Home EN Flashcards

1
Q

Common conditions indicated for home EN?

A
  • Dysphagia
  • Recurrent aspiration
  • Severe malnutrition
  • GI obstruction, impaired GI motility, gastroparesis
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2
Q

What may dysphagia be related to?

A
  • CVA
  • Head/neck trauma (Glossectomy)
  • Degenerative diseases
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3
Q

Examples of degenerative diseases?

A

-Advanced parkinsons disease
-Amylotrophic lateral sclerosis
Multiple sclerosis

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4
Q

What is the most common form of EN in home EN?

A
  • PEG

- PEJ is second most common

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5
Q

What is intermittent feeding?

A
  • Formula administered via gravity drip (open system) or via feeding pump (open/closed system)
  • Feeding delivered over 1 or more hours several time per day
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6
Q

Which patients are candidates for intermittent feeding?

A

Patients with normal tolerance/gastric emptying and low risk for aspiration

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7
Q

What is continuous feeding?

A
  • Formula administered via gravity drip (open system) or via feeding pump (open/closed ) but usually a closed system
  • Delivered over 16-24 hrs per day, at a low feed rate
  • May be done during the day or overnight
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8
Q

Which patients are candidates for continuous feed?

A

Patients with impaired tolerance/gastric emptying, small bowel feeding , high risk for aspiration

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9
Q

What is bolus feeding?

A
  • Formula administered via syringe inserted directly into the feeding tube
  • Volume up to 500ml delivered rapidly (less than 10 mins) several times per day
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10
Q

Which patients are candidates for bolus feedings?

A

-Only for patients with normal GI function and at low risk for aspiration

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11
Q

Polymeric?

A
  • Nutritionally complete
  • 1.0-2.0 kcal/ml
  • Intact proteins
  • Protein 15-20%
  • Low residue or fibre-enriched
  • For normal digestion and absorption
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12
Q

What is compleat?

A

-A “real food” formulation which may be used initially to develop tolerance in patients, until switched to a more standard polymeric formula

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13
Q

(T/F) Jevity is a polymeric formula with low-residue/no fibre

A

False

Is fortified with fibre

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14
Q

Which is a standard polymeric formula with low fibre / low-residue?

A

Osmolite

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15
Q

Hydrolyzed?

A
  • Nutritionally complete
  • Energy density from 1.0-1.5 kcal/ml
  • Peptide or amino acid based
  • For impaired GI function, maldigestion and malabsorption or Gi intolerance
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16
Q

Examples of polymeric formulas?

A
  • Peptamen

- Vital peptide

17
Q

Modular?

A
  • Composed of single macronutrients

- Usually used to supplement the energy, protein or fat content of a base formula

18
Q

Discuss the transition of hospital and home of the patient and the role of the dietitian

A

-EN is often initiated in the acute care setting, then the pt will either be discharged to (1) the community with the homecare dietitian or (2) a rehab facility with the rehab dietitian

19
Q

What is the goal of home EN?

A

Ensure the restoration or maintenance of good nutritional status of the patient, safely and comfortably in their home setting

20
Q

What is important for the goal of EN to be achieved?

A

Collaboration between the hospital and homecare dietitians is very important

21
Q

What are the first 4 criteria for home EN?

A

1) Patient/family/caregiver accepts to return home with a tube feeding
2) Medically stable (NOT just MAP)
3) Good tolerance to formula
4) Appropriate home conditions in order to reduce the risk of bacterial contamination

22
Q

How will the home dietitian intervene if they assess to patients home is not appropriate to reduce the risk of bacterial contamination (i.e. pets, uncleanliness)

A

They will switch from an open to a closed system

23
Q

What are the second 4 criteria for home EN?

A

1) Pt is able to manage TF independently, or has help from dependable caregiver
2) Pt or caregiver has good understanding of home TF procedure
3) Pt has the appropriate furniture for their physical condition(i.e. if bedridden, should have a hospital bed a s positioning is important, IV poll to have formula on)
4) Dietitian should be able to provide support to the patient/caregiver/family in the home

24
Q

What are the 5 key roles of the hospital dietitian?

A
  • Assess patients nutritiona l status, requirements
  • Determines the EN formula, feed rate, method of deliver, and if short-term/long-term
  • Educate pt/caregiver how to administer meds, manage intolerance and maintain integrity of the EN tube
  • Organize material require for tube feedings, equipment, prescription, payment)
  • Inform the home care dietitian of the nutrition plan
25
Q

What is the purpose of the NEHD tool?

A

Tool developed to ensure quality continuity of nutrition care for patients on tube-feeding in the community

26
Q

What were some issues which gave rise to the NEHD tool?

A
  • Incomplete/missing nutrition plan
  • Private insurance vs. RAMQ coverage
  • Missing anthro data
  • Late notification of patient discharge
27
Q

What are the 3 NEHD objectives?

A

1) Improve the collaboration and communication between hospital dietitians and CLSC dietitians
2) Optimize the time available to dietitians in hospitals and CLSCs to effectively plan visits and monitor patients receiving EN at home
3) Ensure the quality of the continuum of care for patient with home EN feeding

28
Q

What is NEHD?

A

A tool to access all forms, reference and resources in one place to plan, organize and coordinate EN from hospital to home
–> Available on the internet only

29
Q

What are they 7 steps to follow for organization, coordination and teaching of home EN?

A

1) Organization
2) Type of equipment needed for EN at home
3) Prescription of EN formula and equipment
4) Teaching protocol/feeding plan
5) Review of teaching w/ family and patient
6) Links to equipment suppliers and/or nutritional formula
7) Continuity of nutritional care

30
Q

____ of tube fed patients experience intolerance, and the most of these intolerances are experienced at ____

A

35-65%

At home

31
Q

What are the first 6 roles of the homecare dietitian?

A
  • Liase w/ referring dietitian
  • Review and reinforce teachings
  • Monitor effectiveness of TF plan, adjust if needed
  • Monitor nutritional status
  • Monitor signs/symptom of intolerance
  • Verify swallowing ability, monitor for transition for oral feeds
32
Q

What are the next 5 roles of the homecare dietitian?

A
  • Communicate changes to nutrition plane to CLSC MD, RN
  • Troubleshoot problems w/ equipment and materials
  • Facilitate renewal of prescriptions
  • Assist as needed w/ re-ordering TF supplies
  • Assist as needed w/ return of feeing pumps
33
Q

What are the first 5 roles of the homecare nurse?

A
  • Reinforce teaching received from d/c hospital
  • Assist w/ administration of feedings, flushing and meds
  • Intervene if the patient experiences intolerances, notify the dietitian
  • Provide nursing care as needed for the PEG/PEJ site
34
Q

What are the next 4 roles of the homecare nurse?

A
  • Reinforce protocol for maintaining integrity of feeding tube
  • Reinforce the protocol for changing bags and syringes
  • Verify GRVs
  • Troubleshoot problems w/ equipment and materials
35
Q

Common challenges w/ home EN?

A
  • Feeding tube blockages
  • Running out of syringes
  • Pump malfunctions
  • Damaged, leaking or dirty feeding tubes
  • No GP to renew prescription for formula