Enteral Nutrition Flashcards
1
Q
Causes delayed gastric emptying (6)
A
Hypotension anesthesia Whipple Rapid infusion Cold formula High fat or high fiber formula Stomach cancer
2
Q
Formula attributes that can cause distention
A
Rapid infusion or cold formula
3
Q
How to test for malabsorption (4)
A
Stool
Vitamins
Plasma citrulline
Pxylose absorption test (sugar)
4
Q
Diarrhea dx
A
> 500 mL output in 24 hours
or >3 stools/d for > or equal to 2 days
5
Q
Meds that can cause diarrhea
A
Antibiotics, PPI, prokinetics, glucose
lowering agents, NSAIDs, SSRIs
Those with a lot of sorbitol
6
Q
Secretory diarrhea
A
Body secretes electrolytes which cause water buildup
Cdiff, laxatives, fat/bile malabsorption, Celiac
7
Q
Diarrhea d/t hyperosmolar formula?
A
Only if very high rate or administered into small bowel
highest osmolality 750-1000 - electrolytes much higher
8
Q
Peptide based formula may be better tolerated in ____
A
diarrhea
9
Q
Open delivery hang time
A
4-12 hours
10
Q
Powder/reconstituted formula hang time
A
4 hours
11
Q
Closed delivery hang time
A
24-48 hours
12
Q
After opening, refrigerate tube feeding and use within
A
48 hours
13
Q
Replace spikes/tubing every
A
24 hours
14
Q
3 way stop cock ___ risk contamination
A
Increases
15
Q
SCFA can help control
A
Diarrhea
16
Q
Those at risk for non-occlusive bowel necrosis (4) and possible factors
A
Neonates, critically ill, immune suppressed, compromised gastric acid/microbial barrier
May present later
17
Q
Signs aspiration (7)
A
Hypoxia Wheezing/rhonchi Frothy purulent sputum Fever Agitation Tachy Rales/crackled breaths
18
Q
Unless vomiting, GRV should be replaced up to __ mL
A
250
19
Q
Sterile/liquid formula preferred to ____
A
Powdered/reconstituted
20
Q
Reconstituted formula
A
Fridge immediately
Room temp < or equal to 4 hours
Discard in 24 hours if not used
21
Q
Use ___ water for flushes/meds
A
Sterile/purified
22
Q
Screw cap has ___ bacteria than flip top
A
Less
23
Q
Preferred type of container
A
Recessed spike closed system
24
Q
Feeding pump with drip chamber purpose
A
Prevent retrograde contamination
25
Sterile/decanted formula hang time
8 hours
26
Monitor in dehydration
BUN, Cr, UO
27
Check ___ level as it increases with Na retention
Aldosterone
28
Causes hyperkalemia (2)
```
Metabolic acidosis
Poor perfusion (CHF)
```
29
Cause hyponatremia (2)
```
Increased ADH (SIADH)
Heart/liver/kidney insufficiency
```
30
Cause hypernatremia and what monitor
Increased fluid intake with increased loss (sweat, Fistula, diuresis)
Monitor BUN:Cr
31
Med causes hypophosphatemia (4)
Binding by Epi
Sucralfate
Antacid
Insulin
32
Cause hypercapnia (2)
Overfeeding
Excess CHO in respiratory dysfunction
Consider high fat (30-50%)
33
Cause low Zinc (4)
NG/ostomy/wound loss
| protein losing enteropathy (loss pro from Gi tract)
34
Cause low vitamin K (5) and what to do
```
Abx
Prolonged use low K or low fat formula
Cirrhosis
Malabsorption
Panc insufficiency
```
- consider probiotic
Check INR/PT
35
EFAD tx
Inadequate linoeic acid
Provide 4% of kcal needs
Add modular fat, 5 mL safflower oil
36
