Enteral/parenteral feeding Flashcards
Refeeding syndrome
defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal and metabolic changes
What is the hallmark biochemical feature of refeeding syndrome?
hypophosphataemia
What happens during refeeding?
increased secretion of insulin and decreased secretion of glucagon
insulin needs phosphate, magnesium and thiamine
What serum levels decrease in refeeding?
phosphate, potassium and magnesium
glucose, THIAMINE, sodium, nitrogen, fluid
Refeeding syndrome interventions
identify high risk patients
thorough nutrition assessment prior to initiating refeeding
plasma electrolytes and glucose should be measured at baseline
refeeding should be started at no more than 50% of energy requirement and slowly
vitamin supplement immediately
electrolyte levels should be measured once daily for one week
Patients at high risk of refeeding syndrome
Cancer
Anorexia Nervosa
Elderly
Malnutrition
Chronic alcoholism
NPO status for over 7 days
DKA
Post-operative patients
Chronic diuretic use
Rapid weight loss
Infectious diseases
Enteral Nutrition
the provision of nutrients using the GI tract, but goes directly to the stomach with the use of a tube
Parenteral Nutrition
provides nutrients by IV that do not have adequate GI feedings
What is preferred for feeding? TPN or enteral?
If the GI tract remains functional, than enteral is preferred
Complications of enteral feeding
Gastrointestinal (diarrhea, N&V, cramping, distension, constipation)
Mechanical (tube displacement or obstruction, aspiration)
Metabolic (hyperosmolar dehydration or overhydration
Nursing interventions with enteral feeding
warm water, sodium bicarb
Conditions to use parenteral feeding
1) V or Diarrhea
2) severe GI bleeding
3) intestinal obstructions or fistulas
4) paralytic ileus
5) severe malnutrition with intolerance to enteral feeds
Nursing assessment with parenteral feeds
Check CVC site
Check solution and monitor lab work (daily)
Must be a continuous pump IV
