Lecture 19 Enteral Nutrition Flashcards
Malnutrition in hospital is exacerbated by several factors including….
- prolonged use of “NPO” or “nothing by mouth” for medical procedures and tests
- late identification of those at risk of admission
- conditions such as sepsis and multisystem organ failure
- medical therapies/medications which increase catabolism and or affect tolerance to gastriointestinal feeds
Subjective global assessment
SGA-A
SGA-B
SGA-C
A- well nourished
B- Mildly/moderately malnourished
C- Severely malnourished
What is nutrition support
Provision of nutrition via non-volitonal means
Required when patients are unable to meet their needs in the prescence of an increased metabolic domain
2 routes of nutrition support
Enteral ( oral/tubefeeding) or parenteral route
- enteral being the preferred route when possible
Goals of nutrition support
Assist with maintain or restoring nutritional status
Minimize effects of hypermetabolism
Promote wound healing
Assist with the body’s defense against infection
Reduce complications/mortality
Reduce hospital stay
How do you decide what to feed
Predictive equations ( height, weight sex, days since admission)
Indirect calorimetry - metabolic cart for inpatient setting and occasionally outpatient
What are indications for Enteral nutrition
Existing malnutrition and poor intake
Catabolic patients
Inability to eat
Impaired digestion/absorption
What are contraindications for Enteral nutrition
Nonoperative GI obstruction
Severe short bowel syndrome or malabsorption
Distal high output fistulas
Severe GI bleed
Inability to gain enteral access
Need for EN is < 7-9 days
Aggressive nutrition not warranted or desired
Prescribing mediation to enterally fed patients, must consider….
Anatomic site of delivery
Size of feeding tube
T/F stomach is able to tolerate more concentrated or hypertonic medications than the small bowel
True
What is an NG and when is it used
Used short term
Nasogastric
Larger in diameter, less likely to become occluded by meds, need to clarify if the tube is. For feeding or suction - med administration contraindicated if NG being used for suctioning gastric contents
NJ/ND, indications
Nasojejunal/duodenal
Indications: High risk of aspiration, gastric motility difficulties
Typically smaller diameter tube
If access is quite distal may affect absorption of medications even targeted to the small bowel
Tube occlusion in the setting of permanent tubes
Possible solutions
Liquid meds whenever possible
Alternative route if liquid N/A and alternative route practical
Proper water flushes pre and post medications
Enteral formula composition vary in amounts of …..
Protein,fat and carbs
Vitamins and minerals
Electrolytes
Free fluid
Fiber
What are the types of enteral formulas
Polymeric
Elemental/semi-elemental
Speciality
Modules
Closed system tube feeds
Ready to Hang
Potential reduces risk of contamination
Less nursing time
Drawback: increased wastage
Open system tube feeds
Can or tetrapak
Must pour into a feeding bag for delivery
Hang time of only 8 hours
Potential for increased contamination
4 different perspectives to consider when holding nutrition
- Nutritional perspective
- Nursing perspective
- Pharmacotherapeutic perspective
- Patient perspective
What are some medications of concern
Ciprofloxacin, levofloxacin, alendronate, synthroid
Dietician solutions
More concentrated enteral feed to lower the goal rate
Adjust goal rate to meet daily caloric needs
Monitor feed tolerance daily to ensure adequate nutritional delivery
Enetral nutrition monitoring
Biochemical parameters
Respiratory parameters
Gastrointestinal tolerance
Consistency of goal rate provision
Fluid balance
Interactions with EN
Contributing factors for GI symptoms
Affects of medications on fluid status
Blood sugar management
Affect of medications on micronutrient
