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Advanced Medical Nutrition Therapy II > Enteral Nutrition Support (part 1) > Flashcards

Enteral Nutrition Support (part 1) Flashcards

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USMLE® Step 1 flashcards
1
Q

_____ ____ is the provision of nutrients into the GIT through a tube

A

Enteral nutrition

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2
Q

Indications for enteral nutrition:

A

-Poor appetite
-Dysphagia
-Oral or esophageal trauma or cancer
-Altered mental status; comatose state
-Mechanical intubation
-Malnutrition
-Hypermetabolic states (ex: severe burns, CF)
-Gastroparesis; total gastrecotmy

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3
Q

Relative contraindications for enteral nutrition (indications for parenteral):

A

-Malfunctioning small bowel
-Severe bowel inflammation
-Hemodynamically unstable
-Expected short-term duration
-Terminal illness

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4
Q

What causes a malfunctioning small bowel:

A

-Small bowel obstruction
-Small bowel ileus
-Severe GI hemorrhage
-Intractable vomiting or diarrhea
-Severe malabsorption
-Severe short bowel syndrome
-High output small bowel fistula (>500 mL/day)

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5
Q

Benefits of enteral nutrition (compared to parenteral nutrition):

A

-Maintains small bowel function (digestive and absorptive capacity, mucosal barrier function and integrity-> prevention of bacterial translocation)
-More effective metabolism and utilization of nutrients (1st pass metabolism)
-Provides luminal nutrients: glutamine, may provide fiber
-Avoid the complications of parenteral nutrition
-Lower cost that parenteral nutrition

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6
Q

What are the general characteristics of feeding tubes?

A

-Material: polyurethane or silicone
-Lumen
-Eyelets
-Ports (may contain additional ports for irrigation and medication administration)

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7
Q

The outer diameter of the tube lumen is designated by ____ units (1 Fr = 0.33 mm)

A

French

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8
Q

For _____ feeding, the smallest tube diameter possible should be used for patient comfort

A

Nasoenteric

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9
Q

We should not use fiber-containing formulas with tubes that are less than ____ French

A

8

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10
Q

A nasogastric tube should only be used for short term, less than ___-___ weeks

A

4-6

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11
Q

Nasogastric tubes require proper ____ functioning

A

Stomach

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12
Q

Nasogastric tubes are around ____-____ inches in length

A

40-43

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13
Q

Nasogastric tubes are typically ____-____ French

A

8-12

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14
Q

Nasogastric tubes are inserted at the bedside by _____ or _____

A

MD, RN

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15
Q

You must confirm the placement of an NG with an ____

A

X-ray

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16
Q

There are also NG ____/____ tubes

A

Suction/drainage

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17
Q

NG tubes take advantage of normal _____ and _____ processes in the stomach

A

Digestive and bactericidal

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18
Q

One advantage of NG tubes is that any ____ methods can be used

A

Administration

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19
Q

Another advantage of NG tubes is that it is easily placed and does not require ____ or a medical procedure

A

Surgery

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20
Q

NG tubes are also more ____ effective than other tubes

A

Cost

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21
Q

What are disadvantages/possible complications of an NG tube?

A

-Increased risk of misplacement on insertion
-Easily displaced
-Sinusitis and nasal erosion
-Increased risk of clogging
-Increased risk of GERD leading to aspiration
-Cosmetically unappealing

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22
Q

A nasoduodenual tube is also used for short-term use, less than ____-___ weeks

A

4-6

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23
Q

Indications of a nasoduodenal tube:

A

-Delayed gastric emptying
-Gastroparesis

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24
Q

You need to confirm the tip location of a nasoduodenal tube with an ____

A

X-ray

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25
Q

A complication with a nasoduodenal tube is…

A

The tip often coils or pulls up into the stomach

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26
Q

You cannot use ___ or ____ feeding with a nasoduodenal tube

A

Bolus, intermittent

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27
Q

Nasojejunal tubes are also used for short-term, less than ___-___ weeks

A

4-6

28
Q

Nasojejunal tubes are between ___-___ inches in length

A

55-60

29
Q

Nasojejunal tubes have a small bore size of ___-___ French

A

8-10

30
Q

Nasojejunal tubes are placed endoscopically or fluoroscopically to confirm the tip is past the ____ _____ _____

A

Ligament of Treitz

31
Q

“____” bedside placement of a nasojejunal tube is challenging

A

Blind

32
Q

Indications for the use of a nasojejunal tube:

A

-Delayed gastric emptying
-Persistent nausea
-Severe, acute pancreatitis
-High aspiration risk

33
Q

Advantages of nasojejunal tube feeling:

A

-May reduce risk of aspiration
-Can still feed into the small bowel while providing gastric suction

34
Q

Disadvantages of nasojejunal tube feeding:

