Enteral Nutrition Flashcards by Tara Hale

bolus feeding

rapid administration of 250-500 mL of formula several times daily

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intermittent drip feeding

administration of formula several times daily, over 20-30 minutes

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continuous feeding

administration of formula for 10-24 hours per day using a pump to control the feeding rate

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closed enteral system

a sterile, pre-filled container of formula that’s delivered to a patient via a feeding tube and pump

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open enteral system

uses a feeding bag or syringe to deliver formula into a feeding tube

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enteral nutrition

feeding through the gastrointestinal tract using a tube, catheter, or stoma that delivers nutrients distal to the oral cavity

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French size

a measurement of the tube’s external diameter
1 Fr = 0.33 mm

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gastrointestinal decompression

a procedure that removes excess gas and fluid from the GI tract

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gastrojejunostomy

a surgical procedure that creates a new connection between the stomach and the jejunum, the middle part of the small intestine

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hang time

the amount of time a formula can stay at room temperature before it needs to be replaced

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hemodynamic stability

a state where the body’s cardiovascular system maintains adequate blood flow to all organs and tissues

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modular enteral formulas

dietary supplements that can be added to commercial or home-prepared formulas to meet specific nutritional needs

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polymeric formula

a nutrition supplement that contains whole proteins, carbohydrates, and fats

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nasoduodenal tube (NDT)

a small tube that goes through the nose and into the duodenum, the first part of the small intestine

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nasojejunal tube (NJT)

a small, soft tube that is inserted through the nose and into the small intestine

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percutaneous endoscopic gastrostomy (PEG)

a procedure used by a physician to insert a feeding tube through the skin. and into the stomach using an endoscope

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percutaneous endoscopic jejunostomy (PEJ)

a minimally invasive surgical procedure that involves placing a feeding tube directly into the jejunum, the second part of the small intestine

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osmolality

number of water-attracting particles per weight of water in kilograms (expressed as mOsm/kg)

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indication

a symptom that suggests certain medical treatment is necessary

contraindiction

a medical condition or factor that makes it unsafe or inadvisable to administer a specific treatment, procedure, or medication

formulary

a list of prescription drugs that are covered by a health insurance plan

kcal:N ratio

a way to assess how much protein is in a diet; used to ensure that pt gets enough nitrogen to maintain muscle mass.
stable - 150:1 to 200:1
critically ill patients - 100:1
Obese critically ill - 30:1 to 50:1

gastric residual volume (GRV)

the amount of fluid remaining in the stomach after a meal or tube feeding

What are the general considerations related to providing medications to patients on tube feeding (TF)?

Some medications may affect the safety and tolerance of EN, rate adjustments with the provision of medications known to interact with formula or clog the EAD, and administration scheduling in conjunction. Flushing protocol

Reglan - What type of medication is it, and why might it be used in patients on TF?

Metoclopramide; shown to improve gastric emptying and tolerance of EN. Also they can be used to reduce the risk of aspiration.

Phenytoin (Dilantin) - What recommendations would you make about this medicatoin in regard to the TF?

anti-convulsant medication used to control seizures. I would recommend liquid suspension and a 2 hour break in feeding pre and post drug administration to allow for better medicaion absorption..

What must you consider when deciding between enteral and parentral feeds?

PN is indicated in clinical situations where the patient cannot meet nutritional needs either by an oral diet or using EN. Inability to digest and absorb nutrients, intractable vomiting, GI tract obstruction, Impaired GI motility, abdominal trauma.

A tube feeding would be indicated if a patient is not expected to be able to eat orally (PO) for about how long?

En is indicated for adult patients with a functioning GI tract who present with inadequate oral intake for 8-14 days or in whom inadequate oral intake is expected to continue over a 7-14 day period.

Surgical or endoscopic tube placement would be indicated if a patient was expected to be unable to eat orally for about how long?

Patients expected to use EN >3 months should have a percutaneous endoscopic feeding tube placed.

Standard polymeric formula

EN formula containing nonhydrolyzed macronutrients intended for those with normal digestive function, pt with ineadequate oral intake and have no specific dietary restrictions or malabsorption issues

Elemental formula

EN formula that contains hydrolyzed macronutrients which could be used for those with malabsorptive disorders, persistent diarrhea, and interolerance to EN wwith severe acute pancreatitis

Specialized formulas

are tailored to meet the specific nutritional needs of patients with particular medical conditions, TBI or Renal Disease

How would you decide whether to recommend continuous, intermittent, or bolus feeds?

Depending on the patient's clinical status or disease state, needs and goals, ethical situation, gastrointestinal anatomy and function, expected duration of EN therapy, and the ability to safely access the GI tract.

For a relatively uncomplicated patient, what rate could you generally start the TF at and how would ou advance that feeding (mL/hr)

Initiating adult formula at 10-40 mL/h and advancing to goal rates by 10-20 mL/h every 6-8 hours.

What is a free water flush? How often are free water flushes generally given?

Free water flush - instill warm water into the EAD using a syringe and apply a gental back - and - forth motion with the plunger of a syringe flush feeding tubes with minimum of 30 mL of water every 4 hours during continuous feedings or before and after intermittent feedings.

Sufficiency of nutrient intake: intake/output (monitoring for EN or PN)

Nut. Unstable - daily Nut. Stable - weekly

Electrolytes, BUN, and creatinine (monitoring EN or PN)

Nut. Unstable - Daily, then 3x a week Nut. stable - 3x/week

Magnesium, phosphorus, calcium (monitoring for eternal or parenteral)

Unstable - Daily, then 3x/week Stable - 3x/week

Liver function tests

unstable - weekly stable - as needed

triglycerides

unstable - weekly stable - every 1-2 weeks

weight

unstable - daily stable - weekly

Hydration/Fluid status: physical assessment of skin turgor, presence of edema, temperature; oral cavity for color, texture, moisture/dryness

Unstable - daily Stable - 3x/week

vital signs: blood pressure, respirations, pulse

Unstable - daily Stable - 3x/week

bowel function

unstable - daily stable - as needed

blood glucose

unstable - 4 x daily until stable stable - every 1-2 weeks

nitrogen balance

unstable - PRN (as necessary) stable - PRN

If you were educating a patient going home on tube feeding, what would be some key elements of the education?

Appropriate routes of administration shall be defined, intake goals identified, and estimated duration of therapy, and criteria for discontinuation of therapyy should be addressed.