Enteral and Parenteral Nutrition Flashcards
What is the definition of malnutrition?
The deficiency or excess or imbalance of energy, protein and other nutrients
What are the 4 categories of malnutrition?
Under-nutrition resulting from insufficient food intake
Over-nutrition caused by excessive food intake
Specific nutrient efficiencies
Imbalance due to disproportionate food intake
What are the 4 basic questions to early identification of malnutrition?
Have you lost weight?
If yes, how much weight have you lost and over what time frame
What is your current weight?
What is your current height?
What is the main cause of malnutrition in hospital? What leads to this cause?
Disease
Pro-inflamm effect of illness is the culprit
What are the indications for oral nutrition?
Consistent with medical and patient’s goal
Inadequate or oral intake to meet nutrient needs
Func GI tract
Safe func swallow
What are the indications for enteral nutrition?
Consistent with medical and pt goals
Oral intake deemed unsafe, inadequate or impossible to meet nutrient needs
Func GI tract
Accessible GI tract
What are some conditions that require enteral support?
Impaired ingestion
Inability to consume adequate nutrition due to: condition or hyper-catabolic state
Impaired digestion and absorption
Severe wasting/malnutrition
What are some benefits of enteral nutrition?
Preserves GI tract integrity and func
Red infections and non-infectious complications associated with disease and injury
Less expensive than parenteral nutrition
Generally safer than parenteral nutrition
What are some contraindications of enteral nutrition?
Non-operative mechanical GI obstruction Paralytic ileus Severe GI bleed Perforation of GI tract Inability to gain access to GI tract Intervention not warranted or desired
What are the two routes for enteral nutrition?
Nasoenteric
Percutaneous enterostomy
What are the types of nasoenteric routes and what is the duration for this type of feeding?
Nasogastric (NG)
Nasoduodenal (ND)
Nasojejunal (NJ)
Short term(less than 3-4 weeks)
What are the types of percutaneous enterostomy routes and what is the duration for this type of feeding?
Gastrostomy (PEG) or Jejunostomy (PEJ) Long term (more than 4 weeks)
What are the categories of enteral formulas?
Polymeric Formulas: Req digestive capability
Semi-elemental formulas: Reg minimal digestion for absorption
In what situation would you use the different types of polymeric formulas?
Standard Formula: CVA with swallowing dysfunction
Higher Protein: Post-surg, pressure ulcer, burns, wounds, sepsis
Nutrient Dense: Hyper catabolism, fluid restriction
What is parenteral nutrition?
Infusion of a sterilized, specialized form of liquid nutrients through a vein into bloodstream via an IV catheter
What are two important factors to remember when providing parenteral nutrition?
Must be sterile
Cannot put anything but elemental substances
What are some indications for parenteral nutrition?
Consistent with med and pt goals
Pt unable to meet nutrition needs with enteral nutrition
Pre-op support in severely malnourished pt
GI incompetency
What are the TPN routes? (2)
Peripheral Parenteral Nutrition
Central Parenteral nutrition
Is Peripheral TPN short or long term use?
Short term
Is Central TPN short or long term use?
Long term
What are some restrictions of peripheral TPN?
Often unable to meet caloric needs
Site rotation every 3-5 days
Principle complication - thrombophlebitis
What are some contraindications for PN?
Func and usable GI tract
Prognosis does not warrant aggressive nutrition support
Aggressive intervention not wanted by pt
Risk judged to be greater than benefits
What are some indications for TPN?
Hypermetabolic state with poor enteral tolerance and accessibility
GI tract not working
What is refeeding syndrome?
Rapid nutritional repletion in severely malnourished pt
Hypernatremia, hypophosphatemia, hypokalemia and hypomagnesemia
What kind of fluid and electrolyte imbalance do you see in refeeding syndrome?
Hypernatremia, hypophosphatemia, hypokalemia and hypomagnesemia
(High sodium, low phosphorous, potassium and magnesium)
What are the complications of refeeding syndrome?
Fluid retention
Heart and resp failure
What are the symptoms of refeeding syndrome?
Edema
Cardiac arrhythmias
Muscle weakness
Confusion
What precautions should be taken to prevent refeeding syndrome?
Monitor glucose, electrolytes, PO4 and Mg every 3 days
Correct low serum levels prior to feeding
