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MNT II > Enteral Nutrition > Flashcards

Enteral Nutrition Flashcards

1
Q

Contraindications for EN

A
  • Inadequate resuscitation or hypotension; hemodynamic instability
  • Ileus
  • Intestinal obstruction
  • Severe GI bleed
  • Expected need less than 5-7 days if normally nourished
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2
Q

Conditions that Require EN

A
  • Impaired ingestion
  • Inability to consume adequate nutrition orally
  • Impaired digestion, absorption, metabolism
  • Severe wasting or depressed growth
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3
Q

Advantages of EN vs TPN

A
  • Preserves gut integrity
  • Possibly decreases bacterial translocation
  • Preserves immunological function of gut
  • Reduces costs
  • Fewer infectious complications in critically ill pts
  • Safer and more cost effective in many settings
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4
Q

Advantages of EN

A
  • Intake easily/accurately monitored
  • Provides nutrition when oral is not possible or adequate
  • Supplies readily available
  • Reduces risks associated with disease state
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5
Q

EN Formula Selection

A
  • Determine best choice by medical and nutrition assessment

- Meet specific nutrition needs

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6
Q

Monomeric EN Formula

A
  • Elemental/hydrolyzed
  • Predigested nutrients
  • Free amino acids and/or short peptide chains
  • Has low fat content or high percentage of MCT, LCT, structured lipids
  • Use in pts with compromised digestive and/or absorptive capacity
  • More expensive than standard formulas
  • Tend to be more hyperosmolar because of small particle size
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7
Q

Contraindications for EN

A
  • Severe acute pancreatitis
  • High output proximal fistula >500ml/day
  • Inability to gain access
  • Intractable emesis or diarrhea
  • Aggressive therapy not warranted
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9
Q

EN Complete Formulas

A

Enteral formulas designed to supply all needed nutrients when given in sufficient volume. May also be used in smaller quantities to supplement regular diets.

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10
Q

EN Formula Categories

A
  • Polymeric
  • Monomeric
  • Fiber containing
  • Disease specific
  • Rehydration
  • Modular
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11
Q

Polymeric EN Formula

A
  • Whole protein nitrogen source
  • For use in pts with normal or near normal GI function
  • Protein isolate formulas
  • Blenderized formulas
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12
Q

Protein Isolate Formulas

A

Protein that has been separated from a food (casein from milk, albumin from egg).

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13
Q

Rehydration Formula

A

For pts requiring optimal ratio of CHO to electrolytes to facilitate fluid and electrolyte absorption, rehydration.

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14
Q

Blenderized Formulas

A

May contain pureed meat, vegetables, fruits, milk, starches with vitamins and minerals added. Can be made at home or purchased commercially.

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15
Q

Open System

A
  • Product is poured into a feeding bag
  • Allows modulars such as protein and fiber to be added to feeding formulas
  • Less waste in unstable pts
  • Shorter hang time
  • Increases nursing’s time
  • Increased risk of contamination
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16
Q

Fiber-Containing EN Formula

A

Containing a source of fiber; reportedly beneficial for prevention/treatment of altered bowel function in enterally fed pts. Soy polysaccharide is the most common fiber additive in enteral feedings; effectiveness in treating diarrhea in tubed pts unproven.

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17
Q

Formula Selection

A

The suitability of a feeding formula should be evaluated based on:

  • Functional status of GI tract
  • Physical characteristics of formula (osmolality, fiber, caloric density, viscosity)
  • Macronutrient ratios
  • Digestion and absorption capability of pt
  • Specific metabolic needs
  • Contribution of the feeding to fluid and electrolyte needs or restriction
  • Cost effectiveness
18
Q

Calorie-Dense EN Formula

A
  • May be used in fluid-restricted or volume-sensitive pts
  • Useful for nocturnal feedings where nutrition must be delivered over brief time span
  • Calorie density range from 1.3-2 kcals/ml
  • Monitor fluid/hydration status
19
Q

