Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PR4152 > IC7 feeds > Flashcards

IC7 feeds Flashcards

1
Q

considerations of human disgestive system

A

stomach
GIT
accesorry organs: liver, gallbladder, pancreas
sphincters at outlets to control flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

stomach role and function

A
  • digest food, reservoir to store food
  • Pyloric sphincter control rate of release – dumping syndrome (NVD, cramp) because intestines cannot hold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

GIT role and function

A
  • digestion, absorption, excretion
  • secreions
    ○ Secretion of fluids: 1-2L lq/d. gastric acids, electrolytes
    ○ Secretion of enzymes: intrinsic factor (vitB12), enzymes
    ○ Gut hormones: cholecystokinin
  • GALT: gut associated lymphoid tissue (Peyer patches eg)
    ○ Immune cells to protect from infection, luminal mechanical barrier
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

accessory organs function

A

duodenum (when food passage in duodenum) –> produce cholecystokinin

  • Stimulate pancreatic contraction (pancreatic enzymes)
  • stimulate liver to secrete ball and gall bladder to secrete the BILE
  • Without this: gall bladder don’t contract, bile not flowing = cholestasis & jaundice may occur (IFALD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

decr intake –> malnuritrion

A

○ Medications that affect taste/ LoA
○ Ascites (accumulate of fluid, press onto GI –> stomach cannot expand, satiety)
○ Chemo (NV)
○ Malabsorption (major surgery resection of intestine, less nutrition absorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

incr expenditure –> malabsorption

A

○ Stress (trauma, surgery, infection, burns, sepsis) more expenditure so more resources for wound healing
○ Dialysis (protein loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

effects of malnutrition

A

○ Incr complications
○ Poor wound healing
○ Compromised immune status
○ Impairment of organ function
○ Incr mortality
○ Incr use of healthcare resource

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

nutritional screening and assessment steps

A

1) nutritional screening at admission (quick 3mins of nutrition risk pt)

2) Refer to dietitian/ nutritional specialist
for nutritional assessment

3) Formulation of nutritional regime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

2) Refer to dietitian/ nutritional specialist
for nutritional assessment

A

In depth, systematic process of pt data to identify nutrition-related problems

(7 point subjective global assessment) Scale 7 – 1 (severely malnourished)

  • Anthropometric (height and weight)
  • Biochemical (electrolytes, serum Albumin: liver function, not accurate for malnutrition (affected by fluid overload, infection)
  • Clinical (PMH, med, PE)
  • Diet history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3) Formulation of nutritional regime includes ___ + ___

A
  • Energy requirements (kcal)
    Total energy expenditure dependent on resting/ basal metabolic rate, physical activity, stress factor
  • protein requirements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

3 method to calc energy requirements

A

1) indirect calorimetry
2) weight base
3) predictive eqns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Indirect calorimetry (*GOLD STANDARD)

A
  • Measurement of gas exchange (CO2, O2) during consumption of substrates to produce required energy
  • But difficult to measure accurately gas collected

C6H12O6 + 6O2 —> ATP + 6CO2 + 6 H20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

weight based

A

25-35kcal/kg for general hospitalized pts (ESPEN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Predictive equations – Scofield eqn, Harris-Benedict eqn

A
  • Only estimate basal metabolic rate
  • Need x1.2 for activity and x1.2 for stress factor
    * Less accurate than calorimetry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

protein requirements (g)

A
  • dependent on medical conditions

healthy: 0.8 g/kg/d
trauma/surgery/burn/ sepsis/ critical ill: 1.5 - 2g/kg/d
CKD:
(not on HD 0.6 - 0.8)
(HD 1.2)
CRRT (2g)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

enteral nutrition

A

For pts who are unable to receive/ tolerate adequate nutrition by oral route

(swallowing impairment, mechanical ventilation, altered mental status, motility disorders)

  • pre-pyloric (NG, PEG)
  • post-pyloric (NJ, PEJ)
  • nasal vs stomy tubes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

pre-pyloric EN pros and cons

A
  • More physiologic, maximise function of GIT
    • Stomach still acts as reservoir
  • Higher tolerance to bolus feeding
  • Higher tolerance to wide range of enteral pdts
    • Pdt with high osmolarity, less SE of diarrhea as stomach can hold pdts first
  • May be used for venting
    • Remove gastric fluids (when obstruction occurs, reduce Vol, but risk of ASPIRATION PNEUMONIA)

cons: NOT for feeding in pts with delayed gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

post-pyloric EN pros and cons

A
  • Smaller bore, less discomfort
  • May be used in conditions that result in dysfunctionality in proximal GIT
  • Minimize ASPIRATION risk

cons: higher risk of tube clogging due to smaller diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

modes of EN admin

A

Bolus (3 main meals)

continuous EN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

bolus EN admin

A

Bolus (3 main meals)
* Usually by gravity, mimics oral intake
* More physiologic
* No pump required
* Greater freedom for ambulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Continuous EN

