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PHM 604 GI > Enteral Feeding > Flashcards

Enteral Feeding Flashcards

1
Q

Malnutrition Definition

A
  • Lack of nutrients
  • Not meeting metabolic demands of the body
  • Typically associated with weight loss, but can be seen in obesity
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2
Q

Susceptible populations for Malnutrition

A
  • Elderly
  • Infants (especially premature, not breastfeeding)
  • GI conditions (Crohn’s > UC, bariatric surgery, pancreatitis)
  • Patients using feeding tube
  • Cancer
  • AIDS
  • Neurologic/developmental impairment (swallowing difficult)
  • Hospitalized (↑ complications, stay length, mortality, acutely ill)
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3
Q

When to consider nutritional support: Inpatient

A

Healthy: 7 days without eating
Critically ill: start earlier than 7 days for decreased mortality

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4
Q

When to consider nutritional support: Outpatient

A
  • Patients with or at risk for malnutrition
  • Susceptible populations
  • Longer-term support
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5
Q

Enteral vs Parenteral?

A

If gut is functioning, use it. Enteral benefit:
- Has immune benefit (acid, mucosal layer, peristalsis, flora, GALT IgA)
- Maintains gut integrity
- Keeps bile flowing (no bacteria backflow, prevents gallstones)

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6
Q

Enteral Nutrition Tubes: NG

A

For short term hospital nutritional support

Nasogastric (NG):
- Easy to place
- High aspiration risk (food in lung -> pneumonia)
- Stomach decompression possible
- Can give bolus feed to mimic meals

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7
Q

Enteral Nutrition Tubes: ND & NJ

A

For short term hospital nutritional support

Nasoduodenal (ND) & Nasojejunal (NJ)
- Difficult to place
- Reduced aspiration risk
- Increased likelihood of clogging
- With NJ cannot crush and flush meds

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8
Q

Enteral Nutrition Tubes: Abdominal wall placement (G-tube)

A

For patients with advanced cystic fibrosis, developmental issues

  • Can give bolus feed to mimic meals
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9
Q

Enteral Nutrition Tubes: Abdominal wall placement (J-tube)

A

For patients with advanced cystic fibrosis, developmental issues

  • Cannot crush and flush meds
  • Give liquid meds (crush between 2 spoons, mix into 10mL sterile water for each med SEPARATELY do not COMBINE)
  • Do not crush SR, ER, enteric coated products (check lexicomp)
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10
Q

Administration of meds: NJ, J-tubes

A
  • Do not crush and flush
  • Crush with 2 spoons, mix with 10mL sterile water
  • Separate, do NOT combine meds
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11
Q

Administration of meds: NG, ND, G-tubes

A
  • Can crush meds, give 15-30 mL flush before and after
  • Separate meds to avoid clogging
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12
Q

Administration of meds: Liquid preps

A
  • Increased osmolality (~600 mOsm)
  • Dilute with sterile H2O
  • Cause diarrhea with higher osmolality
  • Viscous prep -> dilute since it will stick to tubing
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13
Q

Enteral Feeds/Drug Interactions (PO)

A

Hold feeds 1-2 hours before and after:
- Phenytoin
- Quinolones
- Levothyroxine
- Warfarin

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14
Q

How do you know which Enteral Formulation to use?

A
  1. Calculate kcal requirement (20-30 kcal/kg/day)
  2. Determine need for special situations
    - Renal/heart failure (fluid restricted) -> less volume
    - ESRD -> less potassium/phosphate
    - Diabetic -> more calories from fat, less carbs, more fiber
    - Burns/Trauma -> need high protein
    - Pancreatitis -> need low fat
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15
Q

Enteral administration strategy: bolus feeds

A

Bolus feeds: (only G tubes)
- Total mL/200mL = # of boluses
- Keep pt tolerance in mind (if pt vomits, lower mL or slow bolus)
- Typical bolus 200-400mL over 15-60 min

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16
Q

Enteral administration strategy: continuous feeds

A

Continuous feeds: (over 24h)
- Total mL/24hr = mL/hr rate
- Start at 20mL/hr and reassess q4h

Semicontinuous: 10-16h overnight (USELESS ROFL)

17
Q

Determining fluid requirements

A

1 mL/kcal/day or 30-40 mL/kg/day
Check enteral formula
- Determine H2O
- Subtract from daily required H2O
- Give as free water q4-6h (divide by 4 or 6)

18
Q

Monitoring for intolerance

A
  • Diarrhea
  • Bloating, abdominal distention
  • Electrolytes
  • GI wall tube
  • Nasal tube
  • Maintain tube patency (no clog)
19
Q

Intolerance monitoring: Diarrhea

A

> 3 liquid stools/day (depends on rate, composition, fiber, prokinetics)

20
Q

Intolerance monitoring: Bloating, abdominal distention

A
  • use prokinetics
  • administer post-pyloric feed
  • use continuous rather than bolus
  • slow infusion if continuous
  • decrease volume of bolus
21
Q

Intolerance monitoring: Electrolyte imbalances

A
  • hypernatremia
  • refeeding syndrome (rapid depletion, replete K+, phosphate, magnesium)
22
Q

Intolerance monitoring: GI wall tube

A
  • exit site infection
  • leaking
  • bleeding
23
Q

Intolerance monitoring: Nasal tube

A
  • sinusitis
  • keep head of bed elevated 30-45 degrees to reduce aspiration risk
24
Q

Intolerance monitoring: Maintaining tube patency

A
  • ensuring there is no clog
  • flush tube
  • use cola, pancreatic enzymes, Na+ bicarb

PHM 604 GI (4 decks)

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