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Advanced MNT 2 > Enteral Nutrition Part 2 > Flashcards

Enteral Nutrition Part 2 Flashcards

1
Q

types of enteral nutrition formulas

A

polymeric
hydrolyzed
semi-elemental
elemental

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2
Q

what are polymeric formulas

A

intact macronutrients
-proteins
-polysaccharides
-glucose polymers
-LCT

*nutritionally complete

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3
Q

polymeric formulas require ?

A

normal digestion and absorbtion

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4
Q

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

A

1-1.2

50-60
30-35
15

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5
Q

polymeric formulas are supplemented with _______ AND ________

A

high nitrogen (15% protein)

fiber (15 g/L)

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6
Q

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

A

infections
trauma
surgery
burns

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7
Q

concentrated polymeric formulas are…
______ kcal/ml

A

1.5-2.0

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8
Q

concentrated polymeric formulas are for patients who _________ or _________

A

require a fluid restriction
have higher kcal needs

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9
Q

polymeric blendarized formulas are made from __________

A

whole foods

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10
Q

possible advantages of blenderized polymeric formulas

A

consuming same food as family
health benefits from phytonutrients

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11
Q

contraindications of blenderized tube feeding

A

immunocomprimised patietns
tube <14 Fr

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12
Q

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

A

safe food handling techniques
recipe/food components

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13
Q

polymeric formulas for renal disease

A

low fluid and electrolytes
variable protein

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14
Q

polymeric formulas for diabetes

A

lower in CHO
high in fat
contain soluble fiber

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15
Q

polymeric formulas for pulmonary disease

A

low CHO
high in fat
may include extra antioxidants

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16
Q

polymeric formulas for immune disease are called ____________ formulas

A

immune modulating formulas

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17
Q

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

A

protein
22-25%
omega 3 fatty acids
arginine

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18
Q

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

Use with cation for _______

A

TBI
major surgery
severe trauma

severe sepsis

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19
Q

hydrolyzed formulas contain ____________ nutrients and __________

A

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

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20
Q

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

A

partially hydrolyzed
peptide-based
MCT

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21
Q

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

A

malabsorption
pancreatic insufficiency
crohn’s disease

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22
Q

elemental formulas are _________ with ________
they also have a __________

A

completely hydrolyzed (free amino acids)
minimal fat
higher osmolality

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23
Q

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

A

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

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24
Q

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

A

size & number

hydrolyzed
higher

300

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25
Q

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

A

Abdominal distention
Diarrhea

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26
Q

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

Used to _____________

A

modify pre-existing commercial formulas or food

27
Q

Factors to Consider when Selecting an EN Formula

A

GI function

Nutritional needs of the patient

Physical characteristics of the formula=> osmolality, viscosity

Cost of the formula

28
Q

Protein in Polymeric formulas

A

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

29
Q

protein in Semi-elemental

A

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

30
Q

Protein in Elemental formulas

A

Crystalline, L-amino acids

31
Q

protein amount in formulas vary from ____% of total kcal

A

7-25%

32
Q

considerations for protein type in formulas

A

food allergies
maldigestion/malabsorption
most are gluten free

33
Q

Carbohydrates amount in formulas varies from ______% of kcal

Sources:
______
______
______

A

28-90%

Maltodextrin, corn syrup solids
Modified corn starch
Most are lactose free

34
Q

types of fiber used in formulas

A

insoluble fiber
soluble fiber
fructo-oligosaccharides (FOS)

35
Q

insoluble fibers in formulas

A

soy fiber

36
Q

soluble fibers used in formulas

A

pectin
guar gum

37
Q

benefit of soluble fibers in formulas

A

Trophic affect on colon mucosa

may help to decrease diarrhea, delays gastric emptying

38
Q

Fructo-oligosaccharides (FOS) fiber in formulas ?

benefit?

A

Prebiotic fibers

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

39
Q

sources of fat in formulas

A

vegetable oils (e.g., canola, soybean, safflower oil)

Fish oil=> omega-3 fatty acids
MCT oil=> fat malabsorption

40
Q

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 _____

A

2-55%

elemental
pulmonary & diabetic

4%
linoleic acid
10%
lipid

41
Q

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 ______

A

volume

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

42
Q

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

A

1.0-1.2
85%

1.5
75%

2.0
70%

43
Q

Closed Feeding System are _________

A

sterile containers pre-filled with formula

44
Q

Closed Feeding System Advantages:
Minimize problems with ________
Reduces ________

A

contamination
time & labor

45
Q

Open feeding system are ___________

A

contents of formula cans are poured into a bag or container

46
Q

Methods of EN administration

A

Continuous feeding
cyclic feeding
bolus feeding
intermittent feeding

47
Q

continuous Feeding is administered at ______ rate over a ____hr period

provided using a ________

A

steady
24 hour period

infusion pump

48
Q

Continuous Feeding indications

A

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

49
Q

Advantages to continuous feedings

A

best tolerated administration

50
Q

cyclic feeding is _______ tube feeding over _____ hours through __________

A

continuous
8-20
infusion pump

51
Q

usually cyclic feeding are for _____

A

night

52
Q

indications for cyclic tube feeding

A

Patients at home requiring small bowel feeding

Transitioning to an oral diet but with a questionable appetite

53
Q

Cyclic Feeding Advantages

A

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

54
Q

Disadvantages of cyclic feeding

A

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

55
Q

Bolus feedings are ____ per day over a _______

Max of _____ per feeding
_____ feeding only
administered with _____

A

3-6
shorter period (5-10 min)

500 mL
gastric
syringe

56
Q

indications for bolus feeding

A

medically stable
home or rehabilitation patient
independent patients

57
Q

Advantages of bolus feeding

A

Ease of administration; decreased time

Patient can adjust feedings to their schedule

More physiologic

Less expensive

58
Q

Disadvantages of Bolus Feedings

A

higher risk of GI intolerance

higher risk of aspiration

cannot use with small bowel feeding

59
Q

Intermittent Feeding is infused at specific _______ throughout the day through _____ or ______

____ feedings per day
_______ mL over _____

____ feeding only

A

intervals
gravity drip
infusion pump

4-6 feedings
240-720 mL over 20-60 min

gastric

60
Q

Intermittent Feeding Indications

A

medically stable
home and rehabilitation setting

61
Q

Intermittent Feeding Advantages

A

more flexible schedule (compared to continuous)

less expensive than continuous or cyclic (if gravity drip)

more physiologic

may be better tolerated than bolus

62
Q

Intermittent Feeding Disadvantages

A

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

63
Q

Factors To Consider to Determine Administration Method

A

Enteral access route

Patient condition (critical vs. non-critical)

GI function; GI tolerance of tube feeding

Patient’s mobility and independence level

64
Q

Disadvantages of continuous

A

can be expensive
not normal eating

Advanced MNT 2 (17 decks)

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