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CNSC Exam > Home Enteral Nutrition > Flashcards

Home Enteral Nutrition Flashcards

1
Q

the largest payer of home enteral and PN is

A

Medicare

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2
Q

education materials for home EN/PN should be at a ____ level

A

6-8th grade level

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3
Q

what should be evaluated on a home care provider performance improvement plan

A

hospital re admit rate (also, mortality rate, customer satisfaction, complications, problem reporting/resolution)

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4
Q

benefits of a home nutrition support team

A

earlier transition to PO or EN, avoids multiple lab draws, improved coordination of care, more psychosocial support, earlier identification of potential problems and deficiencies

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5
Q

a non-profit organization for education and support that is free to all home PN or EN patients

A

Oley Foundation

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6
Q

what are the benefits of a nutrition support support group

A

increased quality of life, decreased depression, decreased incidence of catheter related sepsis

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7
Q

how often should electrolytes be monitored in nutrition support

A

Initially: weekly until clinically stable

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8
Q

What makes a patient a good candidate for home EN

A

physical & emotional well being, willingness to go home, adequate storage pace, electricity, running water, phone in the home, patient support/support network, back up battery for powered infusion pump

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9
Q

Medicare: in order to be covered for a tube feeding pump at home you must have

A

nausea/vomiting, GERD, gastroparesis, dumping syndrome

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10
Q

in order to be covered for home enteral feeding ____ must not be possible

A

PO intake

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11
Q

according to medicare, permanence of EN or PN is defined as > ____ days

A

90 days

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12
Q

when an anatomic or motility disorder will interfere with oral intake for > 90 days, EN will be covered. True or False

A

True

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13
Q

for an enterally fed home patient, a pump will be covered if

A

intolerance to bolus or gravity feeding is demonstrated

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14
Q

Third Party insurance payers are the ____ likely to pay for EN formulas because they equate to the cost of a grocery bill

A

third party

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15
Q

the 3 most important monitoring for HEN patients who are stable are

A

weight, I/O and bowel function

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16
Q

if a PEG tube dislodges after the tract matures (>6 weeks) a replacement tube can be

A

reinserted and surgery is not required

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17
Q

if a PEG tube dislodges that has an immature tract, within ___ hours a dilator can be used to open the tract IN THE HOSPITAL NOT AT HOME

A

12

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18
Q

what is the best way to ensure the patient is performing proper tube feeding technique

A

return demonstration

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19
Q

To ensure the best adherence to feeding and improved psychosocial health of a tube fed patient their tube feeding schedule should be

A

integrated into the patient/family’s way of living and should simulate normal meal times

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20
Q

in a stable home EN patient, it would be most appropriate to routinely monitor

A

weight, intake/output, bowel fx

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21
Q

enteral feeding should be incorporated into the patient’s/families

A

lifestyle, mimic normal meal times

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22
Q

what is encouraged of family members of an enterally fed patient at home

A

participation, dinner table socializing

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23
Q

a home tube fed patient’s administration schedule should mimic

A

normal meal times

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24
Q

patient education materials should be at the ___ to ____ grade level

A

5th to 6th grade level

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25
Q

the best way to to know the patient/family’s understanding of EN delivery is

A

return demonstration/ teach back

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26
Q

an active process where the patient can demonstrate themselves and verbalize the process is called

A

teach back/ return demonstration

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27
Q

Teach Back/Return demonstration helps the patient/family get accurate _______, verify ______ and reinforce new home care ________

A

information
understanding
skills

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28
Q

the maximum hang time for an open enteral system IN THE HOME SETTING is

A

12 hours

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29
Q

the maximum hang time for a closed system in the HOME setting is

A

24-48 hours

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30
Q

the best way to care for the skin around a feeding tube is

A

mild soap and water, rinse and keep dry thoroughly, clean under the external bolster

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31
Q

when are dressings recommended for PEG tubes

A

only if there is drainage

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32
Q

the home care improvement plan for an enterally fed tube feeding patient measures ________ in the home tube feeding setting

