Enteral Nutrition

Question 1

ASPEN guidelines for NS initiation.

Answer 1

When a pt has not eaten for 7-14 days, they need NS. (Expected or documented)

Question 2

Define enteral nutrition. What is another term for it?

Answer 2

Give nutrients through the GI tract by tube or catheter into stomach, duodenum, or jejunum.

EN = TF

Question 3

What do you consider when choosing where nutrients should enter?

Answer 3

Length of EN use 
High risk aspiration pt? 
Normal digestion? 
Any planned surgeries? 
Volume that needs fed.

Question 4

What are the 5 main forms of EN?

Answer 4

NG
ND
NJ 
PEG 
PEJ

Question 5

Highlights of nasoduodenal/nasojejunal (ND/NJ).

Question 6

Highlights of Percutaneous Endoscopic Gastronomy(PEG).

Answer 6

> 4 weeks use and nasal route unavailable
Minimal wound complications
Uses all of the GI tract (good!)
Risk of aspiration and infection

Question 7

Percutaneous endoscopic jejunostomy (PEJ) highlights.

Answer 7

> 4 week usage, when stomach can’t be used
Lowest risk of aspiration
Small diameter tubes get clogged easily
Infection risk!

Question 8

What is Bolus type feeding?

Answer 8

250-500mL in 10-15 minutes
3-8x per day
Only used when straight into stomach
Risk of aspiration, fullness, nausea, GI intolerance

Question 9

What is intermittent type feeding?

Answer 9

250mL in 20-30 minutes (q4-6 hours start to start time)

Gravity drip and good to transition to eating/meal times

Question 10

Type of continuous feeding.

Answer 10

Delivered for 8-24 hours at 10-50mL/hour.
Progress to 10-20mL/hour every 6-8 hours
Start low and slow!

Question 11

What are the 5 “types” of enteral formulas?

Answer 11

Standard-polymeric 
Elemental
Specialized-for
Disease 
Modular 
Breast milk

Question 12

What is osmolality?

Answer 12

It goes up with the number and size of particles in solution increase. High osmolality attracts water to GI tract.

Question 13

What is normal blood, Iso, and hyper osmolality values.

Answer 13

Blood: 280-320 mOsm/kg
Iso: 200-500 mOsm/kg
Hyper: above 500

Question 14

Standard formula

Answer 14

$ 
Meal replacements 
Have lactose-free and fiber added used for sports and wt management. 
1-1.2 kcal/mL
Isotonic

Question 15

Elemental Formula

Answer 15

$$
Use wtb compromised GI function
Predigested protein and AA

1-1.2kcal/mL
Good for Chrons disease.

Question 16

Specialized formula

Answer 16

$$$
Made for specific diseases
.8-2.0kcal/mL
Usually hypertonic

Question 17

Modular formulas

Answer 17

$$ plus labor
Provides single nutrients
Protein, vitamin, MCT (6-12C)

Question 18

Rules for Flushes

Answer 18

Use sterile water and usually 30mL water
Continuous- every 4 hours
Intermittent- before and after feelings
Sodium bicarbonate used for clogged PEJ

Question 19

Water intake terminology,

Answer 19

Water from the flush- flush water

Water from formula- free water

Both combined- total fluid

Question 20

Do you have to wait for BM after surgery to start EN?

How long do you wait to use installed PEJ?

Answer 20

(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.

Question 21

Define nutrition support.

Answer 21

Deliver formulated enteral or parenteral nutrients to pts who need to maintain or restore nutrient status and prevent malnutrition.

Question 22

What are the benefits of using EN vs TPN?

Answer 22

Preserve gut barrier, usage, immune mucosa
Less LOS
Increase wound healing
Less hyperglycemia

Question 22

Best times to use TF/EN

Answer 22

PEM b/c not eating 
Dysphagia 
Chron's (nutrient malabsorption) 
Hypermetabolism 
Ventilator dependent 
Anorexic

Question 23

What is Ileus?

Answer 23

No peristalsis

Question 24

When should you not use TF/EN?

Answer 24

Short bowel syndrome 
Uncontrolled vomit/diarrhea 
Severe malabsorption 
Upper GI hemorrhage 
Complete obstruction 
acute pancreatitis

Question 25

Highlights of nasogastric (NG)