A

-Difficult placement
-Tube displacement
-Sinusitis; nasal necrosis
-Cosmetically unappealing
-Prone to clogging due to small bore size
-Potential GI intolerance (the jejunum is sensitive to high volume or hyperosmolar feeding)

35
Q

You cannot use ____ or ____ feeding with a nasojejunal tube

A

Bolus or intermittent

36
Q

A tube _____ is when a tube is surgically or endoscopically placed into the GIT via the abdominal wall

A

Enterostomy

37
Q

Indications for the use of tube enterostomy:

A

-Long-term enteral nutrition: >4-6 weeks
-Dementia
-Neurological disease
-Chronic severe dysphagia
-Oral, esophageal, or gastric cancer

38
Q

A Percutaneous Endoscopic Gastrostomy (PEG) tube is used for ___-___ feeding and requires an endoscopic placement

A

Long term

39
Q

A PEG tube requires someone to have a proper functioning ____

A

Stomach

40
Q

Contraindications for a PEG tube:

A

-GI obstruction proximal to the stomach
-Obesity
-Ascites
-Gastric varices

41
Q

A PEG tube is between ___-___ French

A

15-28

42
Q

Advantages of a PEG tube:

A

-No surgery required
-More physiologic for digestion and absorption
-More comfortable and aesthetic
-Can use any administration method
-Decreased risk of clogging secondary to larger bore size
-May decrease risk of aspiration (compared to NG tube)

43
Q

Disadvantages/possible complications with a PEG tube:

A

-If dislodged, must be replaced within a few hours or the tract will close
-Site infection
-Potential for skin breakdown from leakage of gastric contents
-Migration of internal bumper through the gastric wall

44
Q

Migration of the internal bumper of a PEG tube through the gastric wall can cause possible leakage of gastric contents internally, causing _____

A

Peritonitis

45
Q

A gastrostomy tube (GT) use used for ___-___ feeding and must be surgically placed

A

Long-term

46
Q

In order for a G tube to be used, a patient needs to have a well-functioning ____

A

Stomach

47
Q

A G tube is indicated for…

A

-Patients requiring enteral nutrition who are either undergoing a surgical procedure or cannot undergo endoscopic placement

48
Q

G tubes are usually between ____-____ French

A

15-28

49
Q

Advantages of G tubes:

A

-More physiologic for digestion and absorption
-More comfortable and aesthetic
-Can use any administration method
-Decreased risk of clogging secondary to larger bore size
-May reduce risk of aspiration (compared to NG tube)

50
Q

Disadvantages/possible complications of G tubes:

A

-Requires surgery and general anesthesia
-Potential for skin breakdown from leakage of gastric contents
-Site infection
-Dislodgement of the tube; peritonitis
-Migration of internal bumper through the gastric wall

51
Q

A Jejunostomy Tube (JT) is for long-term use and is ____ placed

A

Surgically

52
Q

Indications of a J tube:

A

-Gastroparesis
-Total gastrectomy
-Chronic N/V
-Total esophagectomy

53
Q

What administration methods of feeding can be used with a J Tube?

A

-Pump-controlled continuous infusion
-Cyclic feeding

54
Q

J Tubes are between ___-___ French

A

10-20

55
Q

Advantage of a J Tube:

A

-Decreases aspiration risk

56
Q

Disadvantages of a J Tube:

A

-Dislodgement; difficult to replace
-Occlusion
-Wound infection; skin erosion
-Potential GI intolerance to goal rates/volumes (no bolus or intermittent feeding)
-Bowel obstruction

57
Q

A ____ ____ Jejunostomy is a very small bore tube, around 5-8 French

A

Needle Catheter

58
Q

Disadvantages of a needle catheter jejunostomy:

A

-Easily dislodged
-Clogs easily (fiber-containing formulas are not recommended)

59
Q

A Gastrojeunostomy (GJ Tube) is a ____-____ tube

A

Multi-lumen

60
Q

With a GJ Tube, one lumen is for ____ ___, while the second lumen feeds into the jejunum

A

Gastric suction

61
Q

A GJ Tube can be used if someone has long-term ____ with severe nausea

A

Gastroparesis

62
Q

GJ Tubes are placed with ____ or ____ placement

A

Surgical or endoscopic

63
Q

With a GJ tube, the G tube is ___-___ French while the J Tube is ___-___ French

A

15-28; 6-12

64
Q

Advantages of GJ Tubes:

A

-Simultaneous gastric decomposition/drainage and feeding into small bowel
-Reduced aspiration risk

65
Q

Disadvantages of GJ tubes:

A

-Risk of bleeding and infection of the abdominal wall
-Migration of internal bumper through the gastric wall
-Dislodgement
-Cannot use bolus or intermittent feeding

66
Q

Factors used to determine the optimal enteral access route:

A

-Anticipated duration of enteral feeding
-Condition/function of the stomach
-Risk of aspiration
-Planned surgical intervention

Advanced Medical Nutrition Therapy II (19 decks)

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