A

outcomes

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33
Q

what NEEDS to be included in the home care improvement plan for home enterally fed patients

A
  1. hospital re admits
  2. complications
  3. patient/family satisfaction
  4. problem reporting/resolution
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34
Q

Under the Centers for Medicare and Medicaid Prosthetic Device Act, hone enteral nutrition patients (HEN) are only covered if they meet the criteria for permanent disease of the structures that ________________ or disease of the small bowel that impairs. WITH these 3 documented indicators

A
  1. permit the food to reach the small bowel
  2. digestion/absorption of a PO diet
  3. test of performance documented by MD
  4. statement of permanence (90 days)
  5. statement of needing to maintain weight/strength not possible by taking in oral nutrition supplements
  6. serum albumin <3.4 g/dL , fecal fat test
  7. weight loss >10% >/= 3 months
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35
Q

In enteral nutrition discharge instructions the following needs to be documented. Name of the _______, total ______, route of _______, care of the ________, product hang time, stability at room temp, inspection of the product, expiration dates , _____ prevention, what to do when you _______, phone number for the home care company and proper_____

A
  1. name of the formula
  2. total daily volume needed
  3. route of administration
  4. care of the enteral access device
  5. infection prevention
  6. run out of supplies
  7. storage
36
Q

the most common complication associated with PEG tube placement is ____ which can occur within days to months

A

peristomal infection

37
Q

examples of Medicare coverage part B conditions

A

obstruction 2/2 head/neck cancer
motility disorders
severe dysphagia

38
Q

which conditions are not covered by medicare for home EN

A

anorexia, malnutrition, nausea

39
Q

Medicare reimbursement for nutrition education by an RD is only covered for

A

diabetes
renal disease (pre dialysis)
kidney transplant

40
Q

managed care / private insurance companies usually use ______ criteria for HPN coverage

A

medicare criteria

41
Q

managed care/private insurance companies usually require _________ and medical _____ and sole source of ______ in order to cover EN

A

pre authorization
medical necessity
sole source of nutrition

42
Q

how often initially should electrolytes, glucose, BUN, Cr, Mag, Phos be monitored

A

weekly for 4 weeks or until clinically stable

43
Q

what type of venous access devices are indicated for home PN use

A

PICC lines (Hickman)
Implanted Ports
Tunneled CVCs

44
Q

a permanent ____ must be placed before discharging home with HPN

A

venous access device (central)

45
Q

upon initiation of home PN, initial lab data should be obtained when

A

prior to starting home PN

46
Q

the patient/training policies for home PN should address

A

education
training
evaluation of the patient/caregiver competency

47
Q

home infusion companies are responsible for the delivery of

A
  1. nutrition products
  2. supplies
  3. nursing care
  4. formula delivery
  5. equipment delivery
48
Q

assessing of micronutrient status in HPN patients requires thorough ______

A

symptom observation

49
Q

copper deficiency masks _____deficiency making it difficult to assess home PN patients

A

B12

50
Q

Hypermagnesemia results from ______ in HPN patients

A

commercial trace element preparation

51
Q

manganese is almost fully excreted by the ________

A

hepatobiliary system (bile)

52
Q

try to decrease the dose of manganese in patients on HPN with

A

hepatobiliary disease or liver disease

53
Q

who are at risk for a manganese toxicity

A

long term PN over 30 days with obstruction of the biliary duct

54
Q

when there is a toxicity of manganese with inability to excrete it through the bile, it can deposit in the ______ especially with IV manganese

A

brain

55
Q

what is the BEST way to detect manganese levels

A

whole blood manganese

56
Q

what is the best indicator for chromium deficiency

A

there is NO known reliable indicator of chromium status

57
Q

what are the roles of chromium

A
  1. potentiates the action of insulin

2. plays a role in glucose, protein and lipid metabolism

58
Q

which populations are at risk for chromium deficiency

A
  1. pregnancy

2. Type 2 DM

59
Q

if a patient is hyperglycemic, give ______ supplementation and see if the blood glucose resolves

