Enteral Formula and ONS Flashcards
carbohydrate content may vary from
30-90%
common sources of carbohydrates
maltodextrin, modified cornstarch, and corn syrup
maltodextrin
most complex source; easily digested; low osmotic contribution
modified cornstarch
used to reduce osmolality of high osmolar formulations
fat content may vary from
1-55%
common sources of fats
vegetable oils, long-chain triglycerides, medium-chain triglycerides
examples of vegetable oils
corn, canola, soybean, sunflower, and safflower
long-chain triglycerides
source of essential fatty acids (linoleic and alpha-linoleic acid)
medium-chain triglycerides
most efficient in patients who have pancreatic insufficiency; does not require bile salts or pancreatic lipase for absorption
common sources of proteins
polymeric protein sources; oligomeric, semielemental, or peptide formulations; free amino acids, specialty amino acids
polymeric protein examples
cow milk protein, whey protein isolates, caseinates, soy protein isolates, milk protein concentrate, and beef
oligomeric, semielemental, or peptide formulations
have undergone enzymatic hydrolysis
examples of oligomeric, semielemental, or peptide formulations
hydrolyzed casein, whey, lactalbumin, wheat, soy and meat protein
free proteins
intended to avoid allergens (usually included in monomeric or elemental formulations)
specialty amino acids
- branched chain amino acids
2. glutamine, arginine
branched chain amino acids promoted for
liver disorder
glutamine, arginine is used for
immunomodulating properties in critically ill patients
types of fiber
soluble, insoluble, and fructooligosaccharides
most prevalent type of fiber
insoluble fiber
insoluble fiber includes
polysaccharides
soluble fiber includes
gum Arabic, guar gum, and pectin
insoluble fiber uses
include constipation prevention, increased stool volume, and decreased GI transit time
soluble fiber uses
include improvement of glucose tolerance, reduction of serum cholesterol, and maintenance of colonic mucosal surface
fructooligosaccharides
naturally occurring non-digestible sugars
fructooligosaccharides are used by
bifidobacteria in the GI tract
fiber-containing formulations can be associated with
abdominal distention, gas, cramping, impaction
how much water content is in an enteral formula concentration of 1 kcal/mL
75-85%
how much water content is in an enteral formula concentration of 2 kcal/mL
70% water
categories of EN products
- polymeric
- chemically defined
- fiber-containing
- peptide-based
- disease-specific formulas
use of polymeric nutritionally complete TF
patients with normal digestive processes and normal organ function
examples of polymeric nutritionally complete TF
osmolite and isocal
polymeric concentrated TF use
patients with normal digestive processes who need fluid restriction
polymeric concentrated TF examples
magnacal and twocal HN
polymeric oral supplement use
to supplement a patient’s oral diet
examples of polymeric oral supplement
boost and ensure
chemically-defined “elemental” TF uses
patients with malabsorption, short bowel, or pancreatic insufficiency
elemental examples
peptamen and subdue
fiber containing TF uses
patients with either constipation or diarrhea or long-term tube feeding
fiber containing TF examples
Jevity and promote w/fiber
peptide based TF uses
patient with malabsorption
examples of peptide based examples
peptamen
acute renal failure without dialysis
low protein, low electrolytes
examples: renalcal diet
acute renal failure with dialysis
more protein, moderate electrolytes
examples: magnacal renal
hepatic failure
increased branched-chain amino acids, decreased aromatic amino acids
hepatic failure
uses of TF
liver failure with hepatic encephalopathy
hepatic failure TF examples
NutriHep
pulmonary failure
increased fat, decreased carbohydrates
pulmonary failure TF uses
patients with chronic CO2 retention
examples of pulmonary failure TF
respalor, pulmocare
diabetes mellitus
increased fat, decreased carbohydrate, added soluble fiber
DM TF use
glucose-intolerant patients
DM TF examples
Glucerna, Glytrol
immunocompromised status
enhanced arginine, glutamine, omega-3 fatty acids, nucleotides, beta carotene
Immunocompromised status TF use
stressed, trauma, burn patients
examples of immunocompromised TF
impact and crucial
stressed states
enhanced branched-chain amino acids, increased protein, or both
stressed state TF uses
stressed patients (burn, trauma, infection)
stressed state TF examples
TraumaCal
2 kinds of modulars
beneprotein and juven
beneprotein uses
used to increase a patient’s protein intake with minimal caloric burden
1 scoop of beneprotein =
6 gm of protein, 25 kcal
juven uses
used for wound care (burns/trauma), HIV/AIDS, cancer
1 packet of juven =
75kcal with 7gm carbohydrates
14gm amino acids (L-arginine, L-glutamine)
monitoring guidelines for EN
- use small-bore feeding tube for nasoenteric feedings and verify placement with abdominal radiograph
- initially order accuchecks every 6 hours with sliding scale insulin
- always elevate head of bed 30 degrees at all times during feedings
- check gastric residuals every 6hrs