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CNSC > Enteral Nutrition > Flashcards

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
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2
Q

Formula attributes that can cause distention

A

Rapid infusion or cold formula

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3
Q

How to test for malabsorption (4)

A

Stool
Vitamins
Plasma citrulline
Pxylose absorption test (sugar)

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4
Q

Diarrhea dx

A

> 500 mL output in 24 hours

or >3 stools/d for > or equal to 2 days

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5
Q

Meds that can cause diarrhea

A

Antibiotics, PPI, prokinetics, glucose
lowering agents, NSAIDs, SSRIs
Those with a lot of sorbitol

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6
Q

Secretory diarrhea

A

Body secretes electrolytes which cause water buildup

Cdiff, laxatives, fat/bile malabsorption, Celiac

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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

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8
Q

Peptide based formula may be better tolerated in ____

A

diarrhea

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9
Q

Open delivery hang time

A

4-12 hours

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10
Q

Powder/reconstituted formula hang time

A

4 hours

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11
Q

Closed delivery hang time

A

24-48 hours

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12
Q

After opening, refrigerate tube feeding and use within

A

48 hours

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13
Q

Replace spikes/tubing every

A

24 hours

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14
Q

3 way stop cock ___ risk contamination

A

Increases

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15
Q

SCFA can help control

A

Diarrhea

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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

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17
Q

Signs aspiration (7)

A 
Hypoxia
Wheezing/rhonchi
Frothy purulent sputum
Fever
Agitation
Tachy
Rales/crackled breaths
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18
Q

Unless vomiting, GRV should be replaced up to __ mL

A

250

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19
Q

Sterile/liquid formula preferred to ____

A

Powdered/reconstituted

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20
Q

Reconstituted formula

A

Fridge immediately
Room temp < or equal to 4 hours
Discard in 24 hours if not used

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21
Q

Use ___ water for flushes/meds

A

Sterile/purified

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22
Q

Screw cap has ___ bacteria than flip top

A

Less

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23
Q

Preferred type of container

A

Recessed spike closed system

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24
Q

Feeding pump with drip chamber purpose

A

Prevent retrograde contamination

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25
Q

Sterile/decanted formula hang time

A

8 hours

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26
Q

Monitor in dehydration

A

BUN, Cr, UO

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27
Q

Check ___ level as it increases with Na retention

A

Aldosterone

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28
Q

Causes hyperkalemia (2)

A 
Metabolic acidosis
Poor perfusion (CHF)
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29
Q

Cause hyponatremia (2)

A 
Increased ADH (SIADH)
Heart/liver/kidney insufficiency
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30
Q

Cause hypernatremia and what monitor

A

Increased fluid intake with increased loss (sweat, Fistula, diuresis)

Monitor BUN:Cr

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31
Q

Med causes hypophosphatemia (4)

A

Binding by Epi
Sucralfate
Antacid
Insulin

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32
Q

Cause hypercapnia (2)

A

Overfeeding
Excess CHO in respiratory dysfunction
Consider high fat (30-50%)

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33
Q

Cause low Zinc (4)

A

NG/ostomy/wound loss

protein losing enteropathy (loss pro from Gi tract)

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34
Q

Cause low vitamin K (5) and what to do

A 
Abx
Prolonged use low K or low fat formula
Cirrhosis
Malabsorption
Panc insufficiency
  • consider probiotic
    Check INR/PT
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35
Q

EFAD tx

A

Inadequate linoeic acid
Provide 4% of kcal needs
Add modular fat, 5 mL safflower oil

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36
Q

Risks refeeding (7)

A 
Inadequate intake 2 weeks
Poorly controlled DM
Cancer
Anorexia
SBS/IBD
Low birth wt premie
Chronic infection like HIV
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37
Q

Symptoms of refeeding (4)

A

Arrhythmia, respiratory distress, HF, aspiration

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38
Q

How start TF with refeeding

A

25% day 1 advance to goal over 3-5 days

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39
Q

Older adults increased risk for dehydration d/t

A

Decreased water reservce 2* decreased LBM

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40
Q

Check for dehydration

Signs progressive dehydration

A

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
Q

Low Cr d/t

A

Low muscle mass

42
Q

Increased urine specific gravity without decrease in UO and levels of each

A

Dehydration
Normal urine specific gravity: 1.028
Normal UO: 0.5-2.0 mL/kg/hr

43
Q

When to increase fluid intake

A

Fever ()12% every 1 degree over 37.8 C/100 F)
Emesis/diarrhea/high output
Hyperglycemia

If miss feeding, give amount in fluid

44
Q

Edema does not guarantee ____ volume adequacy

A

Intravascular

45
Q

Polyurethane vs Silicone (Poly)

A

Poly: less comfort, stiffer, more resistant to fungus, NG, less likely clog
Silicone: PEG

46
Q

Y or dual port

A

Allow for feeding and meds but prevent clog need give meds separately

47
Q

PEG solid vs balloon vs solid bolster

A

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
Q

When place G tube

A

When TF needed for longer than 4-6 weeks

49
Q

Endoscopic/fluoroscopic placement G tube associated with ___ morbidity and cost

A

Less

50
Q

PEG is a ___ risk bleeding procedure

A

High
Hold thienopyridines 5-7 days prior
Hold Coum 5 days prior
Oral anticoag 48 hrs before and after

51
Q

Prophylactic antibiotics for PEG tube placement ____ peristomal infection.