A

chromium

60
Q

what are some causes of zinc deficiency

A

inadequate intake, decreased absorption, increased losses, increased demand

61
Q

primary symptoms of zinc deficiency

A

loss of taste, altered smell, rash, alopecia, gonadal hypofunction, night blindness

62
Q

every HPN patient should get ____ daily unless there is a toxicity / potential for toxicity or national shortage

A

micronutrients

63
Q

whenever a patient has a nutrient omitted what should be done

A

monitor for deficiency or toxicity that can develop over time

64
Q

are lab values always the best indicators for normal micronutrient status

A

NO

65
Q

normal lab values of micronutrients can give a false ______

A

sense of security

66
Q

failure to monitor which long term micronutrient can result in toxicities of these micronutrients in PN: zinc, manganese, folate or molybdenum

A

manganese

67
Q

hypermanganesemia can occur in all ____ patients regardless of liver function

A

long term PN patients

68
Q

PN contains these potential toxic elements from an ASPEN 2009 review

A

manganese, copper, chromium

69
Q

in the 2012 ASPEN recommendations, there was a recommended decrease of these trace elements

A

manganese and copper

70
Q

symptoms of manganese toxicity

A

headache, Parkinson’s like abnormalities

71
Q

Case: A malnourished patient with metastatic ovarian cancer is diagnosed with inoperable, partial SBO. She is taking in small amounts of a full liquid diet by mouth but is unable to take enough nutrition to maintain her weight. She has lost 12% of her body weight in the past 2 months. According to current Medicare guidelines the patient’s HPN will be covered under which of the following circumstances

A
  1. the medical record must document failure of EN feeding tube or explain why it is not an option
  2. it is critical to document a non functional GI tract
72
Q

diagnosis of a SBO alone is _____ qualifying for HPN

A

Not

73
Q

Large volume, small volume, pharmacy bulk PN components must be labeled with the amount of ______ anticipated to be in the product when the product _________

A

aluminum, expires

74
Q

the amount of aluminum on PN labels are about ____________ than what is actually in the PN bag of an individual patient

A

10 times more

75
Q

pharmacies are not require to list _____ content of each individual patient’s PN bag

A

aluminum

76
Q

symptoms of aluminum toxicity

A

neurological, hepatic, hematologic, skeletal muscle

Sx are non specific, non sensitive, can include some metabolic bone disease but is not the primary symptom

77
Q

the most practical way to manage micronutrients in long term PN patients is to

A

perform micronutrient assessment every 6 months including nutrient intake assessment, assessment for potential losses, medications/surgical history and a nutrition focused physical exam

78
Q

what are the causes of nausea and vomiting in long term EN patients

A

rapid EN infusion, gastric outlet obstruction from tube migration, excessive feeding volume, gastroparesis

79
Q

how is nausea and vomiting prevented in home EN patients

A
  1. decrease TF rate/volume of an EN infusion of N/V occurs
80
Q

many third party payors (insurance companies) equate the cost of EN formulas to the cost of _____ and DON’T cover the expense

A

groceries

81
Q

if a patient cannot afford their formula, what are their options

A
  1. work with an RD to find an alternative

2. there are non profit/indigent care programs to help

82
Q

EN formula may be covered under Medicare Part _____ and is usually only covered to about ____%. Patients with supplemental ______ may have the rest of the 20% covered.

A

Medicare Part B
20%
Supplemental insurance

83
Q

Home blenderized EN formulations should be discarded after _____ hours at home. Their hang time should be ____ hours.

A

Discard after 24 hours

hang time 4 hours

84
Q

which non profit organization is a great resource for home PN/EN patients

A

Association of GI motility Disorders

85
Q

a 69 year old male on a continuous, high-protein, high fiber tube feeding is running at 65mL/hr via a PEG. The TF was selected to assist with wound healing and diarrhea. The tube feeding is stopped every 6 hours , residuals are checked and the tube is flushed with 30mL of water. The patient is provided liquid medication via the PEG tube 2 times a day. The tube now seems occluded, why?

A

inadequate flushing

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