Medical nutrition therapy: Enteral nutrition *** Flashcards
How is an inadequate oral food intake defined?
- When a patient is unable to eat for > 7 days.
- When the intake is less than 60% of recommended intake for > 10 days.
It’s a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat free mass and body cell mass) leading to diminished physical and mental function and impaired clinical outcome from disease:
Malnutrition
What are some options to improve the nutritional intake?
- Dietary counselling, conventional food, and oral nutritional supplements (ONS).
- Tube feeding: May be required when patients are unable to consume sufficient nutrition via the oral route.
- Parenteral nutrition: Will be needed in cases of severe gut dysfunction, when nutrition given orally or via tube feeding is not an option.
What nutritional management is used in the oral strategies?
Food and oral nutritional supplements.
What nutritional management is used in the enteral strategies?
Tube feeding.
What nutritional management is used in the IV strategies?
Parenteral nutrition.
What factors must be taken into account to decide which method of nutritional management to use?
- The goals of care.
- The patient’s nutritional needs.
- