Enteral Nutrition Flashcards
ASPEN guidelines for NS initiation.
When a pt has not eaten for 7-14 days, they need NS. (Expected or documented)
Define enteral nutrition. What is another term for it?
Give nutrients through the GI tract by tube or catheter into stomach, duodenum, or jejunum.
EN = TF
What do you consider when choosing where nutrients should enter?
Length of EN use High risk aspiration pt? Normal digestion? Any planned surgeries? Volume that needs fed.
What are the 5 main forms of EN?
NG ND NJ PEG PEJ
Highlights of nasoduodenal/nasojejunal (ND/NJ).
Highlights of Percutaneous Endoscopic Gastronomy(PEG).
> 4 weeks use and nasal route unavailable
Minimal wound complications
Uses all of the GI tract (good!)
Risk of aspiration and infection
Percutaneous endoscopic jejunostomy (PEJ) highlights.
> 4 week usage, when stomach can’t be used
Lowest risk of aspiration
Small diameter tubes get clogged easily
Infection risk!
What is Bolus type feeding?
250-500mL in 10-15 minutes
3-8x per day
Only used when straight into stomach
Risk of aspiration, fullness, nausea, GI intolerance
What is intermittent type feeding?
250mL in 20-30 minutes (q4-6 hours start to start time)
Gravity drip and good to transition to eating/meal times
Type of continuous feeding.
Delivered for 8-24 hours at 10-50mL/hour.
Progress to 10-20mL/hour every 6-8 hours
Start low and slow!
What are the 5 “types” of enteral formulas?
Standard-polymeric Elemental Specialized-for Disease Modular Breast milk
What is osmolality?
It goes up with the number and size of particles in solution increase. High osmolality attracts water to GI tract.
What is normal blood, Iso, and hyper osmolality values.
Blood: 280-320 mOsm/kg
Iso: 200-500 mOsm/kg
Hyper: above 500
Standard formula
$ Meal replacements Have lactose-free and fiber added used for sports and wt management. 1-1.2 kcal/mL Isotonic
Elemental Formula
$$
Use wtb compromised GI function
Predigested protein and AA
1-1.2kcal/mL
Good for Chrons disease.
Specialized formula
$$$
Made for specific diseases
.8-2.0kcal/mL
Usually hypertonic
Modular formulas
$$ plus labor
Provides single nutrients
Protein, vitamin, MCT (6-12C)
Rules for Flushes
Use sterile water and usually 30mL water
Continuous- every 4 hours
Intermittent- before and after feelings
Sodium bicarbonate used for clogged PEJ
Water intake terminology,
Water from the flush- flush water
Water from formula- free water
Both combined- total fluid
Do you have to wait for BM after surgery to start EN?
How long do you wait to use installed PEJ?
(ASPEN 2009)
No, you can start EN right away (don’t wait 24-48 hours)
No, you can start using PEJ within a couple hours.
Define nutrition support.
Deliver formulated enteral or parenteral nutrients to pts who need to maintain or restore nutrient status and prevent malnutrition.
What are the benefits of using EN vs TPN?
Preserve gut barrier, usage, immune mucosa
Less LOS
Increase wound healing
Less hyperglycemia
Best times to use TF/EN
PEM b/c not eating Dysphagia Chron's (nutrient malabsorption) Hypermetabolism Ventilator dependent Anorexic
What is Ileus?
No peristalsis
When should you not use TF/EN?
Short bowel syndrome Uncontrolled vomit/diarrhea Severe malabsorption Upper GI hemorrhage Complete obstruction acute pancreatitis
Highlights of nasogastric (NG)
