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MNT II > Exam 2: Nutrition Support - EN/PN > Flashcards

Exam 2: Nutrition Support - EN/PN Flashcards

1
Q

What are some benefits of using EN over PN?

A
  • preserves the mucosal barrier function (immune function) & integrity of the gut
  • act of feeding the GIT shown to weaken catabolic response
  • lowers risk of hyperglycemia
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2
Q

Enteral nutrition access selection depends on what criteria?

A
  1. anticipated time required
  2. degree of aspiration risk
  3. clinical status
  4. presence/absense of GI function
  5. pt’s anatomy
  6. whether surgical intervention is planned
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3
Q

Define: Closed system

A

Container/bag is prefilled w/ sterile formula ready to administer

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4
Q

Define: Open system

A

Must open container/bag and pour the formula in

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5
Q

Define: Hang time

A

Length of time an enteral formula is considered safe for delivery to patient

4 hours (open system)

24 hours (closed system)

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6
Q

Nasogastric route

A
  • Most common way to access GIT
  • pts w/ normal GI function
  • NGT (nasogastric) NDT (nasoduodenal) or NJT (nasojejunal) tubes pass through the pylorus to the duodenum or jejunum
  • Used short term (3-4 weeks)
  • location confirmed by xray (can delay feeding)
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7
Q

Percutaneous Endoscopic Gastrostomy (PEG)

A
  • pt under local anesthesia
  • tube placed directly into stomach through abdominal wall
  • preferable option
    • short procedure time
    • limited anesthesia
    • minimum wound complications
  • tubes larger and clog less easily
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8
Q

PEG placement is ________ while gastrostomy tube (g tube) placement is________

A
  1. nonsurgical
  2. surgical
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9
Q

With a G/J tube, which tube is fed through and which is used for medication administration?

A

J tube has smaller diameter so it is used to feed and G tube has a larger diameter so it is used to give crushed medications

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10
Q

You can feed continuous or cyclic feeds into:

A
  1. stomach
  2. duodenum
  3. jejunum
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11
Q

The only place you can bolus feed is

A

Stomach

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12
Q

Define: bolus

A
  • “gulp” or large amount of formula at once, several times per day
  • mimics traditional feeding patterns
  • takes about 15-20 min (about 500 mL/feeding)
  • good for clinically stable patients w/ a functioning stomach
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13
Q

What determines the volume of bolus feed given?

A
  1. patient’s tolerance
  2. patient’s schedule
  3. patient’s goals
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14
Q

Define: intermittent/gravity feeding

A
  • Giving a volume of formula over a period of time; takes longer than bolus feeds (20-60 min)
  • hang bag on IV pole and let drip (Can also use a pump)
  • used for pts who cannot tolerate bolus feeds but do not want to pump feed
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15
Q

Define: continuous feed

A
  • Feeding a small volume of formula via a feeding pump
  • goal = to get 60% cal from TF in 24 hour period
  • mostly used in the hospital setting
    • Start w/ 1/4 to 1/2 volume and increase every 4-6 hours until goal rate achieved
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16
Q

Define: cyclic or nocturnal feeds

A
  • Continuous feeds that last for a set period of time
  • Run at night over 8 or 12 hours
  • Good for patients who don’t get adequate nutrition during the day
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17
Q

Continuous/cyclic feeds are used when

A

The patient can’t tolerate bolus, gravity, or jejunal feeds

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18
Q

Types of TF formulas

A
  1. Isotonic and without fiber
  2. semi-elemental
  3. elemental
19
Q

Isotonic Enteral Products

A
  • Isotonic = equal
  • may or may not have fiber
  • proteins: whole
  • carb source: maltodextrins, sucrose, milk and soy (suitable for lactose intolerance but NOT allergy)
  • Fat source: long chain TGs
  • water = 85%
  • MVI RDA obtained w/ 1 liter of formula
20
Q

Semi Elemental Enteral Products

A
  • partially hydrolyzed (nutrients broken down to increase absorption)
  • proteins: broken down to di- and tripeptides and amino acids
  • carbs: maltodextrin and sucrose
  • Fat: MCTs, long chain TGs
  • water: about 85% (unless higher cal formula)
  • not isotonic
21
Q

