Enteral Formula and ONS Flashcards by Megan Lathrop

carbohydrate content may vary from

30-90%

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common sources of carbohydrates

maltodextrin, modified cornstarch, and corn syrup

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maltodextrin

most complex source; easily digested; low osmotic contribution

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modified cornstarch

used to reduce osmolality of high osmolar formulations

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fat content may vary from

1-55%

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common sources of fats

vegetable oils, long-chain triglycerides, medium-chain triglycerides

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examples of vegetable oils

corn, canola, soybean, sunflower, and safflower

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long-chain triglycerides

source of essential fatty acids (linoleic and alpha-linoleic acid)

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medium-chain triglycerides

most efficient in patients who have pancreatic insufficiency; does not require bile salts or pancreatic lipase for absorption

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common sources of proteins

polymeric protein sources; oligomeric, semielemental, or peptide formulations; free amino acids, specialty amino acids

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polymeric protein examples

cow milk protein, whey protein isolates, caseinates, soy protein isolates, milk protein concentrate, and beef

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oligomeric, semielemental, or peptide formulations

have undergone enzymatic hydrolysis

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examples of oligomeric, semielemental, or peptide formulations

hydrolyzed casein, whey, lactalbumin, wheat, soy and meat protein

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free proteins

intended to avoid allergens (usually included in monomeric or elemental formulations)

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specialty amino acids

branched chain amino acids

2. glutamine, arginine

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branched chain amino acids promoted for

liver disorder

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glutamine, arginine is used for

immunomodulating properties in critically ill patients

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types of fiber

soluble, insoluble, and fructooligosaccharides

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most prevalent type of fiber

insoluble fiber

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insoluble fiber includes

polysaccharides

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soluble fiber includes

gum Arabic, guar gum, and pectin

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insoluble fiber uses

include constipation prevention, increased stool volume, and decreased GI transit time

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soluble fiber uses

include improvement of glucose tolerance, reduction of serum cholesterol, and maintenance of colonic mucosal surface

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fructooligosaccharides

naturally occurring non-digestible sugars

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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

1. polymeric 2. chemically defined 3. fiber-containing 4. peptide-based 5. 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

1. use small-bore feeding tube for nasoenteric feedings and verify placement with abdominal radiograph 2. initially order accuchecks every 6 hours with sliding scale insulin 3. always elevate head of bed 30 degrees at all times during feedings 4. check gastric residuals every 6hrs