Exam 2: Nutrition Support - EN/PN Flashcards
What are some benefits of using EN over PN?
- 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
Enteral nutrition access selection depends on what criteria?
- anticipated time required
- degree of aspiration risk
- clinical status
- presence/absense of GI function
- pt’s anatomy
- whether surgical intervention is planned
Define: Closed system
Container/bag is prefilled w/ sterile formula ready to administer
Define: Open system
Must open container/bag and pour the formula in
Define: Hang time
Length of time an enteral formula is considered safe for delivery to patient
4 hours (open system)
24 hours (closed system)
Nasogastric route
- 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)
Percutaneous Endoscopic Gastrostomy (PEG)
- 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
PEG placement is ________ while gastrostomy tube (g tube) placement is________
- nonsurgical
- surgical
With a G/J tube, which tube is fed through and which is used for medication administration?
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
You can feed continuous or cyclic feeds into:
- stomach
- duodenum
- jejunum
The only place you can bolus feed is
Stomach
Define: bolus
- “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
What determines the volume of bolus feed given?
- patient’s tolerance
- patient’s schedule
- patient’s goals
Define: intermittent/gravity feeding
- 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
Define: continuous feed
- 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
Define: cyclic or nocturnal feeds
- 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
Continuous/cyclic feeds are used when
The patient can’t tolerate bolus, gravity, or jejunal feeds
Types of TF formulas
- Isotonic and without fiber
- semi-elemental
- elemental
Isotonic Enteral Products
- 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
Semi Elemental Enteral Products
- 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
Elemental Enteral Products
- 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
Total volume
Always starting point to calculate calories, protein and water
Determined by multiplying rate by 24 hr
Residuals
Checked every 4-6 hours
How much TF is sitting in the stomach
Beneprotein
Modular component (protein supplement) w/ 6 grams protein per packet; can be used to achieve pt protein goals
