Exam #3 RQ: Nutritional Support/Enteral Nutrition

Question 1

Differentiate between enteral and parenteral nutrition

Answer 1

1) Enteral - usage of the digestive system normal mechanisms of digestion 2) parenteral - administer directly into the blood stream

Question 2

Identify potential issues with a clear vs a full liquid diet

Answer 2

1) clear diets have minimal digestion and stimulation of the GI tract - may have potential issues with osmolarity of the liquid 2) full liquid diets are the transition between liquid and full solid diets - issues include the consumption of lactose which can cause discomfort

Question 3

What are some challenges in using appetite stimulants in to boost nutrient uptake?

Answer 3

1) they have side effects 2) they may not increase appetite enough to cause significant weight gain 3) minimal success

Question 4

List the advantages of enteral nutrition over parenteral nutrition

Answer 4

1) absorption of nutrients by the portal system (portal vein) 2) maintains gut integrity 3) Maintenance gut mucosal lymphoid tissue 4) may protect against the translocation of bacteria into systemic circulation 5) early enteral feeding found to enhance wound healing 6) diminishes the catabolic response and preserves immunologic function 7) decreases incidence of hypoglycemia 8) more convenient and safer than parenteral nutrition 9) less expensive than parenteral nutrition

Question 5

Tube Feeding is Contraindicated if…

Answer 5

1) ileus or bowel obstruction 2) intractable diarrhea 3) GI bleeding 4) ischemic or perforated gut 5) high output fistula/ostomy 6) aggressive nutrition intervention not warranted

Question 6

factors of consideration for administering tube feeding route:

Answer 6

1) length of time of feeding 2) risk of aspiration 3) patients ability to absorb and digest food 4) whether or not there is a planned surgery 5) formula viscosity and volume

Question 7

what is the most used mode of enteral nutrition?

Answer 7

nasogastric tube

Question 8

Advantages of feeding into the stomach

Answer 8

1) stomach is better able to handle osmotic loads without vomiting, cramping, diarrhea, or fluid or electrolyte shifts 2) large reservoir 3) presence of HCl in the stomach may better prevent infection

Question 9

advantages of feeding into the intestine

Answer 9

less risk of aspiration

Question 10

time frame for nasogastric tube

Answer 10

short term 3-4 weeks, used with patients with an intact gag reflex

Question 11

time frame for nasodudenal or nasojejunal tubes

Answer 11

for short term 3-4 weeks, for patients with risk of aspiration, persistent nausea or vomiting, or gastroparesis

Question 12

which type of enteral nutrition is used more long term?

Answer 12

ostomy feedings. Long-term mote comfortable and less noticeable

Question 13

When should a bolus feeding technique be used?

Answer 13

1) long term usage 2) must have normal gastric function 3) rapid uncontrolled administration rates can cause nausea, diarrhea, and cramps 4) people with poor gastroesophageal sphincter competency or limited gastric volume capacity should not use

Question 14

Characteristics of continuous drips

Answer 14

1) administered over a 18-24 hour period 2) requires an infusion pump

Question 15

infusion pump

Answer 15

used in continuous administration of nutrients, is associated with smaller residual volumes in the stomach reduces the possibility of pulmonary aspiration, use of pump requires less supervision.

Question 16

Characteristics of intermittent drips

Answer 16

1) administered at specific intervals throughout the day (300-400 ml of formula are given over 20-30 minutes several times daily)

Question 17

advantages of intermittent drips

Answer 17

allows freedom from equipment for: home tube feedings and patients undergoing an intense rehabilitation program.

Question 18

Cyclic infusion

Answer 18

1) formula is infused 8-16 hours/day usually overnight by infusion pump, and then discontinued in the morning 2) supplement oral intake during the day, once the patient meets 2/3 of caloric needs by mouth, enteral feeding can be discontinued

Question 19

What are the two main enteral product companies?

