Krause ch 13: Nutr support Flashcards
what is EN?
nutr provided thru GI tract via catheter/tube or stoma that delivers nutrients distal to oral cavity
in ICU pt, feeding the GIT has been shown to attenuate ____ and preserve ____ function
catabolic response; immune
less septic morbidity, infectious complications, cost in critically ill who receive ____ instead of ___
EN; PN
undesirable risks/outcomes referred to as:
sentinel events
EN access selection depends on:
1) anticipated length of time required 2) degree of risk for aspiration/displacement 3) clinical status 4) adequacy digestion/absorption 5) pt anatomy 6) future surgery planned
one french size is ___ mm
0.33
potential complications of nasoenteric tubes
esophageal strictures, gastroesophageal reflux resulting in aspiration pneumonia, fistula, injury, mucosa damage, nasal irritation, paralysis, inflammation, varices, ulcerations
nonsurgical technique for placing tube directly into stomach thru ab wall using endoscope
PEG/PEJ
PEG tubes flush to the skin (low profile) known as:
buttons
PEG can be converted to ____ using fluoroscopy or endoscopy by threading small bore tube thru larger tube into jejumum
gastrojejunostomy
alternative options for EN access:
laparoscopic/fluoroscopic techniques
tubes used for pt where prolonged gastrointestinal decompression is anticipated
gastrojejunal dual tubes
how does multiple lumen tube work?
one lumen for decompression, one to feed into small bowel
blendereized (homemade) tube feeds are contraindicated for these pts:
immunocompromised, infusion thru tube smaller than 10 French, continuous feeding, fluid resctriction <900mL/d, multi food allergies, JT is used
what is PBGT diet?
specialized balanced blended food feeding given by g tube in small boluses to decrease symptoms of retching/gagging which can be complication of certain surgery, improve tolerance of bolus feeds for ppl who are volume sensitive
____ (a.a.) has been added to formulas marketed for critically ill pt
arginine
CHO in EN is usually ____ in standard, ___ in flavoured formulas, _____ for hydrolyzed
corn syrup solids; sucrose; cornstarch/maltodextrin
these prebiotics have been added to EN formulas in combo with diet fibre cuz stim production of beneficial bacteria (good changes in colon pH , microbiota, SCFA)
fructooligosaccharides (FOS)
elemental formulas contain less fat, usually in this form:
MCT
____ lipids are absorbed more readily/better tolerated than LCT/MCT combos
structured
does MCT have essential fatty acid?
nope
what is a fibre bezoar?
hard ball of hair/veg fibre that can develop in stomach
closed vs open EN system?
container is prefilled with sterile liquid formula by manufacturer, ready to feed after connection; contents of formula poured into separate empty container and then connected
length of time EN formula hanging at room temp is considered safe for delivery
hang time
how to do gravity feeding?
pour formula into feeding bag equipped w/ roller clamp, adjusted to desired drips per min.
pt with feeding tube tip in ____ should be fed ONLY by continuous or cyclic
small intestine
in critically ill tube fed pt the best methods for reducing aspiration risk is:
HOB elevation, continuous subglottic suctioning, oral decontamination
why predigested formula not best first line option for diarrhea?
formula often not cause of diarrhea
how can diarrhea and constipation coexist?
fecal impaction cuz liquid stool can get past impaction
CPN refers to catheter tip placement in ____ whereas PPN is catheter tip placement in ____
large, high blood flow vein (eg. superior vena cava); small vein (eg. hand/forearm)
ppl who are not good candidates for PPN?
volume-sensitive, cardiopulmonary, renal, hepatic failure
osmolarity is used to calculate ____ while osmolality is used for body fluids
IV fluids
PPn most often provided thru catheters called _____ catheters
midline; midclavicular
this type of catheter needs a large vein
extended dwell catheters
is single lumen or multi lumen catheter best for CPN?
single lumen
this catheter inserted into vein in antecubital area of arm, threaded into subclavian vein (catheter tip placed in superior vena cava)
peripherally inserted central catheter (PICC)
commonly used long term catheter for CPN?
tunneled catheter
a.a. conditionally essential in infants:
taurine
CHO in PN supplied as ___ which yields ____kcal/g
dextrose monohydrate; 3.4
max rate of CHO administration:
5-6 mg/kg/min (critically ill)
^ CHO admin can lead to:
hyperglycemia, hepatic probs, ^ ventilatory drive
lipid admin should not exceed ____g/kg/d
1-1.5
10% lipid emulsion contains ___kcal/mL, 20% has ___kcal/mL
1.1; 2
all lipid emulsions should be administered thru ___ micron filter set
1.2
monitoring of ____ and ___ status recommended for pt receiving PN >6 months
manganese; chromium
why iron not normally part of PN infusion?
not compatible with lipids, may enhance certain bacterial growth
PN solution can be ____ or use ___ bags
compounded; multichamber bags
most common drug additives to PN:
insulin; histamine-2 agonists
why not abruptly stop CPN with high dextrose concentration?
potential for rebound hypoglycemia
primary complication of PN?
infection
signs of infection:
tachycardia, sudden hyperglycemia, elevated WBC, chills, fever
maintenance of adequate BP is called:
hemodynamic stability
types of PN complications:
mechanical, infection/sepsis, metabolic, GI
why refeeding syndrome happen?
new tissue requires ^ amt glucose/K/P/Mg for growth but if intracell electrolytes not supplied sufficiently to keep up with growth, low serum K/P/Mg develop; also CHO metabolism cause shift of electrolytes to intracellular space as glucose moves into cell for oxidation
rapid infusion of CHO stim ___ release, which reduces ____ excretion and increases chance of cardio/pulmonary complications (fluid overload)
insulin; water/sodium
common nutr diagnoses for refeeding syndrome:
excessive CHO intake or excess infusion from EN or PN
initial oral diets in transitional feeds should be low in ____
simple CHO and fat, lactose (reduce chance osmotic diarrhea)
at least ___% of nutr needs should be met consistently by oral intake before PN d/c
75
why move from continuous feed to 12- and 8- hour formula admin cycle?
reestablish hunger/satiety cues for oral intake during day
fat sources in ONS are often ____
long chain TG
health care in LTC focuses on:
QoL, self determination, management acute/chronic disease
legal docs that residents use to state preferences about aspects of care, including those regarding use of nutr support
advance directives
best tube for home feed?
not nasal, use PEG (PEJ good for ppl who need postpyloric feedings)
best admin for home feed?
bolus (if not tolerated, then gravity)
