Enteral Nutrition Part 2 Flashcards
types of enteral nutrition formulas
polymeric
hydrolyzed
semi-elemental
elemental
what are polymeric formulas
intact macronutrients
-proteins
-polysaccharides
-glucose polymers
-LCT
*nutritionally complete
polymeric formulas require ?
normal digestion and absorbtion
Standard polymeric formulas include…
_____ kcal/ml
around ____% CHO
_____% Fat
_____% Protein
1-1.2
50-60
30-35
15
polymeric formulas are supplemented with _______ AND ________
high nitrogen (15% protein)
fiber (15 g/L)
polymeric formulas are for patients with ______, ________, ______, and _______
infections
trauma
surgery
burns
concentrated polymeric formulas are…
______ kcal/ml
1.5-2.0
concentrated polymeric formulas are for patients who _________ or _________
require a fluid restriction
have higher kcal needs
polymeric blendarized formulas are made from __________
whole foods
possible advantages of blenderized polymeric formulas
consuming same food as family
health benefits from phytonutrients
contraindications of blenderized tube feeding
immunocomprimised patietns
tube <14 Fr
for blenderized tube feeding, RDN must provide education on _________ and guidance on ___________
safe food handling techniques
recipe/food components
polymeric formulas for renal disease
low fluid and electrolytes
variable protein
polymeric formulas for diabetes
lower in CHO
high in fat
contain soluble fiber
polymeric formulas for pulmonary disease
low CHO
high in fat
may include extra antioxidants
polymeric formulas for immune disease are called ____________ formulas
immune modulating formulas
immune-modulating formulas are high in _______ with ______% and fortified with immune enhancing nutrients such as _______ and _______
protein
22-25%
omega 3 fatty acids
arginine
may consider use of immune modulating formulas for patients with _____, _________, and _________
Use with cation for _______
TBI
major surgery
severe trauma
severe sepsis
hydrolyzed formulas contain ____________ nutrients and __________
partially or fully hydrolyzed (protein)
decreased amount or alternative fat sources
semi-elemental formulas are ____________ and __________ and usually contain _______
partially hydrolyzed
peptide-based
MCT
semi-elemental formulas are used for patients with __________ from _______ and ______
malabsorption
pancreatic insufficiency
crohn’s disease
elemental formulas are _________ with ________
they also have a __________
completely hydrolyzed (free amino acids)
minimal fat
higher osmolality
_________ 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
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
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
