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CDM 2 Exam 3 > Lecture 5 - Enteral Nutrition > Flashcards

Lecture 5 - Enteral Nutrition Flashcards

1
Q

Goals of nutrition support

A
  1. Provide consistent nutrition support
  2. Prevent deficiencies
  3. Provide adequate nutrition to meet metabolic needs
  4. Avoid complications
  5. improve patient outcomes
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2
Q

Assessment of Nutritional Status

A
  1. Growth Curves
  2. Intake/output
  3. Weight
  4. Anthropometric measurements
  5. Visceral proteins
  6. 24hr urine studies
  7. Immune function tests
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3
Q

Methods to Calc fluid requirements

A

Method 1:
Young healthy adult = 40mL/kg/day
other adult = 35mL/Kg/day
Elderly = 25mL/kg/day

Method 2:
> 50yrs old, 1500ml + 20ml/kg for each kg > 20
< 50yrs old, 1500ml + 15ml/kg for each kg > 20

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4
Q

Harris Benedict Formula

A

BMR (men):
66 + 13.7wt(kg) + 5Ht(cm) - 6.8(age)

BMR(women):
655 + 9.6Wt(kg)+1.8(Ht) -4.7(age)

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5
Q

Actual Energy Expenditure

A

BMR X activity factor X injury (stress) factor

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6
Q

Activity Factors

A

Bed Rest = 1
Ambulatory = 1.3
Fever = 1.13

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7
Q

Risk Factors

A 
Starvation = 0.7
Surgery = 1.2
Trauma (severe) = 1.35
Head Injury = 1.5
Sepsis = 1.6
Burn < 40% TBSA = 1.5
Burn > 40% TBSA = 2.1
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8
Q

If patient is obese then use….

A

adjusted bodyweight

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9
Q

If over feeding pt (> 40kcal/kg/day) can lead to..

A

Fatty liver
Hyperglycemia
Prolonged mechanical ventialtion 2 excess CO2 production

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10
Q

Indirect Calorimetry

A

Gold standard
Measure O2 consumption + CO2 produced
Done for severe hours
Also determines respiratory quotient

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11
Q

RQ levels

A

0.85 = goal
> 09 = suggest overfeeding
0.7 = predominate fat utilization

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12
Q

Carb ino

A
  1. Limited storage capacity
  2. Preferred fuel source for CNS,renal medulla
  3. Enteral carb = 4kcal/g, IV dextrose = 3.4kcal/g
  4. Recommended 45-60% of total calories
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13
Q

Fat info

A
  1. major endogenous fuel source
  2. 9kcal/g
  3. contains essential fatty acids, Omega 6/3
  4. Typically 10-35% of total daily calories
  5. Deficiency triene:tetraene ratio > 0.2
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14
Q

Protein daily intake

A

Health adult = 0.8g/kg/day

Severe burn pt = 2g/kg/day

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15
Q

Typical nutritional requirements for healthy adult

A

Calories: 25-30kcal/kg/day
Protein: 0.8-1g/kg/day
Fluids: 30ml/kg/day

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16
Q

Surgical patients at risk for…

A

increased risk of malnutrition

  1. inadequate intake
  2. surgical stress
  3. increased metabolic rate
  4. wound healing = anabolic state
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17
Q

Strongest predictor of surgical outcomes is….

A

Inverse relationship between pre op albumin lvls and morbidity and mortality

Takes awhile to increase due to 1/2life….~20days
Acute phase response, check with CRP

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18
Q

Prealbumin

A

shorter 1/2life than albumin, so can asses acute changes in nutritional status

tests more expensive

Check with CRP

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19
Q

Other ways to assess nutritional success?

A

Nitrogen balance

Protein intake gm/6.25 - (UUN + 4) = balance in g

Positive value = Intake of N2 > losses = good
Negative value = Intake of N2 < losses = bad

20
Q

Traditional Post OP nutritional Care

A
  1. when to restart “house” diet depends on condition of GI tract
  2. oral feeding delay 24-48hrs post op
  3. Start clear liquids when bowel function returns…shouldn’t be on this for more than a few days
21
Q

Enteral Nutrition

A
  1. used when oral intake is inadequate or CI
  2. Utilizes delivery of nutrition via a tube into GI tract
  3. ** req functional GI tract **
22
Q

