Enteral Nutrition Part 2 Flashcards by Sydney Perry

types of enteral nutrition formulas

polymeric
hydrolyzed
semi-elemental
elemental

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what are polymeric formulas

intact macronutrients
-proteins
-polysaccharides
-glucose polymers
-LCT

*nutritionally complete

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polymeric formulas require ?

normal digestion and absorbtion

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Standard polymeric formulas include…
_____ kcal/ml
around ____% CHO
_____% Fat
_____% Protein

1-1.2

50-60
30-35
15

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polymeric formulas are supplemented with _______ AND ________

high nitrogen (15% protein)

fiber (15 g/L)

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polymeric formulas are for patients with ______, ________, ______, and _______

infections
trauma
surgery
burns

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concentrated polymeric formulas are…
______ kcal/ml

1.5-2.0

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concentrated polymeric formulas are for patients who _________ or _________

require a fluid restriction
have higher kcal needs

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polymeric blendarized formulas are made from __________

whole foods

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possible advantages of blenderized polymeric formulas

consuming same food as family
health benefits from phytonutrients

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contraindications of blenderized tube feeding

immunocomprimised patietns
tube <14 Fr

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for blenderized tube feeding, RDN must provide education on _________ and guidance on ___________

safe food handling techniques
recipe/food components

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polymeric formulas for renal disease

low fluid and electrolytes
variable protein

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polymeric formulas for diabetes

lower in CHO
high in fat
contain soluble fiber

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polymeric formulas for pulmonary disease

low CHO
high in fat
may include extra antioxidants

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polymeric formulas for immune disease are called ____________ formulas

immune modulating formulas

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immune-modulating formulas are high in _______ with ______% and fortified with immune enhancing nutrients such as _______ and _______

protein
22-25%
omega 3 fatty acids
arginine

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may consider use of immune modulating formulas for patients with _____, _________, and _________

Use with cation for _______

TBI
major surgery
severe trauma

severe sepsis

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hydrolyzed formulas contain ____________ nutrients and __________

partially or fully hydrolyzed (protein)
decreased amount or alternative fat sources

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semi-elemental formulas are ____________ and __________ and usually contain _______

partially hydrolyzed
peptide-based
MCT

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semi-elemental formulas are used for patients with __________ from _______ and ______

malabsorption
pancreatic insufficiency
crohn’s disease

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elemental formulas are _________ with ________
they also have a __________

completely hydrolyzed (free amino acids)
minimal fat
higher osmolality

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_________ formulas for long term use have a risk
what is the risk?
what do you do for those at risk?

elemental
EFAD
provide 5 ml of safflower oil per day thru tube

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osmolality affected by _____ & ______ of nutrient particles in a solution (protein, CHO, & electrolytes)

The more nutrient dense or the more _________ nutrients in a formula=>the ________ the osmolality

Standard polymeric formulas: ~_____ mOsm/kg H2O

size & number

hydrolyzed
higher

300

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If administered directly into the small intestine, hyperosmolar formulas can cause: _________ and _________

Abdominal distention Diarrhea

Modular products are composed of individual nutrient modules=> protein, arginine, glutamine, fiber, fat Used to _____________

modify pre-existing commercial formulas or food

Factors to Consider when Selecting an EN Formula

GI function Nutritional needs of the patient Physical characteristics of the formula=> osmolality, viscosity Cost of the formula

Protein in Polymeric formulas

Intact proteins: caseinates, whey protein concentrates, soy protein isolate

protein in Semi-elemental

Hydrolyzed casein or whey=> oligopeptides, di- & tri-peptides

Protein in Elemental formulas

Crystalline, L-amino acids

protein amount in formulas vary from ____% of total kcal

7-25%

considerations for protein type in formulas

food allergies maldigestion/malabsorption most are gluten free

Carbohydrates amount in formulas varies from ______% of kcal Sources: ______ ______ ______

28-90% Maltodextrin, corn syrup solids Modified corn starch Most are lactose free

types of fiber used in formulas

insoluble fiber soluble fiber fructo-oligosaccharides (FOS)

insoluble fibers in formulas

soy fiber

soluble fibers used in formulas

pectin guar gum

benefit of soluble fibers in formulas

Trophic affect on colon mucosa may help to decrease diarrhea, delays gastric emptying

Fructo-oligosaccharides (FOS) fiber in formulas ? benefit?

