Enteral Nutrition Flashcards
What are CIs to enteral nutrition?
- severe malabsorption syndromes
- GI obstruction /ileus
- Intractable diarrhea
What routes of enteral nutrition is used for short term (<2 weeks)?
nasoenteric
orogastric
What route of enteral nutrition is used for long term?
enterostomy; mostly percutaneous endoscopic gastrostomy
What are problems with intermittent feeding?
larger fluid/ osmotic burdens over shorter periods of time –> diarrhea, less tolerated
What is a meal replacement?
semi-palatable partially digested proteins given as a supplement or full nutrient replacement in those ABLE to swallow
What products are used for meal replacement?
- Ensure
- Osmolite
- Isosource
- Boost
What is elemental/ peptide replacement?
non-palatable predigested protein given via tube feeding
What patients receive elemental/ peptide replacement?
- malabsorptive issues (IBD,IBS)
- transition from TPN to enteral
What products are used for elemental/ peptide replacement?
Vivonex
Peptamen
Vital
What products used for respiratory insufficiency have increased fat?
Pulmocare
Respalor
What products used for diarrhea have increased fiber?
Jevity
Ultracal
What products used for renal insufficiency have decreased protein and electrolytes?
Nepro
Suplena
What products used for diabetes have fructose fat and fiber?
Glucerna
What should be done to feeding tubes to avoid clogging?
administer free water via tube
What should be done to manage diarrhea with tube feedings?
- decrease amount
- decrease rate
- add fiber
- antidiarrheal agents
What agents can be considered for high residuals with possible aspirations?
Octreotide
Metoclopramide
Erythromycin
What can cause vomiting due to tube feedings?
high residuals (overly full)
What type of dosage forms should never be used with tube feeding?
enteric coated
extended-release (some exceptions)
How should medications be administered via feeding tube?
- use liquid formulations when possible
- crush all tablets and mix with water
- administer medications separately
- flush with water after each medication
How long should tube feeds be held before and after administering medication?
hold 2 hours before and 3 hours after all meds
What are the reasons for medication absorption issues with tube feeding?
- part of GI tract being bypassed
- decreased surface area
- decreased time in acidic environment
What medication will bind to proteins in feed?
Phenytoin
What medication needs to be administered on an empty stomach?
levothyroxine
What medications with chelate with feed?
Quinolones
Tetracyclines
What medication needs high fat for absorption?
Griseofulvin
What medications have less efficacy due to bypassing the acidic environment in the stomach?
Ketoconazole
Omeprazole
What are ways to unclog feed from the tube?
- flush with distilled water
- Viokace (pancreatic enzyme) with sodium bicarbonate
