Enteral Nutrition Flashcards
Subjective Global Assessment
SGA A = Well Nourished
SGA B = Mildly Malnourished
SGA C = Severely Malnourished
What is more preferred for Nutrition Support Enteral or Parenteral
Enteral is the more preferred route when possible
Enteral Nutrition
- Definition
Providing nutrition directly into GI tract
- Bypasses the oral cavity
Enteral Nutrition
- Indications
- Existing malnutrition
- Poor intake
- Catabolic patient (trauma/burns)
- Inability to eat (stroke/brain injury)
- Impaired digestion/absorption (cystic fibrosis)
Enteral Nutrition
- Contraindications
- Nonoperative GI obstruction
- Unmanageable Nausea/vomiting
- Severe short bowel syndrome
- Malabsorption
- Distal high output fistula
- GI bleed
- Inability to enteral access
- EN is needed for less than 7-9 days (not severe enough)
- Aggressive nutrition is not wanted by patient
Enteral Nutrition
- Height of Bed
Set bed upright at 30 degrees unless contraindicated
Enteral Access
- Considerations
Site of delivery
Size of feeding tube
Stomach vs Small Bowel
Stomach is able to handle more concentrated or hypertonic medications than small bowel
Some medications are optimally absorbed at certain sites
- Antacids target the stomach
Different kinds of Enteral Access tubes
NG (Nasogastric) Tube
- 18 French
Corpak / Kaofeed
NJ/ND (Nasojejunal/Duodenal) or post-pyloric
NG Tube
- Use
Nasogastric Tube
- Large in diameter
- Less likely to occlude
- Can be used for feeding or suction (one or the other can not be for both)
Corpak
- Use
- Gastric or Jejunal
- Small diameter
- Higher risk of occlusion
- Only for feeding, no suction
Kaofeed
- Use
- Gastric or Jejunal
- Small diameter
- Higher risk of occlusion
- Only for feeding, no suction
NJ/ND
- Use
Nasojejunal/Duodenal (Post Pyloric)
- Small Diameter
- Increased chance of occlusion
- Less chances of aspiration events (vomit)
- Is very distal, can affect absorption of medication
- Have to consider formulation of medications (gastric vs post-pylori)
Solutions to Tube Occlusion
- Liquid medications when possible
- Alternative route if practical
- Proper water flushes pre and post medications
Different Types of Enteral Formulas
Polymeric
Elemental/Semi-Elemental
Specialty
Modules
Types of Enteral Formulas
- Polymeric
Intact Macromolecules
Is the standard that most patients start with
Types of Enteral Formulas
- Elemental/Semi-Elemental
Predigested Macromolecule
- Bit easier to tolerate
Is used for patients with malabsorption (short bowel syndrome)
Types of Enteral Formulas
- Specialty
Disease Specific
- Not always needed for first line therapy
Types of Enteral Formulas
- Modules
Protein Powder
- For catabolic patients to boost their protein levels
MCT OIl
- Adds extra calories for not a lot of volume for people who are not tolerating
Closed System Tube Feeding
- Ready to hang
- Reduces risk of contamination
- Less nursing time (Hang time: 24-48 hours)
- Increased waste
Open System Tube Feeding
- Can pour into a feeding bag for delivery
- Higher potential for contamination
- Hang time: Only 8 hours (More nursing care)
4 Perspectives on holding nutrition
- Nutritional Perspective
- Nursing Perspective
- Pharmacotherapeutic Perspective
- Patient Perspective
Holding Feeds
- Nutritional Perspective
- Caloric/Protein delivery
- Goal tube feed rate
- Tube feed tolerance
- Glycemic control
Holding Feeds
- Nursing Perspective
- Work flow
- GI tolerance leading to nursing care issues
- Spacing medications for incompatibilities
Holding Feeds
- Pharmacy Perspective
- Alterations of medications absorption patterns and bioavailability
- Efficacy of medications
Holding Feeds
- Patient Perspective
- Most effective treatment
- Safest treatment
- Quality care
Medications of Concern
- Ciprofloxacin, Levofloxacin
- Dilantin
- Alendronate
- Synthroid
Holding Feed
- Dietitian solutions
- More concentrate enteral feed to lower goal rate
- Adjusting goal rate to meet daily needs
- Monitor feed tolerance daily to ensure adequate nutritional delivery
- Intermittent or night feeds (If not critically ill)
Holding Feed
- Pharmacy Solutions
- Frequency of medication dosing
- Alteration of route of medication
- Dosing based on therapeutic monitoring
Nutrition that affects calories
- Propofol (Can add a lot of calories and make it hard to feed with fat through IV lines)
- Dextrose containing IV solutions (high carbohydrate formula)
- Dialysate
Delivery Methods - Continuous
- Use
For Critically ill/intubated
- Refeeding risk
- Poor glycemic control
- Intolerance to feed
Delivery Methods - Intermittent
- Use
Bolus that is infused via pump, gravity drip, syringe
- Large volume over 20 mins to 2 hours 4-6 times a day
- Mimics regular meal times
Enteral
- Diarrhea
Rule out C. Diff
Give antidiarrheal
- Imodium, Lomotil
Enteral
- Constipation
Less common
Metamucil
FIbre containing solution