Indications for Enteral nutriton

A
  1. prev malnourished patient unable to eat for > 5-7days
  2. Adequately nourished pt unable to eat > 7-9days
  3. adaptive phase of short bowel syndrome
23
Q

CI to Enteral nutrition

A
  1. Severe acute pancreatitis
  2. High output enteric fistula distal to feeding tube
  3. Severe GI dysfunction
  4. Inability to obtain access
  5. Intractable V/D
  6. expected need < 5 days malnourished or <7-9days normally nourished
24
Q

Benefits of Enteral nutrition

A
  1. Prevents guy atrophy
  2. preserves guy barrier function
  3. decreases bacterial translocation
  4. promotes peristalsis
  5. Less expensive than parenteral nutrition
25
Q

Typical EN patients….

A

Functional GI tract

Inadequate oral intake

26
Q

Conditions where EN used

A
  1. impaired nutrient digestion
  2. inability to consume adequare oral nutrition
  3. malabsorption
  4. impaired metabolism
  5. severe wasting/growth retardation
27
Q

NG Tube

A
  1. Short Term
  2. Intact gag reflex
  3. Normal gastric function
  4. low aspiration risk
  5. easy tube placement, no surgery required
  6. allows for bolus/intermittent feedings
28
Q

G tubes

A
  1. surgically placed directly into stomach
  2. long term, > 30days
  3. allows for bolus/intermittent or continuous feedings
29
Q

PEGs

A
  1. placed through endoscope
  2. Different kinds, G/J tubes
  3. Allow for gastric decompression and simultaneous JT feedings
  4. tube in intestine not stomach
30
Q

Standard formula

A 
Polymeric
Normal/minimally impaired digestion
Required absorption
Intact protein
meal replacement
May contain fiber
31
Q

Hydrolyzed formula

A

for GI compromise
Improved digestion
Protein typically small peptides

32
Q

Elemental

A 
Limited GI function
minimal residue
Protein is free amino acid
minimal fat or high % MCT oil
\$\$$, taste bad tho
33
Q

Disease specific formulas

A

signed for specie organ dysfunction or metabolic abnormality

may or may not be nutritionally complete

34
Q

Methods of EN delivery

A

Bolus
gravity
pump = if small bowels

35
Q

G tube feeding

A

Continuous 1st
Start 30ml/hr, advance in 20ml q8hrs to goal volume

Bolus
start 120ml bolus, inc by 60ml q bolus to goal, freq = q3-8hrs

check for residuals

36
Q

Small bowel J tube feeding

A

continuous feeding only

start 20ml/hr, inc 20ml hrs to goal

dont check for residuals

37
Q

Gastric residuals

A

Check q 6hrs

If > 150ml, replace residual, old feeds X 4hrs and recheck
If < 150ml, restart
if still more than 150, continue to hold

38
Q

Monitoring G tube feedings

A

Gastric residuals
Blood sugar
Complete chem panel q weekly
Check albumin, prealbumin q week

39
Q

Aspiration precautions

A
  1. Keep head of bed > 30deg all time

2. *don’t use blue dye to test for aspiration

40
Q

Complications of EN

A
  1. access
  2. administration
  3. GI
  4. Metabolic
  5. Psychologic
41
Q

Mechanical complications of Tubes

A
  1. inadvertent tube removal
  2. tube kinking
  3. clogging
  4. inadvertent intubation
  5. leakage of gastric contents into the abdomen
42
Q

Infectious complications of tubes

A

Aspiration pneumonia, Risk = altered mental status, GI dysmotility, prevent b keeping head of bed elevated

Percutaneous tube site infections
Upper respiratory infections

43
Q

Diarrhea info

A

Major cause of EN interruption

Maybe due to meds

C.diff prone

Management - switch to peptide-based or semi-elemental formula…add fiber

44
Q

Medication admin with tube

A
  1. Liquid form when available
  2. Dilute thick meds
  3. Watch Sorbital content**
  4. Crush tab, mix with water to form slurry
  5. Flush tube w/ water before and after giving dose, 1 at time
  6. Dont Mix meds with feeding
45
Q

Determining EN prescription

A
  1. Estimate calorie, protein,fluid needs
  2. select most appropriate EN formula
  3. Determine route
  4. determine method (continuous vs bolus)
  5. Determine goal rate/volume

CDM 2 Exam 3 (13 decks)

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