rate if too high switch to continious if caused by bolus
35
avoiding nausea in ent
make sure tube placed nicely decrease rate of infusion gut dysfunction could mean ent not good
36
cause of diarrhea in ent
50% bc of meds soribitol in liquid meds rapid feeding rate hypertonic formula fed into jejunum
37
metabolic complications with etn
dehydration refeeding syndrome
38
explain refeeding syndrome
- MN body used to using fat as primary energy source - eating properly again but body not used to normal metabolism = not equipped for it - we need P, Mg K to metablize CHO, but not enough so body sucks it out from blood into cells - electrolytr shift = no nerve muscle signals - =heart failure etc
39
avoiding refeeding syndrome
slow feeding multiple days to get to etn goal thiamine supplement

NUTR 4040 (4 decks)

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