A

reduces

52
Q

PEG contraindications (6)

A

Ascites, coagulopathy, varices, active head/neck cancer, morbid obesity, inflamed gastric wall

53
Q

Most common method PEG placement

A

Ponsky/Pull

54
Q

Fluoroscopic placement advantages

A

No sedation, can place in those with stenosis/trauma upper GI or head/neck cancer
Decreases risk tumor seeding

55
Q

Open/laparotomy when to do

A

When can’t do other methods
requires anesthesia
Typically when doing other GI surgery or have trauma/obstruction

56
Q

Laparoscopic method placement called

A

Stamm technique

57
Q

When place G-J

A 
Impaired gastric motility
Pancreatitis
Panc surgery
Need to feed while decmpressing
Can be placed as other methods
58
Q

PEJ placement

A

Modification of pull method
More difficult
Fluoroscopic, endo or surgical

59
Q

Enterostomy tube can be removed/replaced once

A

Stoma tract has matured (1-2 weeks) however most MD like wait 4-6 weeks
Especially steroids, immunosuppressed, obese, poor wound healing

60
Q

What can happen if remove PEG before stoma tract matured

A

Stomach fall away from abd wall and cause bowel contents -> peritoneum

61
Q

Percutaneous tube with internal bolster can remove using ___ method

A

Traction

62
Q

If there is pain after replacing tube…

A

Tube may be in stoma tract instead of lumen, or perforated the peritoneum. If its fixed without leakage, can use

63
Q

Clean PEG tube

A

Mild soap/water

Abx ointment or hydrogen peroxide not recommended

64
Q

If PEG drainage, can have dressing if

A

There isn’t excess tension

65
Q

Complications of too much PEG tension (2)

A

Promotes infection

Buried bumper syndrome

66
Q

Causes tube clogging (4)

A

Not flushing right
Accumulation of pill fragments
Freq GRV checks
High protein/fiber formula

67
Q

What to flush with

A

Water
Can use pancreatic enzymes
Don’t use anything acidic

68
Q

Form of med to use for small bore feeding tube prevent clogging

A

Liquid rather than crushed

But liquid has higher viscosity, osmolality, sugar

69
Q

NG complications (8)

A 
Epistaxis
Aspiration/respiratory compromise
Misplacing
Dislodging
Malfunction
Sinusitis
Occlusion
Ischemia
70
Q

How to check for peritonitis

A

Infuse water soluble contrast with imaging

71
Q

Enterostomy complications (6)

A 
Peritonitis
Nec fasc
Perisomal infection
Leakage
Buried bumper
Fistulous tracts
72
Q

Risk factors for leakage (3)

A

Infection
Excess cleaning with hyd perox or povidone iodone
Excess tension/side torsion on external position

73
Q

Buried bumper syndrome

A

mucosa growth over external bumper d/t excess tension, poor wound healing, significant weight gain
Need remove tube

74
Q

Prevent patient from pulling tube (5)

A 
Nasal bridle
Abd binder
Mittens
Cut external tube length to 6-8 cm 
Use low profile device
75
Q

Additional complications of G-J or J tube

A

Frequent malfunction or small extension tube

Jejunal volvulus or perforation

76
Q

NG Fr size and length

A

8-16

38-91 cm

77
Q

Nasoenteric Fr and length

A

8-12

91-240 cm

78
Q

Gastrostomy Fr and low profile

A

12-30

12-24

79
Q

If giving liquid drugs/electrolytes into small bowel

A

dilute 30-60 mL

80
Q

Blenderized TF: Use within, Hang time

A

Refrigerator temperature immediately after preparation. Discard after 24 hours.
Hang time 2 hours

81
Q

Home NS must be able to monitor

A

Weight, hydration status, blood/urine glucose, early sign infection, care access device

82
Q

4 meds may be altered with EN

A

Coumadin
Phenytoin
Carbamazepine
Fluroquinolones (cipro)

83
Q

Hyper granulation cause, # excess tissue, and tx

A

Tube not stable/moist exit site
>0.25 in
Cauterize silver nitrate, stabilize

Do not use occlusive dressing

84
Q

When stop TF for distention

A

At least 8-10 cm

85
Q

Intermittent vs bolus feeding

A

Same amount
Intermittent 45 minutes with or w/o pump
Bolus 15 minutes via gravity or syringe

86
Q

Home NS

A 
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
Q

TF syndrome

A

Inadequate fluid provision leads to azotemia, hypernatremia, dehydration

88
Q

Flushes

A

30 mL Q4 or before/after bolus
15mL before between and after meds
30 mL after GRV check

89
Q

3 recommendations for checking GRV

A

60 mL syringe
Large bore feeding tube
First 2 days of feeding

90
Q

PI plan for home care NS providers

A

Mortality, readmission, complications, pat/family satisfaction, problem reporting and resolution

91
Q

Home care nutrition screening within

A

72 hours

92
Q

Possible favorites for non occlusive bowel necrosis

A

Possible factors: jejunal feeds, hyperosmolar formula, peristalsis disorder

93
Q

Consider use of _____ formulations in the patient
with persistent diarrhea, with suspected malabsorption or
lack of response to fiber.

A

small peptide

94
Q

MICU/SICU TF recs if diarrhea

A

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
Q

Immune modulating formula in

A

Trauma, SICU and TBI

96
Q

EN in burn when start

A

. 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
Q

Factors that delay gastric emptying include

A

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
Q

A formula prepared from reconstituted powder or with added modular components should be infused for no more than-

A

4 hours”

99
Q

Cholestasis has been associated with ILE doses greater than ___ in adult patients receiving long-term PN

A

1 g/kg/d

CNSC (7 decks)

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