Introduction to Enteral Nutrition Flashcards
EN may be contraindicated in the early post transplant period in adult patients with hematopoietic cell transplants because:
Potential mucosal toxicities related to the conditioning regimen
Early initiation of EN has been suggested to benefit ICU patients by educing infectious complications, LOS, and possibly reducing mortality. Which group of patients might be at significant risk from early EN?
Patients with increasing vasopressor support
What is an indication to place a gastrojejunostomy feeding tube?
Diabetic gastroparesis or any other delayed gastric emptying or obstruction
Tube feedings can be effectively used in which condition?
Open abdomen or any condition with a functioning gut
What is the best rationale for initiating EN?
It may be implemented in patients who cannot or will not eat adequately
In patients with pancreatitis, what are important to consider when predicting tolerance of EN?
APACHE II score, duration of NPO, abdominal pain
A diabetic patient presents with early satiety, bloating, occasional vomiting, and extensive weight loss. After a thorough GI workup the patient is diagnosed with gastroparesis. Which type of enteral formula would be more efficacious in the patient?
Concentrated, standard, polymeric
A patient is receiving EN during her second trimester of pregnancy. Nutritional assessment data reflects and average maternal weight gain of 0.42 pounds per week, normal fetal growth, and albumin of 2.0, and a nitrogen balance of +2 g/day. Based on the data, what parameters is not useful in assess the efficacy of EN in pregnancy?
Albumin
What is not a perceived benefit of early EN in critically ill patients?
increased intestinal permeability
What is the primary advantage of a PEJ vs a PEG?
Reduced incidence of migration
A patient admitted with TBI is determined to need EN for 3 weeks. What is the preferred method of feeding tube placement?
Nasoenteric (Nasogastric)
What is most often a contraindication of PEG placement?
Ascites
What is an advantage if g tube vs NGT?
it is appropriate for long term feeds
What is the least likely to be problematic for placement of PEG in liver disease patient?
Hep C
What is least likely to facilitate transpyloric placement of NGT?
Weighted tube tips
What intervention may assist with the appropriate placement of NGT in an alert patient?
Have the patient flex his head slightly forward
Compared to gastric feeds, small bowel feeds are associated with what outcome in critically ill patients?
Increased nutrient delivery
Placement of a j tube would not be beneficial for what patient?
Short bowel syndrome
What is the gold standard for determining proper placement of a feeding tube placed at bedside?
Radiographic confirmation
In patients with severe acute pancreatitis EN has been shown to decrease infection rate, decrease hospital stay and decrease mortality but not:
decrease pain.
Skin level or low profile enteral access have many desirable features including:
Can be capped when not in use
What is the most important intervention to reduce the risk of pulmonary aspiration during gastric tube feedings?
Elevate the head of bed 30-45 degrees
What medication has not been shown to lead to diarrhea in an EN patient?
Alpha2 adrenergic agonist
What EN formula is least likely to be contaminated with micro organisms?
Ready to hang formula
A 45 to male was admitted with chronic stg IV pressure ares, sepsis, and acute respiratory failure requiring mechanical ventilation. The patients BUN us stable, he has no additional GI losses via drains or tubes. A primary polymeric high protein formula was started on day 1 of admission. On day 7, the primary care team requested an evaluation of the protein dose provided by EN. It provides 130 grams (1.5 g/kg) protein per day. What is the best method to assess protein requirement adequacy?
Nitrogen balance study
Use of semi elemental formula in place of polymeric formula should be considered with:
Intolerance to polymeric formula
Use of an immune modulating formula may be beneficial in all patients except:
severe sepsis patient
What are examples of modular products?
MCT oil, glucose, fiber and protein
What would be the most appropriate tube feeding formula for a patient with extensive second and third degree burns?
High protein
Drugs in microencapsulated bead or pellet form are most effectively administered through large bore feeding tubes when mixed with:
Orange juice
What can be employed to reduce the risk of feeding tube occlusions?
Flush with water before and after medications
Tube feeding is often held before and after enteral administration of what medications?
Warfarin, ciprofloxacin, phenytoin
What is the maximum hang time for closed system enteral formulas
48 hours
A 74 yo pt with a hx of alzheimer’s dementia and dysphagia requiring EN, presents to the hospital with fever, hypotension, poor skin turgor and dry mucus membranes. He is 5’9” and 67 kg. He is receiving 1200 ml free water per day from EN and 400 ml from flushes. His estimated calorie need is 1800 kcals/day. How should his fluid needs be estimated?
30 ml/kg
a 56 yo female with dysphagia who is afebrile and weighs 60 kg is on a standard 1.0 formula at 180 ml/hr over 10 hours. What volume of water flushes would best meet her daily estimated needs?
300 ml
Lactose is a common ingredient in which type of formula?
Standard infant formula
What patient population would most likely have difficulty tolerating polymeric EN?
Chyle leak
What characteristic of enteral formulas is most likely to increase splanchnic blood flow in a critically ill patient?
High fat
Hospital preapred formula should be stored at what temperature?
4 C or 39 F
A 60 yo female is admitted with a stroke and fails a swallowing eval. A NGT is placed and the physician requests an isotonic formula. What is the calorie density of an isotonic formula?
1.0 kcal/ml
What is the best initial feeding regimen for a critically ill adult?
Full strength formula initiated at a low rate.
A patient with ARDS receiving EN will benefit most from:
Avoidance of overfeeding
The use of EN formulas enriched with BCAAs may benefit patients with:
Refractory encephalopathy
What medication would be appropriate to crush and deliver via feeding tube?
Medications that are not coated, time released like XL or CD
What describes the method of preparing and administering medications via a feeding tube?
crush individual tablets and mix with water prior to separate administration