Elemental Enteral Products

A
  • Most broken down so GIT doesn’t have to work as hard to absorb nutrients
  • protein: amino acids
  • carb: maltodextrin, sucrose
  • Lipid: MCT
  • NOT isotonic
22
Q

Total volume

A

Always starting point to calculate calories, protein and water

Determined by multiplying rate by 24 hr

23
Q

Residuals

A

Checked every 4-6 hours

How much TF is sitting in the stomach

24
Q

Beneprotein

A

Modular component (protein supplement) w/ 6 grams protein per packet; can be used to achieve pt protein goals

25
Q

Parenteral Nutrition - When to choose it

A
  • No gut
  • no enteral access
  • enteral support fails to meet nutrition requirements
  • Expected length of NPO > 5-7 days and/or moderately - severely malnourished
26
Q

Short term parenteral nutrition

A

PPN (peripheral parenteral nutrition)

Catheter in peripheral veins (cephalic, brachial, basilic veins)

27
Q

PPN

A
  • Lower cost & lower risk of infection
  • larger/more diluted solution needed (b/c veins used are smaller/more prone to collapse)
  • contains no more than 10% dextrose
  • osmolarity cannot exceed >900mOsm
  • contraindicated in CHF, renal failure, HTN
    • pts can’t handle large volume of fluid
28
Q

Long term parenteral nutrition

A

TPN (total parenteral nutrition)

Catheter ends in superior vena cava (high volume blood flow)

29
Q

TPN

A
  • Long term
  • Catheters used: CVC (central venous catheter)
    • types: hickman, tunneled, Broviac, PICC
    • can have multiple lumens
  • can handle hypertonic solutions
  • start w/ 50% dextrose on day 1 (prevents large blood sugar spike)
30
Q

PICC (peripherally inserted central catheter)

A
  • newer CVC (central venous catheter)
  • lower infection risk
  • tip ends in the superior vena cava
  • placed at bedside
31
Q

Superior vena cava

A

pumps 2 liters of blood per second

blood moves so quickly that TPN solution dilutes almost immediately

32
Q

PPN needs a ________ line and TPN needs a ________ line

A
  1. peripheral
  2. central
33
Q

Nutritional components of PN: dextrose

A
  • dextrose monohydrate
  • range 10-25%
  • 1 gm = 3.4 cal
34
Q

Nutritional components of PN: protein

A
  • Crystalline amino acids
  • range 2.75-15%
  • 1 gm = 4 kcal
35
Q

Nutritional components of PN: lipids

A
  • Soybean oil w/ egg emulsifiers
  • range 10-30%
  • 1 gm = 9 kcal
    • 10% = 1.1 kcal/mL
    • 20% = 2.0 kcal/mL
    • 30% = 3.0 kcal/mL
36
Q

Nutrition provided by Diprovan

A
  • 1.1 kcal/mL (multiply rate by 1.1 to get total daily kcal)
  • Subtract from TPN or EN
37
Q

2 types of TPN

A
  1. 2 in 1 (dextrose and a.a in one bag)
    • lipids not hung every day
    • not given if TG > 500
  2. 3 in 1 (all nutrition components in same bag)
38
Q

TPN calculations

A

can be ordered as percentages or as grams/day (preffered/safest)

39
Q

PN: lipid choices

A
  • every day
  • every other day
  • 3x/week
  • dependent upon pt’s condition, nutritional goals, TG, facility
40
Q

How to prevent essential fatty acid deficiency (EFAD)

A

Provide 250 mL of 20% lipids 2x/week

41
Q

Refeeding syndrome

A
  • caused by overly aggressive PN (specifically carbs)
  • potentially lethal
  • cardiac and pulmonary complications result from fluid overload
  • monitor serum magnesium, potassium and phosphorus
42
Q

How to prevent refeeding syndrome

A
  • start with 25-50% so glucose levels don’t dramatically increase; look at labs to check tolerance (specifically Mg, K and P)
  • if labs drop dramatically, refeeding is occurring
43
Q

Transitional Feeding

A
  • parenteral to enteral: takes 2-3 days; stop parenteral when enteral reaches 75%
  • parenteral to oral: stop parenteral when oral reaches 75%
  • enteral to oral: reduce enteral to night only to reestablish hunger/satiety cues
44
Q
A

MNT II (6 decks)

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