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Advanced Medical Nutrition Therapy II > Enteral Nutrition Support (part 3) > Flashcards

Enteral Nutrition Support (part 3) Flashcards

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USMLE® Step 1 flashcards
1
Q

What are some mechanical complications of enteral nutrition?

A

-Nasopharyngeal irritation
-Skin irritation
-Tube displacement
-Tube obstruction

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2
Q

What are some GI complications of enteral nutrition?

A

-N/V/D/C
-Abdominal bloating
Delayed gastric emptying

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3
Q

What are some metabolic complications of enteral nutrition?

A

-Electrolyte imbalances
-Fluid imbalances
-Overfeeding/underfeeding
-Refeeding syndrome
-Essential fatty acid deficiency

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4
Q

What complications can occur with administration of tube feeding?

A

-Microbial contamination
-Aspiration pneumonia

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5
Q

Tube obstruction can be caused by…

A

-Inadequate irrigation of feeding tube
-Medication interactions
-Undissolved formula due to insufficient mixing
-Adding modular products
-Precipitation of caseinates in formula due to adding acidic substances (e.g., fruit juice) to the tube feeding
-Homemade blenderized TF that isn’t thoroughly liquified

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6
Q

What can be done to prevent tube obstruction?

A

-Follow appropriate procedure to mix and administer tube feeding formulas and modular products
-Flush with a minimum of 30 mL water every 4 hours for continuous or cyclic feeding and before and after each bolus or intermittent feeding

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7
Q

To unclog a tube, instill ___ ___ with a 30-60 mL syringe into a tube and let sit for about 20 minutes

A

Warm water

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8
Q

If the tube remains clogged, instill ____ ____ ____ solution mixed with a small amount of water

A

Uncoated pancreatic enzyme

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9
Q

What are factors that increase the risk of aspiration?

A

-Body position (supine, Trendelenberg position)
-Displaced feeding tube
-GERD
-Large-diameter nasoenteric tubes
-Neuromuscular disorders
-Decreased consciousness/sedation
-Vomiting
-Bolus feeding

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10
Q

What can be done to prevent aspiration?

A

-Good oral care
-Elevate HOB to >30-45 degrees
-X-ray confirmation of nasoenteric tube position after placement
-Mark nasoenteric tube, monitor placement, and verify placement before each feeding
-Monitor for signs of GI intolerance every 4 hours
-Continuous feeding
-Position feeding tube distal to the ligament of Treitz (jejunum)

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11
Q

Enteral ___ ___ was previously used to monitor for aspiration (FD&C blue #1, Methylene blue), but is no longer recommended

A

Food dye

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12
Q

Why is enteral food dye not recommended?

A

-Not a sensitive indicator of early aspiration
-In critically I’ll patients, dye has been absorbed, leading to mitochondrial toxicity and death

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13
Q

What are causes of diarrhea that are unrelated to tube feeding?

A

-Medications
-Enteric pathogens (C. diff)
-GI disorders

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14
Q

What medications may lead to diarrhea?

A

-Antibiotics
-Medications containing sorbitol
-Prokinetic agents
-Antineoplastic agents

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15
Q

What are some causes of diarrhea related to tube feeding?

A

-Bolus feeding into the small bowel
-Rapid infusion of hyperosmolar formula into the small bowel
-Intolerance to a specific component of the formula
-Microbial contamination of feeding

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16
Q

Nutritional management of diarrhea:

A

-Determine cause of diarrhea
-Provide adequate fluid and electrolytes
-Change to an isotonic formula
-Change to a formula containing soluble fiber
-Continuous administration
-If fat malabsorption, use a semi-elemental formula containing MCT oil

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17
Q

What are ways to reduce the risk of microbial contamination?

A

-Used pre-filled, closed system formulas
-Wash hands before handling products
-Check expiration date
-Refrigerate unused portion of formula immediately (cover, label, date) and discard after 24 hours
-Change feeding bag and administration set every 24 hours
-Avoid unnecessary additions to tube feeding
-Limit hang time

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18
Q

Guidelines for hang-time of tube feeding:

A

Limit hang time to no more than
-24 hours for closed system
-4-8 hours for open system/canned formulas (4 hours if modular components are added)
-4 hours for reconstituted formulas
-2 hours for blenderized whole food formulas (homemade)

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19
Q

Symptoms of delayed gastric emptying:

A

-Gastric distention and discomfort
-N/V

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20
Q

Consequences of delayed gastric emptying:

A

-Increased risk of GERD and aspiration

21
Q

Delayed gastric emptying can be caused by…

A

-Gastric ileus
-Medications (opioids)
-Supine position
-Pyloric obstruction
-Diabetic gastroparesis
-Whipple surgery
-Increased intracranial pressure
-Hypotension; sepsis
-EN formula with high fat content
-EN formula with high soluble fiber content