Answer 19

Nestle and Abbott Nutrition

Question 20

Polymeric formulas

Answer 20

(POLYMER) contain intact nutrients, composed of complex carbohydrates, proteins, and fats, usually lactose free, considered to be a standard basic tube feeding or general purpose formula, needs functional GI tract

Question 21

Elemental/semi-elemental formula

Answer 21

contain partial or completely hydrolyzed nutrients which require less digestive and absorptive capacity, protein is provided as short-chain peptides and amino acids, carbohydrates come from oligosaccharides, low to no fat. Has high osmolarity so monitoring needs to occur

Question 22

Diseased specific formulas or specialized formulas

Answer 22

used in organ dysfunction or specific metabolic conditions, formulas have been developed for renal, hepatic, respiratory disease, glucose intolerance, trauma, and impaired immune function.

Question 23

Modular formula

Answer 23

increased need for a single nutrient, can be added to a formula or food item to increase calories or protein

Question 24

What is the maximum amount of enteral formula that can be administered per hr?

Answer 24

125 ml/hr = 3,000 ml/day

Question 25

High fiber formulas

Answer 25

normalize bowel function, enhance colonic mucosa integrity and normalize intestinal motility, support bowel integrity by supplying polysaccharides which are fermented by colonic bacteria to yield short chain fatty acids

Question 26

SCFAs

Answer 26

short chain fatty acids ; benefits - have been shown to speed intestinal healing and support mucosal integrity, can correct both constipation and diarrhea.

Question 27

Why is glutamine added to some amino acids?

Answer 27

1) non -essential amino acid 2) considered essential during illness 3) cells depleted by more than 50% following severe illness 4) preferential fuel source for enterocytes in the gut mucosa, especially during stress ( helps gut barrier, integrity, and enhances GI cell mass and height of mucosal villi

Question 28

What components are added to formulas to enhance or maintain a patient’s immunity?

Answer 28

glutamine, arginine, omega-3- fatty acids, and antioxidants. claim to reduce infection rates and decrease the length of stay, but the results are mixed

Question 29

French size saying

Answer 29

The smaller the french size, the more narrow the tube

Question 30

What is the normal osmolarity of the body?

Answer 30

300 mOsm

Question 31

What is the relationship between osmolarity and flow rate?

Answer 31

The more concentrated or elemental a formula, the higher the osmolarity. rate of distribution is slow at first, but then increased as patient tolerates the formula (50 cc)

Question 32

Residuals

Answer 32

the amount of enteral formula present in the stomach. Lets RDs know how much is being digested. residuals greater than 250ml suggest a problem

Question 33

Why is it important to check that the tube is placed properly in the stomach? What are some techniques to ensure this?

Answer 33

We check to make sure that food does not enter where it does not belong (i.e the lungs leading to aspiration). Gold standard - x ray, presence of coughing, alterations in breathing

Question 34

Head angle in bed during enteral nutrition

Answer 34

should be 30-45 degrees to prevent aspiration

Question 35

Why is the tube flushed with water periodically including before and after administering medications

Answer 35

rid of left over substances, reduce rates of clogging, ensure bacteria do not inhabit tube

Question 36

Tube Feeding Syndrome

Answer 36

hyperosmolar/non-ketoic dehydration; need to monitor patient for hydration or dehydration

Question 37

Hyperglycemia in the fed patient

Answer 37

hyperglycemia can occur in patients because of the stress state. Hyperglycemia needs to be monitored to monitor the need to provide insulin in enteral nutrition.

Question 38

How does underfeeding affect patients?

Answer 38

delay of nutrition repletion, wound healing, and lead to unwanted weight loss

Question 39

How does overfeeding affect patients?

Answer 39

hyperglycemia, hypertryglyceridemia, and hepatic steatosis and can lead to refeeding syndrome.

Question 40

Renal solute load

Answer 40

The amount of nitrogenous waste and minerals that must be excreted by the kidney

Question 41

what two populations is RSL important in?

Answer 41

neonatal patients and the elderly

Question 42

What is the normal adult tolerance of RSL

Answer 42

1200-1400 mOsm