Enteral Nutrition Flashcards
Types of access that allow you to crush meds
Nasogastric (NG), orogastric (OG), nasoduodenal (ND), nasojejunal (NJ), gastrostomy (G-tube)
Types of access that don’t allow bolus feeds
Nasoduodenal, nasojejunal, jejunostomy (J-tube)
Short-term access routes
Nasogastric, orogastric, nasoduodenal, nasojeujunal
Long-term access routes
G-tube, J-tube
How does a patient qualify for a standard formula?
Their GI tract is functioning, they require enteral support, and they don’t have organ system dysfunction or another need for a specialty formula
How does a patient qualify for a specialty formula
Functioning GI tract, require enteral support, but they do have organ system dysfunction or another need for a specialty formula
Other route is if they were originally on a standard formula but can’t tolerate it
How do standard formulas vary?
Based on protein concentrations, Kcal/ml, fiber content
How are standard formulas selected?
Based on the patient’s protein needs
How do specialized formulas differ from each other?
Based on disease-specific modifications
When to give EN in the setting of critical illness
Within 48 hours of admission
What does giving early EN in critical illness do?
Attenuates the stress response, reduces inflammatory cytokines and lowers impact on gut permeability; may reduce disease severity and infectious complications with a trend towards reduction in mortality
What can hemodynamic instability result in with critical illness?
Bowel necrosis due to poor gut perfusion and increased oxygen demand
EN and bowel necrosis treatment
Delay EN until the patient is fluid resuscitated and vasopressors are being withdrawn or doses are reducing/stable
Early EN nutrition in previously well-nourished, mild-to-moderately stressed adult patients who aren’t critically ill
May delay initiation of EN for up to 5-7 days but early EN initiation isn’t usually warranted in patients like these
EN GI intolerance can contribute to what?
Aspiration
EN GI intolerance leads to what?
Holding feeds and impacts delivery of nutrition
Gastric volume residual (GVR) details
Volume remaining in the stomach over a given interval (usually <500ml)
Symptoms of intolerance
Presence of flatus and stools
Negative abdominal x-ray, abdominal exam
Absence of bloating, distention, abdominal pain
Prevention/management of EN GI intolerance
Keep HOB at 30-45º
Minimize opioids
Correct fluid and electrolyte abnormalities
Continuous rather than bolus feeding
Post-pyloric feeding
Prokinetic agents (metoclopramide and erythromycin)
Diarrhea complications of EN
More than 3 liquid stools or 500ml on 2 consecutive days
Contributing factors to diarrhea for EN
Rate of feeding, formula composition, contamination, lack of fiber, broad-spectrum bacteria/C. diff, medications
Treatment of EN diarrhea
Antidiarrheals only appropriate when infectious etiologies are rules out
Risk factors for intestinal ischemia in EN
Neonates, critically ill, immunosuppressed, jejunal feeding, hyperosmolar feeds, disordered peristalsis
Prevention of intestinal ischemia
Delay feeding until fully volume resuscitated
Initiate with iso-osmolar, fiber-free formulas
Monitor for signs and symptoms
Metabolic complications of EN
Similar to TPN: glucose, fluid, electrolytes, macronutrients and micronutrient perturbations
Mechanical complications of EN
Feeding tube occlusion, malposition, nasopulmonary intubation
Infectious complications of EN
Aspiration, sinusitis, gastric tube-related complications (exit-site infections, intra-abdominal infections, leaking, bleeding, excess granulation tissue)
How often to monitor fluid and weights in EN
daily
How often to monitor glucose in EN
q1-6h
How often to monitor electrolytes in EN
daily to 3x/week
How often to monitor visceral proteins in EN
1-2x/week
How often to monitor CBC, PT/PTT in EN
1-2x/week
How often to monitor protein turnover in EN
weekly
How often to monitor for GI tolerance in EN
Daily up to q4h
