Enteral and Parenteral Nutrition Flashcards
- Describe indications for enteral nutrition (EN) and parental nutrition (PN) - Explain the benefits of early feeding in critical illness - Describe the route of feeding for EN and PN - Compare the pros and cons of EN and PN - Drug interaction with EN & PN - Explain how to manage problems such as refeeding syndrome and other complications in nutrition support - Plan feeding regime based on: 1. nutrient adequacy 2. possible adverse reactions & contraindications
What is Nutritional Support
Therapy?
- Provision of enteral and parenteral nutrients to treat/prevent malnutrition
- Overall aim is to ensure that total nutrient intake (energy, protein, fluid and micronutrients), meeting all patients needs.
- Maintain/restore optimal nutrition status and health
What are some indicators of nutrition support?
Can be for malnourished/risk of malnutrition
Malnourished
* BMI of less than 18.5
* unintentional weight loss greater than 10% within last 3-6 months
* BMI less than 20 & unintentional weight loss greater than 5% within last 3-6 months.
Risk of Malnourished
* eaten little to nothing for more than 5 days
* have poor absorptive capacity
What are some benefits of EN?
EN - Enteral Nutrition
- Maintaining gut mucosal physiology
- Preserves gut barrier function
- Promotes peristalsis
- Inexpensive compared to parenteral nutrition
What are the indications of Enteral Nutrition
- Dysphagia
- Neuromuscular disorder affecting swallowing reflex
- Chemotherapy induced anorexia and HIV
- Conditions with increased metabolic and nutritional demands (Sepsis, Cystic Fibrosis, Burns)
- Dementia
- Neuromuscular disorder include: Parkinson’s disease, multiple sclerosis, cerebrovascular accident.
Here is one for you to think about:
What are considered to be contraindications for enteral nutrition?
Mainly there are two:
Relative contraindications and absolute contraindications
Relative contraindications
* Severe hemodynamic instability
* Ileus
* Vomitting/diarrhea
* Upper gastrointestinal bleeding
Absolute contraindications
* Bowel obstruction
* Major gastrointestinal ischemia
* High-output fistula
- Severe hemodynamic instability - Low BP, it will require the heart to pump more blood for the digestions to occur, hence it will add the workload on the heart, hence becoming even more unstable.
- Ileus - temporary lack of the normal muscle contractions of the intestines.
- Fistula - an abnormal connection between two body parts, such as an organ or blood vessel and another structure.
What are some of the tube feeding administration available
Talk about the right time
- Bolus - Rapid delivery via syringe, <10 mins
- Intermittent - Feeding delivered via syringe/pump, it’s a mixture of bolus and continuous
- Continuous - Pump required, is being fed continuously.
What are factors determining EN tube placement site?
Written behind are just some factors, for more factors please refer to lecture slides
- Length of therapy
- Planned surgical/endoscopic procedure
- Patient’s comfort & QOL
- Administration and feeding schdule
- For length of therapy, nasogastric is usually suitable for two weeks. If its longer than gastrostomy is recommended.
What are some characteristics of NGT?
Nasogastric Tube Feeding - NGT
Charecteristics include:
* Short term (< 30 days)
* Has normal gastric function
* Low aspiration risk
* Generally smaller tubes = better suited
For smaller tubes, may clog when viscous formulas are used.
- Diameter of feeding tube measured in french units
- 1F = 33 mm in diameter
- Aspiration - the action of drawing fluid by suction from a vessel or cavity.
What are the benefits of using NGT
- Easy tube placement
- No Surgery
- Easy to check gastric residual
- Accommodates bolus & intermittent feeding
- Reduces cost and safer
- Preserves gut integrity
- Fewer infectious complications
This card pertains on the consideration and benfits of using this:
Ostomy Tube
Considerations
* Long Term feeding (> 30 days)
* When tube unable to pass through the nose
Benefits
* Reduce nasal discomfort
* Can be given via bolus, intermittent, pump
Now this is an extra question for you:
Types of Ostomies
3 Types of Ostomies:
1. Colostomy - A colostomy is a surgically-created opening into the colon (large intestine) through the abdomen. Its purpose is to allow the stool to bypass a diseased or damaged part of the colon. The output from a colostomy includes liquid or formed stool (or somewhere in between), gas, and odor.
2. Ileostomy - An ileostomy is a surgically created opening into the small intestine through the abdomen. With an ileostomy, a section of the small intestine and large intestine (colon) have been removed or bypassed. The output from an ileostomy after surgery is generally a steady liquid type of drainage. Over time though, the stool will become thicker and more paste-like.
3. Urostomy - A urostomy is a surgically-created opening to drain urine. A urostomy allows urine to flow out of the body after the bladder has been removed or bypassed. The output from a urostomy is urine and possibly some mucus.
What are some of the characteristics when it comes to selecting an enteral formula selection?
Gastrointestinal function
Physical characteristics
* Osmolality
* Lactose content
* Fiber content
* Caloric density
* Fluid and electrolytes
* Cost effectiveness
Enteral Formula Categories
- Polymeric
- Monomeric
- Fibre Containing
- Disease specific
- Modular
- Rehydration
For more information, pls refer to the notion page being done on this topic. (Can’t link that mothafatha here so you’d have to sendiri cari lah bye)
What are some practice recommendations to be carried out when performing EN feeding?
- Should be prepared in clean environment using aseptic techniques.
- Store unopened formulas in
dark, dry, cool conditions - Formula cannot be exposed to room temp for more than 4 hours
- Sterile, decanted formula - 8 hour hang time
- Powdered, reconstituted formula - 4 hour hang time
What are some common PN solutions ?
Mainly 2 types
- “3 in 1” solution - protein, fat & CHO in one bag, 1 pump is used
- “3 in 2” solution - protein & CHO in 1 bag,
lipid soluble in glass bottle
Give continuously or cyclically (8-12 hrs/day)
