FEN: Enteral Nutrition II

Question 1

List three lab values that should be monitored with enteral nutrition

Answer 1

1. Blood glucose concentration
2. Prealbumin weekly
3. Serum sodium and other electrolytes

Question 2

What is an exception to monitoring prealbumin weekly?

Answer 2

Caution in critically ill patients because it reflects acute-phase response rather than nutrition status

Question 3

List four non-lab value parameters that should be monitored with enteral nutrition

Answer 3

1. Head of bed elevation
2. GI tolerance
3. Wound healing
4. Other medications that add additional calories

Question 4

To what degree should head of bed be elevated to prevent enteral feeding aspiration?

Answer 4

30-45 degrees

Question 5

List three parameters or signs/symptoms that can be monitored to check for GI tolerance to enteral feedings

Answer 5

1. Abdominal pain or distension
2. Stool frequency and volume
3. Nausea, vomiting and diarrhea

Question 6

Checking ___________ is not recommended to determine GI tolerance of EN

Answer 6

Gastric residuals

Question 7

List two medications that add additional calories that require EN rates to be adjusted

Answer 7

1. Propofol

2. Clevidipine

Question 8

Diarrhea can occur with medications having a high _______

Answer 8

Osmolality (e.g. medications mixed in sorbitol)

Question 9

____ formulations for drug administration using enteral access, but they should be ____

Answer 9

Liquid, but they should be diluted

Question 10

Describe how to dilute liquid medications for enteral access

Answer 10

They should be diluted with 2-3 times the medication volume with water

Question 11

How to flush feeding tube for drug administration?

Answer 11

Flush with 20 mL of water before and after each drug administered

Question 12

What two types of pill formulations, in general, should not be crushed?

Answer 12

1. Sustained release

2. Enteric coated

Question 13

How to administer a tablet by feeding tube?

Answer 13

1. Mix crushed tablets or capsule contents with 10-15 mL of water
2. Administer each drug separately

Question 14

What may be done to prevent reduced bioavailability for certain drugs when administered with enteral access?

Answer 14

Discontinue tube feedings before and after drug administration temporarily

Question 15

List four drugs for which discontinuing tube feedings before and after drug administration temporarily is common

Answer 15

1. Fluoroquinolones
2. Phenytoin
3. Warfarin
4. Bisphosphonates

Question 16

Give an example of when considering feeding tube location is important when administering drugs with enteral access

Answer 16

Antacids need to be administering into the stomach, not the duodenum

Question 17

List five general steps in developing an EN regimen

Answer 17

1. Determine caloric requireements
2. choose a formula and assess calories per millileter
3. Determine infusion rate
4. Ensure that the patient will receive sufficient protein
5. Ensure that the patient will receive about 30 mL/kg/day of water

Question 18

In general, what is a typical caloric requirement range?

Answer 18

25-35 kcal/kg/day

Question 19

In general, what is a typical protein requirement range? Who does this exclude?

Answer 19

0. 8-2 g/kg/day
1. Changes based on BMI (i.e. obesity)
2. And burns/trauma

Question 20

How to calculate the infusion rate?

Answer 20

1. Determine the total volume of EN nutrition by using the kcal/mL of the selected EN formula and the total caloric requirements
2. Divide that total volume over 24 hours

Question 21

How to ensure the patient is receiving enough water with their EN feedings?

Answer 21

1. Product information will give the water content
2. Calculate the amount of free water given with the volume of EN feedings, and find the additional water required compared to 30 mL/kg/day.
3. Administer as water flushes through feeding tube every 4-6 hours.