A

Continuous (many small meals)
* Pump assisted delivery at a constant rate
* Better tolerated, less bloating
* Lower risk of ASPIRATION

22
Q

types of EN formula

A

Modular

(semi) elemental - oligomeric
elemental - monomeric

Polymeric

Immune-modulating Disease-specific

23
Q

Modular

A
  • Single nutrient
  • Used as fortifier to enhance a specific nutritional component/ augment oral diet
  • Used in acute setting, short period (renal/ resp/ liver fail)

protein powder, MTG (bypass lymphatic system)

24
Q

[oligomeric]
(semi) elemental

A
  • Contains PARTIALLY hydrolysed nutrients
    Proteins –> peptides (semi)
  • For pts with impaired GI function
  • Impaired tolerance to standard feeds
  • Meal replacement as well, protein is partially hydrolysed into peptides
25
Q

[monomeric] elemental

A

completely hydrolysed to improve digestion, lactose free, aa based, elemental formula

26
Q

polymeric

A
  • Contains intact macronutrients
  • Require sufficiently functional GIT for digestion
  • Meal replacement with pt with intact GIT

isocal (clear feed): easily digested, more tolerable

27
Q

Immune-modulating
Disease-specific

A
  • Contains additions/ restrictions of specific nutrients to meet needs for disease management
    • Can be for other disease not marketed
    • Caloric dense + fluid restricted: CKD & HF
  • May or may not meet indiv full nutritional needs
28
Q

glucerna
fresubin protein energy
nepro HP
nepro LP
nutrifriend

all are caloric dense 1 - 1.8kcal/ml

A

glucerna - low GI
fresubin protein energy - high protein 20g/serving
nepro HP - high protein 18g
nepro LP - low protein, K, Phosphate
nutrifriend - omega-3 FA EPA/DHA

29
Q

Drug-nutrient interaction in EN

A
  • Not an issue with bolus/ intermittent feeding
  • Administration of incompatible drugs may cause:
    □ Ppt
    □ curdling, clamping of proteins
    □ Alteration of DF (sustained/ PR/ EC)
30
Q

prevent drug-nutrient interaction

A
  • Prevention and mitigation
    □ Stop feeding, flush access device before and after drug admin
    □ Use therapeutic alternatives available in appropriate DF (suitable for crushing)
31
Q

Complications of EN

A

○ Occlusion of feeding tubes (jejunal > gastric tube) , med admin, formula (concentrated/ high protein/ fibre will adhere to tube walls)
○ Tube migration
○ Infection 2nd to microbial contamination (water encourage microbial growth)
* Do not dilute feeds, just flush water separately

○ Aspiration
○ NVCD
○ Refeeding syndrome!!

32
Q

Strategies to maximise tolerance to EN

A

○ Continuous > bolus
○ Prokinetic agents (metoclopramide, domperidone, IV erthromycin)
○ Post-pyloric feeding (if gastric feeding not tolerated)
○ Isotonic formula (boost isocal)
○ Semi-elemental/ elemental feeds in pt with malabsorptive issue (short bowel syndrome)

33
Q

if the gut works, use it

A
  • maintain functional integrity of the gut
  • undergo 1st pass metabolism, promote efficient nutrient utilisaion
  • maintain normal gallbladder function
  • maintain gut-associated and mucosal-associated lymphoid tissues
  • less complications than PN – line sepsis, IFALD
  • less expensive
34
Q

PARENTERAL NUTRITION

A
  • For patients who are unable to receive or tolerate adequate nutrition by enteral route (paralytic ileus, small bowel obstruction, high output/ proximal fistula, mesenteric ischemia)
  • Parenteral access devices
    ○ Peripheral
    ○ Central
35
Q

peripheral pros and cons
PICC, midlines

A

pros

  • Tip is located outside of central vessels. Small tube
  • No fluid restriction
  • <2 weeks use

cons

  • Requires frequent re-site ~72hrs
  • Nutrient delivery limited by osmolarity and conc
    • Burning, welling, pain
    • 900mOsmol
36
Q

central pros and cons
Post-a-cath > peripheral central > tunnelled central > Non-tunneled central

A

pros

  • Position of catheter tip is large bore blood vessel
    • Distal superior vena cava, inferior vena cava, right atrium)
    • Dilutes high osmolarity, more tolerable
  • Used for longer term care (less re-site >2wks)

cons
* Larger tube
* Fluid restricted, can use hypertonic sol

37
Q

Post-a-cath > peripheral central > tunnelled central > Non-tunneled central

A

Post-a-cath, sc port: implant port, near clavicle, for chemo pts

peripheral central PICC: arm to large vessel

tunnelled central veous catheter: lower infection risk

Non-tunneled central venous catheter: short live for 2wks, high risk infection

38
Q

commercial vs customised formulation

A

Commercial (can add more of specific electrolytes) vs customised formula ( adjust ratio of macromolecules for pt tolerability)