Risks refeeding (7)
```
Inadequate intake 2 weeks
Poorly controlled DM
Cancer
Anorexia
SBS/IBD
Low birth wt premie
Chronic infection like HIV
```
37
Symptoms of refeeding (4)
Arrhythmia, respiratory distress, HF, aspiration
38
How start TF with refeeding
25% day 1 advance to goal over 3-5 days
39
Older adults increased risk for dehydration d/t
Decreased water reservce 2* decreased LBM
40
Check for dehydration
| Signs progressive dehydration
Dry tongue/mucosal membranes
Orthostatic HTN
High BUN, osmolality and Hct (Na can be anywhere)
Dysphagia/ poor skin turgor (>2 second sternum), sunken eyes with dim vision, pain urination, muscle cramps, delirium
41
Low Cr d/t
Low muscle mass
42
Increased urine specific gravity without decrease in UO and levels of each
Dehydration
Normal urine specific gravity: 1.028
Normal UO: 0.5-2.0 mL/kg/hr
43
When to increase fluid intake
Fever ()12% every 1 degree over 37.8 C/100 F)
Emesis/diarrhea/high output
Hyperglycemia
If miss feeding, give amount in fluid
44
Edema does not guarantee ____ volume adequacy
Intravascular
45
Polyurethane vs Silicone (Poly)
Poly: less comfort, stiffer, more resistant to fungus, NG, less likely clog
Silicone: PEG
46
Y or dual port
Allow for feeding and meds but prevent clog need give meds separately
47
PEG solid vs balloon vs solid bolster
Solid: Increased longevity, used for initial placement
Balloon: radiologic/surgical placement - 4-6 mo lifespan
Solid bolster: In capsule like a balloon, longevity and easy to place
48
When place G tube
When TF needed for longer than 4-6 weeks
49
Endoscopic/fluoroscopic placement G tube associated with ___ morbidity and cost
Less
50
PEG is a ___ risk bleeding procedure
High
Hold thienopyridines 5-7 days prior
Hold Coum 5 days prior
Oral anticoag 48 hrs before and after
51
Prophylactic antibiotics for PEG tube placement ____ peristomal infection.
reduces
52
PEG contraindications (6)
Ascites, coagulopathy, varices, active head/neck cancer, morbid obesity, inflamed gastric wall
53
Most common method PEG placement
Ponsky/Pull
54
Fluoroscopic placement advantages
No sedation, can place in those with stenosis/trauma upper GI or head/neck cancer
Decreases risk tumor seeding
55
Open/laparotomy when to do
When can't do other methods
requires anesthesia
Typically when doing other GI surgery or have trauma/obstruction
56
Laparoscopic method placement called
Stamm technique
57
When place G-J
```
Impaired gastric motility
Pancreatitis
Panc surgery
Need to feed while decmpressing
Can be placed as other methods
```
58
PEJ placement
Modification of pull method
More difficult
Fluoroscopic, endo or surgical
59
Enterostomy tube can be removed/replaced once
Stoma tract has matured (1-2 weeks) however most MD like wait 4-6 weeks
Especially steroids, immunosuppressed, obese, poor wound healing
60
What can happen if remove PEG before stoma tract matured
Stomach fall away from abd wall and cause bowel contents -> peritoneum
61
Percutaneous tube with internal bolster can remove using ___ method
Traction
62
If there is pain after replacing tube...