Fiber-Containing EN Formula

A
  • Soluble fiber (guar gum, oat, fiber, pectin) may exert trophic effect on colonic mucosa and be useful in normalizing bowel function
  • Most enteral feedings in amounts typically used contain less than recommended fiber intake for adults (20-35g)
  • Pts with impaired gastric emptying should not be fed fiber-containing formula into the stomach
21
Q

Disease Specific EN Formula

A
  • Designed for pts with specific disease states

- Available for pts with respiratory disease, ARDS, diabetes, renal failure, hepatic failure, and immune compromise

22
Q

Hepatic Specific Formula

A
  • Generally have reduced aromatic amino acids and increased branched chain amino acids
  • More expensive than standard products
  • Often lower in protein than standard formulas (may be too low for most live pts)
  • Standard (high protein) products are generally appropriate for pts with liver disease
23
Q

Renal Specific Formula

A
  • Originally developed in an effort to delay the need for dialysis as long as possible
  • Typically are calorie dense (2.0 kcal/ml)_ products with relatively low protein levels and modified electrolytes
  • Generally too low in protein for dialyzed pts and acutely ill pts
  • May be useful for short term use as supplement or calorie source in pre-dialysis chronic renal failure pts
24
Q

Immune Enhancing Formula

A
  • Have added “immune-enhancing” nutrients (arginine, glutamine, omega-3 fatty acids, nucleotides)
  • Meta-analysis suggests that they might be most beneficial in surgical pts
25
Q

Modular Formula

A

Provides protein, fat, or CHO as single nutrients or modular mixtures to allow adjustment of macronutrient mix. May also contribute to renal solute load, osmolality.

26
Q

EN Formula CHO Source

A
  • CHO content ranges from 40-90% of total calories
  • Typically some combination of hydrolyzed cornstarch, maltodextrins, corn syrup solids, sucrose
  • Fructooligosaccharides (FOS)
  • Fiber: soy polysaccharide (most common)
27
Q

Fructooligosaccharide (FOS)

A

Poorly absorbed in the small intestine, fermented in the large intestine, may promote growth of healthy bacteria.

28
Q

EN Formula Lipid Source

A
  • Fat provides isotonic, concentrated energy source
  • Corn and soybean oil common
  • Also safflower, canola, fish oil
  • May include MCTS; more easily digested and absorbed
  • Fat content ranges from 50% of calories
29
Q

EN Formula Protein Source

A
  • Whole protein, hydrolyzed protein, free amino acids
  • Casein, soy protein, lactalbumin, whey, egg white albumin
  • Small peptides absorbed as efficiently as free amino acids
  • Free amino acids are more hyperosmolar
30
Q

Arginine

A

Conditionally essential amino acid with immune-enhancing properties. Research suggest some benefit in wound healing. Recent research suggest may be harmful in septic pts.

31
Q

Glutamine

A

May enhance small intestine growth and repair.

32
Q

Closed System

A
  • Containers are sterile until spiked for hanging
  • Can be used for continuous or bolus delivery
  • No flexibility in formula additives
  • Less nursing time
  • Increases safe hang time
  • Less risk of contamination
  • More expensive than canned formula
33
Q

Branched-Chain Amino Acids

A
  • Thought to prevent or treat hepatic encephalopathy and prevent muscle catabolism
  • BCAA sometimes recommended for refractory encephalopathy.
34
Q

Pulmonary Formula

A
  • Contain higher percentage of total calories from fat to reduce respiratory quotient and make it easier to wean from respirator
  • However, total calorie intake has more impact on respiratory function than formula composition
  • High fat gastric feedings may cause delayed emptying in critically ill pts
35
Q

Enteral Nutriton

A

Nutritional support via tube placement through the nose, esophagus, stomach, or intestines (duodenum or jejunum). Must have functioning GI tract and exhaust all oral diet methods first.

35
Q

Conditions that Require TPN

A
  • GI incompetency

- Hypermetabolic state with poor enteral tolerance or accessibility

35
Q

Disadvantages of EN

A
  • GI, metabolic, and mechanical complications- tube migration; increased risk of bacterial contamination; tube obstruction; pneumothorax
  • Costs more than oral diets
  • Less “palatable/normal”
  • Labor intensive assessment, administration, tube patency and site care monitoring

MNT II (8 decks)

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