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Advanced MNT 2 > Enteral Nutrition Part 3 > Flashcards

Enteral Nutrition Part 3 Flashcards

1
Q

Complications of Enteral Nutrition

A

Mechanical
GI
Metabolic
Administration

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2
Q

Mechanical complications of EN

A

nasopharyngeal irritation
skin irritation
tube displacement
tube obstruction

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3
Q

GI Complications of EN

A

N/V/D/C
abdominal bloating
delayed gastric emptying

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4
Q

Metabolic Complications of EN

A

fluid imbalances
underfeeding
overfeeding
refeeding syndrome
EFAD
electrolyte imbalances

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5
Q

Administration Complications of EN

A

microbial contamination
aspiration pneumonia

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6
Q

TUBE OBSTRUCTION can be caused by…
inadequate _____ of feeding tube
______ interactions
adding _______ products

_____________ in formula due to adding _______
________ formula due to __________
homemade blenderized TF that isn’t ______

A

irrigation
medication
modular

precipitation of caseinates
acidic substances (ex: fruit juice)

undissolved
insufficient mixing
liquified

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7
Q

TUBE OBSTRUCTION prevention

A

follow appropriate procedure to mix and administer the tube feeding and modular products

flush feeding tube with a minimum of 30 ml water every 4 hours for continuous or cyclic
- also before and after each bolus or feeding

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8
Q

To unclog a tube, _____________

If tube remains clogged, instill _____________

A

instill warm water with a 30-60 ml syringe into tube and let sit for ~20 minutes

uncoated pancreatic enzyme solution mixed with a small amount of water

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9
Q

Factors that increase risk of ASPIRATION

Body position _____________
________ feeding tube
______ (condition)
______ diameter nasoenteric tubes
___________ disorders
Decreased _________
_______
______ feedings

A

(supine) Trendelenburg position
Displaced
GERD
Large
Neuromuscular
consciousness/sedation
Vomiting
Bolus

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10
Q

Prevention of ASPIRATION

Good _____
Elevate HOB to >_____ degrees

___________ of nasoenteric tube position after placement
Mark nasoenteric tube, monitor placement, verify placement ___________

Monitor for signs of ________ q ____
___________ feeding
Position FT distal to the __________

A

oral care
30-45

X-ray confirmation
before each feeding

GI intolerance, 4 hrs
Continuous
ligament of Treitz

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11
Q

Causes of diarrhea unrelated to TF

A

medications
enteric pathogens
GI disorders

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12
Q

enteric pathogens that can cause diarrhea

A

Clostridium difficile (C.diff)

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13
Q

Medications that can cause diarrhea

A

antibiotics
meds containing sorbitol
prokinetic agents (reglan)
antineoplastic
Potassium supplement

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14
Q

Causes of Diarrhea Related to TF

A

Bolus feeding into small bowel

rapid infusion of hyperosmolar formula into small bowel

intolerance to a specific component in formula

microbial contamination of feeding solution

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15
Q

Nutritional Management of DIARRHEA

Most important thing is to _________
provide adequate __________
change to ______ formula
change to a formula containing ________
_______ administration

if fat malabsorption, use ________ formula with _____

A

Determine cause
fluid & electrolytes
isotonic
soluble fiber
continuous

semi-elemental
MCT Oil

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16
Q

For flushing can u use tap

A

yes unless ICU, immunocompromised, or unsafe water

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17
Q

how do you know there is a clog in tube

A

alarm on pump or resistance when feeding

18
Q

To reduce the risk of MICROBIAL CONTAMINATION…
use ______, ______ formulas
______ before handling products
check _________

fridge unused portion of formula immediately, cover, label, date, and discard after ____

change feeding bag and administration set every ________
avoid unnecessary ______ to tube feeding

A

prefilled closed
Wash hands
expiration date

24 hours

24 hours
additions

19
Q

Reducing the Risk of Microbial Contamination – Limit Hang-time to no more than:
____ hours for closed system
____ hours for open system/canned formulas
____ hours if modular components are added
____ hours for reconstituted formulas
____ hours for blenderized whole food formulas

A

24
4-8
4
4
2

20
Q

Symptoms of delayed gastric emptying

A

gastric distention
discomfort
N/V

21
Q

Consequences of delayed gastric emptying

A

increased risk of GERD and aspiration

22
Q

Causes of Delayed Gastric Emptying

Gastric ileus
Medications (_____)
Supine position
_______ gastroparesis
_______ obstruction
_______ surgery
Increased __________
________; _____

EN formula with high ____ content
EN formula with a high __________ content

A

opioids
Diabetic
Pyloric
Whipple
intracranial pressure
Hypotension; sepsis

fat
soluble fiber

23
Q

most commonly reported side effect of tube feeding

A

diarrhea (however mostly from something else)

24
Q

Prevention and management of Diarrhea

Elevate HOB during feeding and for ____ after feeding

Monitor _________
________ TF administration
Switch to a ______, _____ EN formula
_________ if possible
Tube tip placed past ___________

