Enteral Nutrition

Question 1

What are CIs to enteral nutrition?

Answer 1

1. severe malabsorption syndromes
2. GI obstruction /ileus
3. Intractable diarrhea

Question 2

What routes of enteral nutrition is used for short term (<2 weeks)?

Answer 2

nasoenteric
orogastric

Question 3

What route of enteral nutrition is used for long term?

Answer 3

enterostomy; mostly percutaneous endoscopic gastrostomy

Question 4

What are problems with intermittent feeding?

Answer 4

larger fluid/ osmotic burdens over shorter periods of time –> diarrhea, less tolerated

Question 5

What is a meal replacement?

Answer 5

semi-palatable partially digested proteins given as a supplement or full nutrient replacement in those ABLE to swallow

Question 6

What products are used for meal replacement?

Answer 6

1. Ensure
2. Osmolite
3. Isosource
4. Boost

Question 7

What is elemental/ peptide replacement?

Answer 7

non-palatable predigested protein given via tube feeding

Question 8

What patients receive elemental/ peptide replacement?

Answer 8

1. malabsorptive issues (IBD,IBS)
2. transition from TPN to enteral

Question 9

What products are used for elemental/ peptide replacement?

Answer 9

Vivonex
Peptamen
Vital

Question 10

What products used for respiratory insufficiency have increased fat?

Answer 10

Pulmocare
Respalor

Question 11

What products used for diarrhea have increased fiber?

Answer 11

Jevity
Ultracal

Question 12

What products used for renal insufficiency have decreased protein and electrolytes?

Answer 12

Nepro
Suplena

Question 13

What products used for diabetes have fructose fat and fiber?

Answer 13

Glucerna

Question 14

What should be done to feeding tubes to avoid clogging?

Answer 14

administer free water via tube

Question 15

What should be done to manage diarrhea with tube feedings?

Answer 15

1. decrease amount
2. decrease rate
3. add fiber
4. antidiarrheal agents

Question 16

What agents can be considered for high residuals with possible aspirations?

Answer 16

Octreotide
Metoclopramide
Erythromycin

Question 17

What can cause vomiting due to tube feedings?

Answer 17

high residuals (overly full)

Question 18

What type of dosage forms should never be used with tube feeding?

Answer 18

enteric coated
extended-release (some exceptions)

Question 19

How should medications be administered via feeding tube?

Answer 19

1. use liquid formulations when possible
2. crush all tablets and mix with water
3. administer medications separately
4. flush with water after each medication

Question 20

How long should tube feeds be held before and after administering medication?

Answer 20

hold 2 hours before and 3 hours after all meds

Question 21

What are the reasons for medication absorption issues with tube feeding?

Answer 21

1. part of GI tract being bypassed
2. decreased surface area
3. decreased time in acidic environment

Question 22

What medication will bind to proteins in feed?

Answer 22

Phenytoin

Question 23

What medication needs to be administered on an empty stomach?

Answer 23

levothyroxine

Question 24

What medications with chelate with feed?

Answer 24

Quinolones
Tetracyclines

Question 25

What medication needs high fat for absorption?

Answer 25

Griseofulvin

Question 26

What medications have less efficacy due to bypassing the acidic environment in the stomach?

Answer 26

Ketoconazole
Omeprazole

Question 27

What are ways to unclog feed from the tube?

Answer 27

1. flush with distilled water
2. Viokace (pancreatic enzyme) with sodium bicarbonate