Lecture 6 Flashcards
1
Q
Enteral Nutrition
Related
Complications
A
GI Metabolic, pulmonary fluid status mechanical
2
Q
Gastrointestinal EN-Related Complications
A
Nausea and vomiting – Occurs in 7-26% of patients on EN • Increased risk of aspiration – Possible etiologies • Delayed gastric emptying / gastroparesis • Hypotension, hemodynamic instability • Stress, sepsis • Anesthesia / surgery • Medications (i.e. narcotics, sedation) • Very cold enteral formula
3
Q
Gastrointestinal EN-Related Complications
Interventions
A
Interventions ü Change EN formula • Low-fibre, low-fat ü Temporarily reduce the formula infusion rate ü If applicable, change feeding modality (i.e. from bolus to intermittent or continuous ü Use room temp feeds ü Liase with team re meds: • Reassess narcotics • Prokinetic agent?
4
Q
Prokinetic Agents
A
• “Prokinetic” = promote movement • Drugs that enhance GI motility – Various mechanisms of action • Stimulate gut motility, esophageal peristalsis, strengthen lower esophageal sphincter pressure to promote gastric emptying • Common prokinetic agents in Canada – Metclopromide (Maxeran®) – Domperidone – Erythromycin (antibiotic)
5
Q
Gastrointestinal EN-Related Complications
A
Abdominal distension – GI ileus – Bowel obstruction – Constipation / obstipation – Ascites – Initial use of high fibre feed
6
Q
Gastrointestinal EN-Related Complications Abdominal distension
Interventions
A
ü Testing to r/o (rule out)obstruction or ileus • Imaging • Abdominal x-ray • CT ü Hold feeds if necessary • Not necessary if intestinal appearance/function are normal and patient not experiencing pain
7
Q
Gastrointestinal EN-Related Complications
Malabsorption
A
– Signs and symptoms (s/s) • Weight loss • Steatorrhea • Diarrhea – Disease related • IBD (Crohn’s, Colitis) • Radiation enteritis • Enteric fistulas • Pancreatic insufficiency • Short bowel syndrome
8
Q
Gastrointestinal EN-Related Complications
Malabsorption
Interventions
A
Interventions
ü Trial (semi) elemental formula
ü (Supplemental) PN if
unresponsive to EN
9
Q
Gastrointestinal EN-Related Complications
Diarrhea
A
Incomplete absorption of fluid and electrolytes from lumen of GIT – No true definition • Abnormal volume & consistency • >500 mL/24h • 3 loose stools/d x 2d – Etiologies • Drugs • Disease, infection • Feeding formulas – Hyperosmolar – Lactose containing
10
Q
Types of Diarrhea
5
A
Secretory • Caused by abnormal ion transport in intestinal epithelial cells resulting in decreased electrolyte absorption
Osmotic • Excess amounts of poorly absorbed substances remain in GIT which obligate water retention 2o to osm
Malabsorption • Conditions resulting in malabsorption of nutrients
Inflammatory • Inflammatory bowel diseases • Infectious etiologies (i.e. C.diff)
Disordered Motility • Diabetic neuropathy • Irritable bowel syndrome • Postvagotomy etc.
11
Q
Conditions Associated with Secretory Diarrhea
A
• Clostridium difficile infection • Intestinal resection • Inflammatory bowel disease • Bile acid malabsorption • Chronic infections • Celiac sprue • Small intestinal lymphoma • Villous adenoma of the rectum • Zollinger-Ellison syndrome • Collagen vascular diseases • Congenital defects • Malignant carcinoid syndrome
12
Q
Enteral Formula
A
Hyperosmolar formulas – What types of formulas tend to be hyperosmotic? • Components of formulas or modulars – Lactose – Read the ingredients! – Clinical observation
13
Q
Managing Diarrhea: Other Nutrition Strategies
A
• Change formula type – Intact protein à peptides • Add soluble or insoluble fibre – Change EN formula – Fibre modular (i.e. Benefibre®) – Metamucil, pectin • Consider PN if warranted
14
Q
Gastrointestinal EN-Related Complications
A
Constipation – Also difficult to define • Physical s/s • Imaging (Abdo XR) – Common causes • Dehydration • Inadequate/excessive fibre • Medications • Immobilization
15
Q
Gastrointestinal EN-Related Complications
Constipation
Interventions
A
Interventions ü Ensure adequate hydration ü Switch to formula with fibre ü Ensure patient is on a “bowel routine” (i.e. medications prn) ü Mobilize patient • “Mobility = motility”
