Enteral Nutrition Safety

Question 1

the agency that regulates medical foods

Answer 1

the Food and Drug Administration (FDA)

Question 2

when should blue dye/blue food coloring be used in enteral tubes

Answer 2

NEVER

Question 3

what is not a nursing responsibility for monitoring jejunal tube feeding

Answer 3

measurement of residuals

Question 4

how can clogging of a feeding tube be prevented when checking residuals

Answer 4

flush the tube with 20-30 mL of water before checking a GRV to prevent clogging

Question 5

which patients are at risk for formula related contamination

Answer 5

neonates, critically ill, immunosuppressed, compromised gastric acid microbial barrier

Question 6

what are the 3 chances of contamination in EN formulas

Answer 6

storage
preparation
administration

Question 7

which type of Enteral Feeding has the lowest chances of contamination

Answer 7

sterile/closed system feedings

Question 8

which type of EN formula has the highest risk of contamination

Answer 8

mixing, dilution, reconstitution (powder)

Question 9

hang time for open systems

Answer 9

4-12 hours

Question 10

hang time for reconstituted formulas

Answer 10

4 hours, room temperature

Question 11

powdered enteral formulas are ____ sterilized

Answer 11

NOT

Question 12

___ water should be used to reconstitute powdered formula

Answer 12

sterile

Question 13

closed enteral systems can hang for ____ hours

Answer 13

24-48 hours

Question 14

formulas should be used ____ after opening which reconstitution with ____ water

Answer 14

immediately, sterile

Question 15

what should be referenced for recommended room temperature and hang time of specific formulas

Answer 15

manufacturer recommendations

Question 16

should a blender be used to mix powders

Answer 16

no, high risk of contamination

Question 17

clean the lids of enteral feeding products with ____ and dry

Answer 17

isopropyl alcohol

Question 18

how often should feeding bags be changed

Answer 18

every 24 hours

Question 19

when material from the lungs, stomach, and throat back up into the feeding tube, where they can proliferate and be re-infused in greater numbers is considered _____ contamination

Answer 19

retrograde

Question 20

most gravity drips have a ____ that decreases the risk of retrograde contamination

Answer 20

drip chamber

Question 21

checking ____ can also lead to contamination of enteral feeding by pulling back gastric contents and infecting the tube feed hub

Answer 21

gastric residuals

Question 22

what is one example of prevention policy for enteral feeding to reduce chance of contamination

Answer 22

enteral quality control programs/institutional protocols

Question 23

what is another example of prevention of EN contamination

Answer 23

define the process for receiving, distributing, storing, preparing, handling and administering EN

Question 24

To ensure safety during EN feedings, visually inspect each TF bottle for ___ and ___

Answer 24

damage

expiration date

Question 25

use proper _____ before feeding administration, and formula handling

Answer 25

hand washing/clean gloves

Question 26

flip top enteral feeding cans should be wiped with _______

Answer 26

isopropyl alcohol

Question 27

visually inspect EN formulas for

Answer 27

separation, thickening, clumping or curdling

Question 28

inhalation of material into the airway is known as

Answer 28

aspiration

Question 29

aspiration PNA can be caused when _____are in the wrong place or inhaled ____ contents

Answer 29

feeding tubes , gastric contents

Question 30

asymptomatic aspiration of saliva is called

Answer 30

silent aspiration

Question 31

dyspnea, wheezing, frothy/purulent sputum, cyanosis, anxiety, fever, tachycardia, rhonchi/rales, leukocytosis, leukopenia or a new / progressing infiltrate are symptoms of

Answer 31

aspiration pneumonia

Question 32

when aspiration occurs from a ventilator it is known as

Answer 32

ventilator associated PNA

Question 33

_____ is one of the most feared complications of EN and can lead to acute pulmonary pathology

Answer 33

aspiration PNA

Question 34

patients with dysphagia may aspirate saliva regardless of enteral feedings, true or false

Answer 34

true

Question 35

what are the steps to reduce aspiration risk during enteral feeding

Answer 35

1. elevated HOB 30-45 degrees 2. sit patient upright or reverse Trendelenburg position 3. good oral care BID with chlorhexidine 4. continuous tube feeding, 5. minimal sedation, suction prior to lying down,

Question 36

to decrease risk of aspiration check GRV's every ___ hours if they are part of your hospital protocol. Start _____ in setting of elevated GRV's in the critically ill and use ___ trees for actions depending on the GRV

Answer 36

4 hours pro-kinetic decision

Question 37

per ASPEN, GRV's should ____ be used routinely to monitor ICU patients with enteral nutrition

Answer 37

NOT

Question 38

if your ICU still uses GRVs, avoid holding EN for GRVs < ____mL in the absence of other signs of feeding intolerance

Answer 38

500mL

Question 39

what methods should be used to check TF placement to decrease the risk of aspiration PNA and tube feeding

Answer 39

1. check visible tube length | 2. routinely check CXR especially if migration is suspected

Question 40

to avoid hypertonic dehydration in EN what should be monitored

Answer 40

``` daily fluid I/O daily body weight serum electrolytes urine specific gravity BUN/Cr raio enteral/IV fluid provision ```

Question 41

excessive fluid intake, rapid feeding, catabolism of LBM tissue with potassium loss, cardiac insufficiencyy/renal/hepatic insufficiency/refeeding syndrome are all causes of

Answer 41

overhydration

Question 42

if a patient is experiencing overhydration during enteral feeding , what can be done/monitored

Answer 42

I/O body weight/fluid status check aldosterone (increases Na retention) diuretic therapy

Question 43

refeeding syndrome, catabolic stress, high ADH/aldosterone, diuretics, diarrhea/NGT loss, metabolic alkalosis, insulin and dilution can all cause _____

Answer 43

hypokalemia

Question 44

if hypercapnia from overfeeding is suspected during enteral feeding what can be done

Answer 44

1. lower phosphorous 2. measure EEN with IC provide balance of CHO, fat and protein

Question 45

if a patient on EN develops low levels of serum zinc what can be done

Answer 45

supplement zinc in EN

Question 46

per ASPEN when EN is being provided in a patient suspected to be at risk for refeeding syndrome provide ____% of energy goal on Day 1 with attention to energy contribution from ____then cautiously advance toward energy goal within ____ to ___ days pending clinical status/electrolyte levels.

Answer 46

25% on day 1 dextrose from IV 3-5 days

Question 47

hyperglycemia is more common in EN Or PN

Answer 47

PN

Question 48

when a patient on Enteral Nutrition experiences hyperglycemia what can be done

Answer 48

1. use EN formula high in fat/fiber 2. manage with insulin 3. advance TF slowly toward goal

Question 49

a BUN/Cr ration over > can indicate dehydration

Answer 49

20:1

Question 50

a patient with renal failure/malnutrition with a BUN of 100 and Cr of 1 with a ratio of 100:1 may still be _____

Answer 50

adequately hydrated

Question 51

typical urine output range

Answer 51

0.5-2 mL/kg/hour

Question 52

1 liter of fluid = ___ kg of weight

Answer 52

1