22
Q

Ways to prevent/manage delayed gastric emptying:

A

-Elevate HOB during feeding and for 30 minutes after feeding
-Monitor abdominal girth
-Continuous TF administration
-Switch to a low-fat, low-fiber EN formula
-Ambulation if possible
-Tube tip placed past the ligament of Treitz

23
Q

The nurse should check ____ ____ ____ every 4 hours for the 1st 48 hours a patient is on tube feeding

A

Gastric residual volume

24
Q

The practice of using gastric residual volume as a monitor of tube feed _____ has been questioned

A

Tolerance

25
Q

We should monitor for a ____ of increasing residual volume

A

Trend

26
Q

If gastric residual volume is _____ or more mL after the second residual check, a promotility agent should be considered

A

250

27
Q

An example of a promotility agent is ____

A

Metoclopramide (Reglan)

28
Q

If gastric residual volume is over ____ mL, hold tube feed and reassess patient status

A

500

29
Q

If a patient’s gastric residual volume is consistently over 500 mL, consider feeding tube placement below the ___ ___ ___

A

Ligament of Treitz

30
Q

____ ____ is a constellation of metabolic alterations that occur within the first few days of refeeding a starved patient

A

Refeeding syndrome

31
Q

Refeeding syndrome is due to a rapid shift of electrolytes from the bloodstream to cells due to insulin, leading to…

A

-Hypophosphatemia
-Hypomagnesemia
-Hypokalemia

32
Q

Refeeding Syndrome can cause symptoms like…

A

-Respiratory distress
-Parethesia
-Lethargy
-Edema
-Muscle weakness
-Cardiac arrhythmias
-Hemolysis

33
Q

Refeeding syndrome can be ____-____

A

Life-threatening

34
Q

Someone is at significant risk of refeeding syndrome if they have any 1 of the following risk factors:

A

-BMI <16 kg/m2
-Weight loss 7.5% in 3 months or >10% in 6 months
-Caloric intake (none for >7 days, or 50% of EER for >5 days, or <50% of EER for >1 month)
-Low levels of potassium, phosphorus, or magnesium before feeding

35
Q

Someone is at a moderate risk of refeeding syndrome if they have any 2 of the following risk factors:

A

-BMI 16-18.5 kg/m2
-Weight loss of 5% in 1 month
-Caloric intake (none for 5-6 days, or <75% of EER for >7 days or <75% of EER for >1 month)
-Low levels of potassium, phosphorus, or magnesium before feeding

36
Q

For those at risk of refeeding syndrome, enteral nutrition can be initiated at a low rate on day 1 (____% of estimated calorie goal) can advanced cautiously over 3-5 days towards the goal

A

25

37
Q

Someone at risk of refeeding syndrome should be supplemented with ___ mg of thiamin before initiating tube feeding

A

100

38
Q

100 mg of thiamin should be continued for 5-7 days longer in patients with…

A

-Severe starvation
-Chronic alcoholism
-High risk or signs of thiamin deficiency

39
Q

For those at risk of refeeding syndrome, we should monitor ____ daily for the first 5-7 days of refeeding and replete as needed

A

Electrolytes

40
Q

What medications increase the risk of clogging?

A

-Cholestyramine
-Ciprofloxacin suspension
-Metoclopramide syrup
-Ferrous sulfate elixer

41
Q

Tube feeding decreases the _____ of Dilantin (phenytoin)

A

Bioavailability

42
Q

MNT for Dilantin:

A

-Hold tube feed for 1-2 hours before and after giving the drug

43
Q

Continuous tube feeding should be initiated at a rate of ____-____ mL/hour

A

20-50

44
Q

We can increase the feeding rate by ___-___ mL every 8-12 hours until goal volume is reached

A

10-20

45
Q

The max rate for continuous tube feeding is ____ mL/hour

A

125

46
Q

For hyperosmolar formulas administered directly to the small bowel, initiate at a ___ __ and increase rate more slowly

A

Low rate

47
Q

For bolus and intermittent tube feeding administration, begin with ____ mL of formula every 4 hours

A

120

48
Q

For bolus and intermittent tube feeding, we can increase the volume by ___-___ mL every 8-12 hours as tolerated until goal volume is reaches

A

60-120

49
Q

What should we monitor for a patient on tube feeding?

A

-Overall tube feeding tolerance (GI status: symptoms, stool output, abdominal distension, gastric residual volume for gastric feeding)
-Presence of complications
-Weight: at least 3x/week
-Nutrient intake: actual volume of TF received, determine adequacy
-NFPE
-Hydration status: daily fluid I and Os, Na, BUN, Osmolality, physical assessment
-Serum electrolytes, BUN, creatinine: daily until stable, and then 2-3x/week
-Clinical status

Advanced Medical Nutrition Therapy II (19 decks)

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