Home EN

Question 1

Common conditions indicated for home EN?

Answer 1

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

Question 2

What may dysphagia be related to?

Answer 2

• CVA
• Head/neck trauma (Glossectomy)
• Degenerative diseases

Question 3

Examples of degenerative diseases?

Answer 3

-Advanced parkinsons disease
-Amylotrophic lateral sclerosis
Multiple sclerosis

Question 4

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

Answer 4

• PEG

- PEJ is second most common

Question 5

What is intermittent feeding?

Answer 5

• 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

Question 6

Which patients are candidates for intermittent feeding?

Answer 6

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

Question 7

What is continuous feeding?

Answer 7

• 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

Question 8

Which patients are candidates for continuous feed?

Answer 8

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

Question 9

What is bolus feeding?

Answer 9

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

Question 10

Which patients are candidates for bolus feedings?

Answer 10

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

Question 11

Polymeric?

Answer 11

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

Question 12

What is compleat?

Answer 12

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

Question 13

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

Answer 13

False

Is fortified with fibre

Question 14

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

Answer 14

Osmolite

Question 15

Hydrolyzed?

Answer 15

• 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

Question 16

Examples of polymeric formulas?

Answer 16

• Peptamen

- Vital peptide

Question 17

Modular?

Answer 17

• Composed of single macronutrients

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

Question 18

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

Answer 18

-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

Question 19

What is the goal of home EN?

Answer 19

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

Question 20

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

Answer 20

Collaboration between the hospital and homecare dietitians is very important

Question 21

What are the first 4 criteria for home EN?

Answer 21

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

Question 22

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)

Answer 22

They will switch from an open to a closed system

Question 23

What are the second 4 criteria for home EN?

Answer 23

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

Question 24

What are the 5 key roles of the hospital dietitian?

Answer 24

• 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

Question 25

What is the purpose of the NEHD tool?

Answer 25

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

Question 26

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

Answer 26

- Incomplete/missing nutrition plan - Private insurance vs. RAMQ coverage - Missing anthro data - Late notification of patient discharge

Question 27

What are the 3 NEHD objectives?

Answer 27

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

Question 28

What is NEHD?

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

35-65% | At home

Question 31

What are the first 6 roles of the homecare dietitian?

Answer 31

- 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

Question 32

What are the next 5 roles of the homecare dietitian?

Answer 32

- 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

Question 33

What are the first 5 roles of the homecare nurse?

Answer 33

- 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

Question 34

What are the next 4 roles of the homecare nurse?

Answer 34

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

Question 35

Common challenges w/ home EN?

Answer 35

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