Prebiotic fibers Fermented to SCFA=>play a role in maintaining colonic mucosal integrity

sources of fat in formulas

vegetable oils (e.g., canola, soybean, safflower oil) Fish oil=> omega-3 fatty acids MCT oil=> fat malabsorption

Amount of fat in formulas varies from ______% of kcal Lower % fat in _______ formulas Higher % fat in _________ formulas To prevent EFAD, must provide at least ___% of total kcal needs from ________; or ____% of total kcal needs from _____

2-55% elemental pulmonary & diabetic 4% linoleic acid 10% lipid

Most EN formulas meet DRI’s for healthy populations Must look in product information to see ________ needed to meet 100% DRIs Adjustments may be necessary in illness such as... _________, _______, and ______

volume wound healing increased losses electrolytes often need to be restricted renal failure

Free water varies with the formula type General rule of thumb: _____ kcal/ml formula provides ~____% free water ____ kcal/ml formula provides ~___% free water ____ kcal/ml formula provides ~___% free water

1.0-1.2 85% 1.5 75% 2.0 70%

Closed Feeding System are _________

sterile containers pre-filled with formula

Closed Feeding System Advantages: Minimize problems with ________ Reduces ________

contamination time & labor

Open feeding system are ___________

contents of formula cans are poured into a bag or container

Methods of EN administration

Continuous feeding cyclic feeding bolus feeding intermittent feeding

continuous Feeding is administered at ______ rate over a ____hr period provided using a ________

steady 24 hour period infusion pump

Continuous Feeding indications

initiating tube feeding critical illness small bowel feedings at risk of refeeding syndrome intolerance to bolus or intermittent feedings

Advantages to continuous feedings

best tolerated administration

cyclic feeding is _______ tube feeding over _____ hours through __________

continuous 8-20 infusion pump

usually cyclic feeding are for _____

night

indications for cyclic tube feeding

Patients at home requiring small bowel feeding Transitioning to an oral diet but with a questionable appetite

Cyclic Feeding Advantages

physical & psychological freedom from equipment for a period of each day per day

Disadvantages of cyclic feeding

Requires higher infusion rate over shorter period time=> possible GI intolerance due to higher rate Need calorie & protein dense formulas=> more expensive Requires a pump

Bolus feedings are ____ per day over a _______ Max of _____ per feeding _____ feeding only administered with _____

3-6 shorter period (5-10 min) 500 mL gastric syringe

indications for bolus feeding

medically stable home or rehabilitation patient independent patients

Advantages of bolus feeding

Ease of administration; decreased time Patient can adjust feedings to their schedule More physiologic Less expensive

Disadvantages of Bolus Feedings

higher risk of GI intolerance higher risk of aspiration cannot use with small bowel feeding

Intermittent Feeding is infused at specific _______ throughout the day through _____ or ______ ____ feedings per day _______ mL over _____ ____ feeding only

intervals gravity drip infusion pump 4-6 feedings 240-720 mL over 20-60 min gastric

Intermittent Feeding Indications

medically stable home and rehabilitation setting

Intermittent Feeding Advantages

more flexible schedule (compared to continuous) less expensive than continuous or cyclic (if gravity drip) more physiologic may be better tolerated than bolus

Intermittent Feeding Disadvantages

Increased risk of GI distress & discomfort (compared to continuous) Increased risk for aspiration (compared to continuous) If gravity drip, cannot use a fiber-containing formula

Factors To Consider to Determine Administration Method

Enteral access route Patient condition (critical vs. non-critical) GI function; GI tolerance of tube feeding Patient’s mobility and independence level

Disadvantages of continuous

can be expensive not normal eating