39
Q

Composition of PN

(concern for ___)

A
  • Nutrition in simplest, most elemental form [stored in separate components]
    ○ Dextrose solution/ AA + electrolytes / Lipid emulsion
  • Admixture of multiple components
    Concern: stability, compatibility especially for
    □ Ca, P – high conc will ppt
    □ Lipid – pH unstable
    □ Dextrose – acidic, pH 2-
40
Q

Drug-nutrient interaction in PN considerations

A
  • Not problem if administer via separate lumens of same access device
  • Admixture vs Y site compatibility
  • TPN (total parenteral nutrition) vs TNA (total nutrition admixture)

Admin of incompatible drugs may cause (ppt, loss of drug activity, phase separation of lipid emulsion, toxicity)

41
Q

Admixture vs Y site compatibility

A
  • Admix: mix in the bag, more likely to have interaction
  • Y site: single lumen but no interaction between lines (separate), still need check for potential DNI
       *  Can consider dual/ triple lumen catheter (only mix in venous large vein is highly diluted)*
42
Q

TPN (total parenteral nutrition) vs TNA (total nutrition admixture)

A

TPN: nutrient fat w/o fat — lipid is more incompatible with more drugs

TNA: every component inside

43
Q

Prevention and mitigation of DNI in PN

A
  • Admin via separate peripheral IV cannula
  • If need: pause PN admin, flush access device before and after drug admin before resume PN infusion
44
Q

device related complications for PN

A
  • Occlusion in IV catheter
    ○ Thrombosis/ clotting
    ○ Inapp flushing techniques
    ○ Ppt from drug incompatibility, crystallization (Ca, P)
    ○ Lipid residues
  • Mal-position
  • Catheter-related bloodstream infection (need aseptic infusion technique)
45
Q

metabolic complications with PN

A

○ Refeeding syndrome
○ Hyper/hypogly (as glucose injected directly into blood stream)
○ Fluid overload (direct into blood stream)
○ Intestinal failure associated liver disease (IFALD)
○ Metabolic bone disease (osteomalacia, soteoporosis in LT)

46
Q

Intestinal failure associated liver disease (IFALD) 3 main causes

A

associated with long nil-by-mouth.

  1. Lack of CCK (no stimulation of gallbladder –> cholestasis)
  2. Oversuppl fats and dextrose accumulate in liver –> fatty liver
  3. Type of TG administered (MCT, LCT oils – provide essential FA).
    • LCT is pro-inflammatory marker –> lead to liver damage
    • Consider using fish oil based (anti-inflamm but insuff essential oils so not given solely) > olive oil based > soybean based (LCT)
47
Q

refeeding syndrome pathophysiology

A
  1. Starvation, malnutrition
    a. Body breaks down protein, fat, mineral, electrolytes, vitamin. Depletion from intracellular stores (muscles, fats).
    b. Salt and water intolerance from reduction in renal excretion
    c. Serum electrolytes may appear normal
  2. Refeeding (body switch to anabolism)
    a. Insulin secretion to incr glucose, K, Mg, PO4 uptake.
    b. Increase protein and glycogen synthesis for storage
  3. Imbalance
    a. Cells will produce energy (use up thiamine) and take back what was depleted (K, Mg, PO4) from bloodstream
    □ Drastic drop
    □ 1 ATP produced = 3 mmol PO4 used (hallmark)
48
Q

refeeding syndrome markers

A

hypoK (3.5 - 5.0mmol/L)
hypoMg (0.75 - 1.07 mmol/L)
hypoPHOSPHATASEMIA (0.85 - 1.45mmol/L)

thiamine deficiency (vit B1)

  • Salt and water retention –> oedema
49
Q

management

A
  1. Identify high risk pts
  2. Check serum electrolytes at baseline
  3. Correct deficiencies prior to feeding. DEFER if critically low
  4. Administer vit B1, thiamine supplement
  5. Initiate feeding slowly, gradual increase next few days to meet nutritional requirements
  6. Continue monitor electrolytes as feeding progresses, adjust amount of replacements needed
50
Q

high risk pts for refeeding syndrome

A

≥1

  • BMI< 16kg/m2
  • intentional weight loss >15% in past 3-6m
  • little or no nutritional intake > 10d
  • low level K, Mg, Phosphate before feed

≥2

  • BMI <18.5 kg/m3
  • unintentional weight loss >10% in past 3-6mnths
  • little or no nutritional intake >5d
  • hx of alc misuse of drugs, insulin, antacids, chemo, diuretics
51
Q

thiamine suppl

A

between 25mg and 100mg, taken once a day.

Severe thiamine deficiency. The usual dose for adults is 100mg, taken 2 or 3 times a day.

PR4152 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions