Enteral Nutrition Support (part 2) Flashcards
_____ formulas contain intact macronutrients
Polymeric
Polymeric formulas consist of…
-Proteins
-Polysaccharides
-Glucose polymers
-LCT
Polymeric formulas require normal _____ and _____
Digestion and absorption
Polymeric formulas are nutritionally _____
Complete
What are some examples of polymeric formulas?
-Standard
-High nitrogen
-Fiber supplemented
-Concentrated
Calorie content of a standard polymeric formula:
1-1.2 kcal/mL
Macronutrient breakdown for a standard polymeric formula?
-50-60% carbohydrates
-30-35% fat
-15% protein
A high-nitrogen polymeric formula has over ___% of total kcal from protein
15%
When would a high nitrogen formula be used?
-Infections
-Trauma
-Surgery
-Burns
Fiber-supplemented formulas contain around ____ g/L of fiber
15
Concentrated polymeric formulas contain ___-___ kcal/mL
1.5-2.0
Concentrated formulas are given to patients who…
-Require a fluid restriction
-Have higher kcal needs
Polymeric formulas can also be ____ (homemade or commercial)
Blenderized
Blenderized formulas are made from ____ foods and are increasing in popularity by patients and families
Whole
Possible advantages of blenderized formulas:
-Consuming the same food as family
-Health benefits from phytonutrients
Contraindications to using blenderized food tube feeding:
-Immunocompromised patients
-Tube <14 French
If using blenderized diet, the RDN must provide education on safe ____-___ techniques and guidance on recipe/food components
Food-handling
What would be included in a renal-disease specific polymeric formula?
-Low fluid and electrolytes
-Variable protein
What would be included in a diabetes-specific polymeric formula?
-Lower carbohydrates and higher fat
-Contain soluble fiber
What would be included in a pulmonary-specific polymeric formula?
-Low carbohydrate, high fat
-May include extra antioxidants
What is included in immune-modulating formulas?
-High protein (25% of total kcal)
-Fortified with immune-enhancing nutrients-> omega-3 fatty acids and arginine
We may consider the use of immune-modulating formulas for patients with…
-TBI
-Major surgery
-Severe trauma
-Use caution in patients with severe sepsis
_____ formulas contain partially or fully hydrolyzed nutrients (protein) and decreased amount or alternative fat sources
Hydrolyzed
Semi-elemental formulas are partially hydrolyzed and ____-based
Peptide
Semi-elemental formulas also usually contain ______
MCT
Semi-elemental formulas are used for patients with ______
Malabsorption
Examples of conditions where partially-hydrolyzed formulas might be used:
-Pancreatic insufficiency
-Crohn’s Disease
_____ formulas are completely hydrolyzed to free amino acids
Elemental
Elemental formulas have minimal ____
Fat
Elemental formulas have higher ____ than regular formulas
Osmolality
Using an elemental for long-term use puts someone at risk for ____ ____ ____ deficiency
Essential fatty acid
For those a risk of essential fatty acid deficiency, provide ____ mL of safflower oil per day via the enteral route
5
____ is affected by size and number of nutrient particles in a solution (protein, carbohydrates, and electrolytes)
Osmolality
Standard polymeric formulas are about _____ mOsm/kg H2O
300
The more nutrient-dense or the more hydrolyzed nutrients in a formula, the _____ the osmolality
Higher
If administered directly into the small intestine, hyperosmolar formulas can cause:
-Abdominal distention
-Diarrhea
Modular products are composed of individual modules such as…
-Protein
-Arginine
-Glutamine
-Fiber
-Fat
Modular products are used to modify pre-existing ____ formulas or foods
Commercial
Factors to consider when selecting enteral nutrition formulas:
-Functional status of the GIT
-Nutritional needs of the patient
-Physical characteristics of the formula: osmolality, viscosity
-Cost of the formula
What types of protein are used in polymeric formulas?
-Intact proteins (caseinates, whey protein concentrates, soy protein isolate)
What types of proteins are used in semi-elemental formulas?
-Hydrolyzed casein or whey (oligopeptides, dipeptides, tripeptides)
What type of protein is used in elemental formulas?
-Crystalline
-L-amino acids
The amount of protein in formula varies from ___-___% of total kcal
7-25
What are things to consider with protein in formulas?
-Food allergies
-Maldigestion/malabsorption
-Most are gluten-free
The amount of carbohydrates in formula varies between ____-____% of kcal
28-90
What are sources of starch that are used in formula?
-Maltodextrin, corn syrup solids
-Hydrolyzed cornstarch
Most formulas are _____ free
Lactose
In formulas that contain insoluble fiber, _____ fiber is usually used
Soy
What types of soluble fiber are included in formulas with fiber?
-Pectin
-Guar gum
Soluble fiber has a trophic affect on colon mucosa and may help to decrease ____ and delay gastric emptying
Diarrhea
____-____ are prebiotic fibers that are fermented to small-chain fatty acids and play a role in maintaining colonic mucosal integrity
Fructo-oligosaccharides
What are sources of fat used in formula?
-Vegetable oils (canola or soy oil)
-Fish oil (omega-3 fatty acids)
-MCT oil (fat malabsorption)
The amount of fat in formula varies from ___-___% of kcal
2-55
Lower fat formulas are ____ formulas
Elemental
Higher fat formulas are ____ and ____ specific formulas
Pulmonary and diabetic
To prevent essential fatty acid deficiency, we must provide at least…
-4% of total kcal needs from linoleic acid OR
-10% of total kcal needs from lipid
Most enteral nutrition formulas meet the ____ for micronutrients for the healthy population
DRIs
Micronutrient adjustments may be necessary with conditions like…
-Wound healing
-Increased losses
-Electrolytes often need to be restricted in renal failure
Free ____ amounts vary with the formula type
Water
1.0-1.2 kcal/mL formula contains about ____% free water
85
1.5 kcal/mL formula contains about ____% free water
75
2.0 kcal/mL formula provides about _____% free water
70
A closed feeding system is composed of ____ containers that are pre-filled with formula
Sterile
Advantages of closed feeding systems:
-Minimize problems with contamination
-Reduced time and labor
____ feeding systems require the contents of formula cans to be poured into a bag or container
Open
With ____ feeding, the formula is administered at a constant steady rate over a 24 hour period
Continuous
Indications of continuous feeding:
-Initiating tube feeding
-Critical illness
-Small bowel feedings
-At risk for refeeding syndrome
-Intolerance to bolus or intermittent feedings
Continuous feeding is provided using an ____ ____
Infusion pump
Advantage of continuous feeding:
-Best tolerated administration method
Disadvantages of continuous feeding:
-Continuously being connected to a pump
-Not physiological
-High cost for people at home
____ feeding is continuous tube feeding over 8-20 hours via infusion pump
Cyclic
Cyclic feeding is usually _____ tube feedings and then off during the day
Nocturnal
Indications of cyclic feeding:
-Patient at home requiring small bowel feeding
-Transitioning to an oral diet but with a questionable appetite
Advantage of cyclic feeding:
-Physical and physiological freedom from equipment for a period of each day per day
Disadvantages of cyclic feeding:
-Requires higher infusion rate over a shorter period of time-> possible GI intolerance due to higher rate
-Need calorie and protein-dense formulas (more expensive)
-Requires pump
____ feeding is administered with a syringe
Bolus
Bolus feeding requires ____-____ feedings per day over a short period of time (5-10 minutes)
3-6
The max amount per feeding should be ____ mL per feeding
500
Indications of bolus feedings:
-Medically stable
-Home or rehabilitation patient
-Independent patients
Bolus feeding can be given if someone gets _____ feeding
Gastric
Advantages of bolus feeding:
-Ease of administration; decreased time
-Patients can adjust feedings to their schedule
-More physiologic
-Less expensive
Disadvantages of bolus feeding:
-Higher risk of GI intolerance
-Higher risk of aspiration
-Cannot use with small bowel feeding
______ feeding is infused at specific intervals throughout the day by gravity drip or infusion pump
Intermittent
Someone on intermittent feeding should get ___-___ feedings throughout the day
4-6
Intermittent feeding is usually ____-____ mL administered over 20-60 minutes
240-720
Indications for intermittent feeding:
-Medically stable
-Home and rehabilitation settings
-Gastric feeding only
Advantages of intermittent tube feeding:
-More flexible schedule (compared to continuous)
-Less expensive than continuous or cyclic (if gravity drip)
-More physiologic
-May be better tolerated than bolus
Disadvantages of intermittent tube feeding:
-Increased risk of GI distress and discomfort (compared to continuous)
-Increased risk of aspiration (compared to continuous)
-If gravity drip, cannot use a fiber-containing formula
Factors to consider to determine administration method of tube feeding:
-Enteral access route
-Patient condition
-GI function; GI tolerance of tube feeding
-Patient’s mobility and independence level
