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Nutrition Therapeutics > Enteral Nutrition > Flashcards

Enteral Nutrition Flashcards

1
Q

EN is the _______ route of nutritional support

A

preferred

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2
Q

EN benefits

A

maintains intestinal integrity and immune function
dec risk infectious and metabolic complications compared to PN
stimulates biliary function and dec potential for cholestasis and cholelithiasis

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3
Q

EN routes

A

nasal
PEG, Gastrostomy
Jejunostomy

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4
Q

gut defenses

A

HCl kills bacteria
mucosal layer prevents bacterial adherence
peristalsis
environment favors good anaerobic bacteria

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5
Q

bedside/short term routes

A

nasogastric (NG), orogastric (OG), esophagostomy

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6
Q

surgical/long term routes

A

gastrostomy, PEG, PEJ

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7
Q

jejunostomy j-tube indication (PEJ)

advantages
disadvantages

A

long term
impaired GE aspiration
(+) : earlier feeding, comfort, reduced aspiration
(-) : procedure risk, smaller tube, NO BOLUS FEEDS, site complications

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8
Q

Gastrostomy G tube (PEG) indication

advantages
disadvantages

A

long term
normal GE

(+) : all feeding methods, comfort, larger tube
(-) : procedure risk, aspiration, site complications

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9
Q

NG, OG indication

advantages
disadvantages

A 
short term
intact gag
normal GE
  (+) : ease of placement, inexpensive, all feeding methods
  (-) : tube placement, aspiration
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10
Q

ND (nasoduodenal), NJ (nasojejunal) indication

advantages
disadvantages

A

short term
aspiration
impaired GE aspiration

(+) : potential reduced aspiration risk, earlier feeding
(-) : skill for placement, smaller tube, NO BOLUS FEEDS

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11
Q

what access options for EN can we not do bolus feeds through

A

ND (nasoduodenal), NJ (nasojejunal) and jejunostomy J-tube

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12
Q

what access option for EN does not allow for crushed meds

A

jejunostomy J-tube

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13
Q

continuous method of admin

A

gastric, small bowel

method of choice in the ICU and other hospitalized patients

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14
Q

cyclic method of admin

A

gastric, small bowel
usually at night
provides supplemental nutrition

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15
Q

bolus method of admin

A

gastric
quick, convenient, physiologic
avoid if high aspiration risk (ND, NJ, J-tube)
avoid in poor gastric emptying

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16
Q

intermittent method of admin

A

slower

for those who do not tolerate bolus feeds

17
Q

+ and - of early EN

A

early EN is within 48h of admin
+ : attenuates stress response, dec inflammatory cytokines and dec impact on gut permeability, may reduce disease severity and infectious complications
-: delay early EN if pt is hemodynamically unstable. initiate when fluid resuscitated and vasopressors are w/drawn

18
Q

EN is not warranted for _________

A

well-nourished, mild-mod stressed adult patients who are not critically ill

19
Q

how long can we delay EN for

A

up to 5-7d

20
Q

standard polymetric formulas for EN

formula is like “baby formula” not a math formula

A 
recommended for most patients
usually 1-2kcal/mL
fiber content
selection based on meeting protein needs
isosource HN, replete fiber, isosource 1.5 cal
21
Q

which standard formula has highest CHO

A

Isosource 1.5 cal

22
Q

which standard formula has the highest fat %

A

Isosource 1.5 cal

23
Q

which standard formula has the highest fiber content

A

REPLETE FIBER

24
Q

isosource HN

A

house-formula
fiber free
isotonic
pre-ESRD

25
Q

replete fiber

A

high protein
with fiber
wound healing

26
Q

Isosource 1.5 cal

A 
high protein
lower CHO (still higher than others though)
27
Q

what specialty enteral formula is for renal dysfunction

A

NOVASOURCE RENAL

28
Q

what specialty enteral formula is for hepatic dysfunction

A

NUTRIHEP

29
Q

If GIT is functioning, patient requires enteral support, and theres no organ dysfunction, which formula do we use?

A

standard (isosource HN, replete fiber, isosource 1.5 cal)

30
Q

If GIT is functioning, patient requires enteral support, and theres no organ dysfunction, standard formula is used but not tolerated well, which formula do we use?

A

specialty

31
Q

EN monitoring: Gastric Intolerance

A

contributes to aspiration
requires holding feeds
GVR (gastric volume residuals) = vol in stomach after given intervals SHOULD BE <50mL
sx of tolerance: flatus and stools, neg abdominal xray, abdominal exam, no bloating, distention, abd pain

32
Q

Are sx of intolerance or GVR a better measure of overall tolerance

A

sx of intolerance

33
Q

ways to prevent GI intolerance with EN

A

keep HOB 30-45 deg.
minimize opioids
correct fluid and electrolyte abnormalities
continuous feeding>bolus
prokinetic agents: Metoclopramide (10mg q6h, dec dose 50% if CrCl<40)
Erythromycin 3-7mg/kg/day

34
Q

EN complications: diarrhea
definition
contributing factors
antidiarrheals when?

A

> 3 liquid stools on 2 consecutive days

rate of feeding, formula composition, lack of fiber, contamination, broad spec ABX (C diff)
meds

antidiarrheals only ok if infectious causes are ruled out

35
Q

EN complications: bowel ischemia
RFs
prevention

A

RF: neonates, critically ill, imm suppressed, jejunal feeding, hyperosmolar feeds, discolored peristalsis
prevention: delay feeding until fo=ully volume resuscitated, initiate w iso-osmolar, fiber free formula, monitor for s/sx

36
Q

metabolic complications

A

glucose, fluid, electrolytes, macronutrient and micronutrients pertubations

37
Q

mechanical complications

A

feeding tube occlusion, malposition, nasopulmonary intubation

38
Q

infectious complications

A

aspiration, sinusitis, gastric tube

39
Q

monitoring of hospital patei\ients

A 
fluids, weights qd
glucose q1-6h
elec daily-TIW
LFT, visceral proteins, CBC, PT/PTT 1-2x/week
protein turnover weekly
GI tolerance daily up to q4h

Nutrition Therapeutics (4 decks)

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