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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

A

intermitt

24
Q

when is continuous feeding ideal?

A

for jejunum/SI insertions

ND.NJ, Pej , j

25
Q

when to not use intermitt or bolus feeding

A

any insertions in SI

26
Q

protocol for starting ETN prescription

A
  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
Q

target rate for continuous feeding

A

75-80 ml/hr

27
Q

who would be getting 10mL increment increase instead of 25mL

A

critically ill
GIT impaired
malnourished

28
Q

what do we monitor post ETN

A
  1. ins and outs
  2. tolerance
  3. aspiration
  4. site care
  5. weight/anthrop
  6. bowel movements
  7. bloodwork
29
Q

signs of aspiration

A

inc body temp
elevated wBC
rattling breath

30
Q

types of ETN complications

A
  1. mechanical
  2. gastrointestinal
  3. metabolic
31
Q

examples of mechanical complications for ENT

A
  1. clogged blocked tubes
  2. tube dislodgment
  3. access site irritation
32
Q

how can u avoid clogged tubes

A

stop feeds 15 mins before and after meds
flush with 15-30ml h20 in this time

33
Q

git complications with etn

A
  1. aspiration
  2. diarrhea
  3. nausea and vomit
34
Q

how to avoid aspiration

A

raise head
lower git placement
decrease infusion rate if too high
switch to continious if caused by bolus

35
Q

avoiding nausea in ent

A

make sure tube placed nicely
decrease rate of infusion
gut dysfunction could mean ent not good

36
Q

cause of diarrhea in ent

A

50% bc of meds
soribitol in liquid meds
rapid feeding rate
hypertonic formula fed into jejunum

37
Q

metabolic complications with etn

A

dehydration
refeeding syndrome

38
Q

explain refeeding syndrome

A
  • 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
Q

avoiding refeeding syndrome

A

slow feeding
multiple days to get to etn goal
thiamine supplement

NUTR 4040 (4 decks)

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