Tube may be in stoma tract instead of lumen, or perforated the peritoneum. If its fixed without leakage, can use
63
Clean PEG tube
Mild soap/water
| Abx ointment or hydrogen peroxide not recommended
64
If PEG drainage, can have dressing if
There isn't excess tension
65
Complications of too much PEG tension (2)
Promotes infection
| Buried bumper syndrome
66
Causes tube clogging (4)
Not flushing right
Accumulation of pill fragments
Freq GRV checks
High protein/fiber formula
67
What to flush with
Water
Can use pancreatic enzymes
Don't use anything acidic
68
Form of med to use for small bore feeding tube prevent clogging
Liquid rather than crushed
| But liquid has higher viscosity, osmolality, sugar
69
NG complications (8)
```
Epistaxis
Aspiration/respiratory compromise
Misplacing
Dislodging
Malfunction
Sinusitis
Occlusion
Ischemia
```
70
How to check for peritonitis
Infuse water soluble contrast with imaging
71
Enterostomy complications (6)
```
Peritonitis
Nec fasc
Perisomal infection
Leakage
Buried bumper
Fistulous tracts
```
72
Risk factors for leakage (3)
Infection
Excess cleaning with hyd perox or povidone iodone
Excess tension/side torsion on external position
73
Buried bumper syndrome
mucosa growth over external bumper d/t excess tension, poor wound healing, significant weight gain
Need remove tube
74
Prevent patient from pulling tube (5)
```
Nasal bridle
Abd binder
Mittens
Cut external tube length to 6-8 cm
Use low profile device
```
75
Additional complications of G-J or J tube
Frequent malfunction or small extension tube
| Jejunal volvulus or perforation
76
NG Fr size and length
8-16
| 38-91 cm
77
Nasoenteric Fr and length
8-12
| 91-240 cm
78
Gastrostomy Fr and low profile
12-30
| 12-24
79
If giving liquid drugs/electrolytes into small bowel
dilute 30-60 mL
80
Blenderized TF: Use within, Hang time
Refrigerator temperature immediately after preparation. Discard after 24 hours.
Hang time 2 hours
81
Home NS must be able to monitor
Weight, hydration status, blood/urine glucose, early sign infection, care access device
82
4 meds may be altered with EN
Coumadin
Phenytoin
Carbamazepine
Fluroquinolones (cipro)
83
Hyper granulation cause, # excess tissue, and tx
Tube not stable/moist exit site
>0.25 in
Cauterize silver nitrate, stabilize
Do not use occlusive dressing
84
When stop TF for distention
At least 8-10 cm
85
Intermittent vs bolus feeding
Same amount
Intermittent 45 minutes with or w/o pump
Bolus 15 minutes via gravity or syringe
86
Home NS
```
A clean water supply
refrigeration and electricity
a sanitary environment,
sufficient space to administer feedings and store supplies
telephone access
```
Back up battery powered infusion pump may be need for TPN
87
TF syndrome
Inadequate fluid provision leads to azotemia, hypernatremia, dehydration
88
Flushes
30 mL Q4 or before/after bolus
15mL before between and after meds
30 mL after GRV check
89
3 recommendations for checking GRV
60 mL syringe
Large bore feeding tube
First 2 days of feeding
90
PI plan for home care NS providers
Mortality, readmission, complications, pat/family satisfaction, problem reporting and resolution
91
Home care nutrition screening within
72 hours
92
Possible favorites for non occlusive bowel necrosis
Possible factors: jejunal feeds, hyperosmolar formula, peristalsis disorder
93
Consider use of _____ formulations in the patient
with persistent diarrhea, with suspected malabsorption or
lack of response to fiber.
small peptide
94
MICU/SICU TF recs if diarrhea
fermentable soluble fiber additive (eg, fructooligossaccharides [FOSs], inulin) be considered all hemodynamically stable MICU/SICU
patients placed on a standard enteral formulation. We
suggest that 10–20 g of a fermentable soluble fiber
supplement be given in divided doses over 24 hours as
adjunctive therapy if there is evidence of diarrhea.
95
Immune modulating formula in
Trauma, SICU and TBI
96
EN in burn when start
. Based on expert consensus, we suggest very early
initiation of EN (if possible, within 4–6 hours of injury)
in a patient with burn injury.
97
Factors that delay gastric emptying include
large boluses of fluid given at one time, increased rate of formula infusion, increased fat content of the solution, and infusion of solutions colder than room temperature
98
A formula prepared from reconstituted powder or with added modular components should be infused for no more than-
4 hours"
99
Cholestasis has been associated with ILE doses greater than ___ in adult patients receiving long-term PN
1 g/kg/d