A

30 min

abdominal girth
Continuous
lower fat, low-fiber
Ambulation
ligament of Treitz

25
Q

Monitoring Gastric Residual Volumes (GRV)

Nurse checks GRV q _____ for the first _____
practice of using GRV as a monitor of TF tolerance has been _______

Monitor for a trend of _________

A

4 hours
48 hours
questioned

increasing residual volumes

26
Q

ASPEN GUIDELINES FOR GRV:
If GRV > _____ ml after ____ residual check=> _________ should be considered=> ___________

If GRV > ______ ml=> ______, reassess patient status

If consistently >_____ ml=> consider _______

A

250
2nd
promotility agent
metoclopramide (Reglan)

500
hold TF

500
FT placement below the ligament of Treitz

27
Q

Constellation of metabolic alterations that occur within the 1st few days of refeeding a starved patient

A

refeeding syndrome

28
Q

refeeding syndrome includes a rapid shift of _______ from _____ to ______ due to ______

leads to _____, ______, _____

A

electrolytes
bloodstream
cells
insulin

hypophosphatemia*
hypomagnesemia
hypokalemia

29
Q

refeeding syndrome can cause

A

respiratory distress
paresthesia
lethargy
edema
muscle weakness
cardiac arrhythmias
hemolysis

30
Q

TO IDENTIFY PPL AT RISK OF REFEEDING SYNDROME…

SIGNIFICANT RISK IF ONE OF THESE:
- BMI ____
- weight loss ________ or _________
- caloric intake of _________, ______, or ________
- low levels of ____, ____, or ____

A

<16

7.5% in 3 months
>10% in 6 months

None for >7 days
<50% of estimated energy requirement (EER) for > 5 days during acute illness/injury
<50% or EER for >1 month

K+, Phos, or Mg

31
Q

TO IDENTIFY PPL AT RISK OF REFEEDING SYNDROME…

MODERATE RISK IF TWO OF THESE:
- BMI ______ kg/m2
- Weight loss: ___________
- caloric intake of _______, ______, or ______
- Low levels of ____, _____, or ____ before feeding

A

16-18.5

5% in 1 month

None or negligible for 5-6 days
<75% of EER for >7 days during acute illness/injury OR
<75% of EER for >1 month

K+, Phos, or Mg

32
Q

Refeeding Syndrome—Prevention & Treatment

First step is to _________

A

identify patients at risk

33
Q

How to prevent Refeeding syndrome with EN

  • EN can be initiated at a low rate on Day 1 (~___% of estimated goal) and advanced cautiously over ___ days toward the goal
  • Supplement with ________ before initiating TF
  • Continue for _____ days or longer in patients with severe _____, chronic _______, or if at high risk or signs of ______ deficiency
  • Monitor _______ daily for the 1st _____ days of refeeding and replete as needed
A

25
3–5

100 mg thiamin
5–7
starvation
alcoholism
thiamin

electrolytes
5-7

34
Q

Consider food-drug interactions with EN
- Some meds increase risk of ______

Other big drug with food drug interaction with tube feeds is ______

A

clogging

Phenytoin (Dilantin)

35
Q

some meds that increase risk of clogging

A

cholestyramine
ciprofloxacin suspension
metoclopramide syrup
ferrous sulfate elixer

36
Q

Phenytoin (Dilantin) is ________ medication
FDI is ________

MNT=>___________

A

Anticonvulsant
TF decreases bioavailability of drug

Hold TF for 1-2 hrs before & after giving drug

37
Q

CONTINUOUS TUBE FEEDING

  • Initiation rate _____ ml/hr
  • Progression=> Increase feeding rate by ____ ml every ____ hrs until goal volume is reached
  • Maximum rate ___ ml/hr

For ________ formulas administered directly to the small bowel or at risk for refeeding syndrome=> initiate at a low rate & increase rate more slowly

A

20-50

10-20
8-12

150

hyperosmolar

38
Q

BOLUS & INTERMITTENT TF ADMINISTRATION

Begin with _____ ml of formula per feeding
Increase by ____ ml per feeding per day as tolerated until goal volume reached

A

120
120

39
Q

MONITORING TUBE FEEDS
- Overall tube feeding ______
- GI status=> symptoms; ____ output; abdominal distention; ____ (_____ feeding only)

  • Presence of complications
  • Weight=> at least _____
  • Nutrient intake=> actual volume of TF received; determine adequacy
A

tolerance
stool
GRVs
gastric

3x/week

40
Q

MONITORING TUBE FEEDS
- NFPE
- Hydration status: Daily fluid I & O’s; Na, ____, ____; physical assessment

  • Serum ____, _____, _____ - daily until stable then _______ a week
  • Serum ______ – daily until stable then _____
  • Clinical status
A

BUN
Osm

electrolytes, BUN, creatinine
2-3x/wk

glucose
weekly

41
Q
A

Advanced MNT 2 (17 decks)

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