Enteral Nutrition Flashcards
Who are the main candidates for enteral nutrition (EN)?
Those individuals who have a functional GI tract, but have a clinical conditions in which oral intake in impossible, inadequate, or unsafe.
What are the indication for EN?
- Individuals with impaired swallowing function caused by neurological disease or oropharyngeal dysfunction, and pts w/ major trauma, burns, wounds, and/or critical illness who may not be able to meet the metabolic demands of illness.
- Severely malnourished preoperative pts who have a functional GI tract may benefit from a course of EN before surgery.
What factors are taken into consideration before placement of any type of feeding tube?
The pt’s clinical status, diagnosis, prognosis, risk and benefits of therapy, discharge plans, quality of life, ethical issues, and the patient’s and family’s wishes.
What contraindications to EN?
- Nonoperative mechanical GI obstruction
- Intractable v/d refractory to medical management.
- Severe short-bowel syndrome (less than 100cm of small bowel remaining.
- Paralytic ileus (absence of bowel sound of flatus.
- Distal high-output fistulas (too distal to bypass with feeding tube)
- Severe GI bleed
- Severe GI malabsorption (eg, enteral nutrition failed as evidenced by progressive deterioration in nutritional status)
- Inability to access GI tract
- Need is expected for
What are some benefits to EN?
- Maintain normal bladder function via stimulation of cholecystokinin release by presence of nutrients in the G.I.
- Luminal nutrients present in enteral formulas like glutamine and SCFA that fuel the small and large bowel, which is 3 important in maintaining gut-associated immune function via support of gut associted lymphoid tissue (GALT) and mucosa-associated lymphoid tissue (GALT).
- Presence of luminal nutrients promote secretion of immunoglobulin A, which prevent bacteria adherence and translocation.
- Provision of Enteral nutrition is less expensive than parental nutrition.
What are the benefits of EN over PN?
Reduced infections, length of stay and overall cost.
Suboptimal nutrition can lead to increased morbidity and hospital LOS. what are a.s.p.e.n clinical guidelines recommendations for initiation of EN for noncritically ill medically stable patients (pt)?
Initiation of EN for pts with inadequate oral intake for 7 - 14days or in pts expected to have inadequate oral intake for a 7 - 14 period.
What are a.s.p.e.n clinical guideline recommendations for initiation of EN for critically ill pt?
No defined recommendation because more research is need but recent research suggest EN initiation within 24 - 48 hrs postoperatively or following injury.
What conditions are associated with hypofusion of the GI tract and how can it affect initiation of enteral feeding?
Critically ill pts including trauma, hemorrhage, burns, sepsis, and cardiogenic shock, pose a risk for diminished splanchnic blood flow that can lead to ischemic bowel, microbial translocation, and multisystem organ failure.
2. EN might be poorly tolerated by an under-perfused bowel. See chp 23&24
What are the methods for verifying placement of NG tubes? what is the best method?
- X-ray, auscultation, air insufflation, observation of volume and color of fluid return through the tube, and measurement of the pH of the fluid.
- The best method is x-ray and the “gold standard” for verification and the rest is unreliable.
What concerns are there in regards to flushing feeding tubes with tap water?
There were concerns that using tap water to flush feeding tubes would cause adverse reaction but there were no reports of adverse reaction. However, in some institutions, they use sterile water to irrigate the feeding tubes in immune compromise patients.
Why is oral hygiene very important to pt on a EN regimen?
Poor oral hygiene and dental disease increases the level of pathogenic bacteria in oral secretions, which adds to the risks for aspiration PNA especially in ventilator-dependent pts or in those with a depressed level of consciousness.
a) List monitoring parameters for EN support.
- Physical assessment, including signs of fluid and nutrient excess or deficiency.
- Vital signs
- Actual fluid and nutrient intake (oral, EN, PN)
- Measurement of output (urine, GI, wound losses, chest tube drainage)
- Wt trends
- Laboratory data (CBC, glu, BUN, Cr, electrolytes, Ca, Mg, P, liver function test, Tg, serum pro, Urine glu, Urine Na, etc. The burden of the test (considering blood volume needed for the test)
b) List monitoring parameters for EN support.
- Markers for nutritional adequacy (alb, prealbumin trend, nitrogen balance studies)
- Review of medications (and dietary supplements if applicable)
- Changes in GI function indicating tolerance of nutrition therapy such as ostomy output, stool frequency, and consistency, presence of blood in the stool, presence of abdominal distension/firmness, increasing abdominal girth, n/v, amt and appearance of residual volume.
When is it appropriate and how do we transition from PN to EN?
If the GI tract is functional and the pt is receiving 33 to 50% of nutrient requirements, PN should be tapered. Once EN is tolerated well and provides >75% of nutrient needs, PN should be discontinued.
When is it appropriate to transition from EN to oral intake?
When the patient is alert and able to manage the mechanics of chewing and swallowing, the speech and language professional should be consulted to begin the transition phase and provide the appropriate diet consistencies.
2. When pt is able to consume 2/3 to 3/4 of nutrient requirements for 2-3 consecutive days, EN can either be slowed, or the # of feedings each day can be progressively decreased.
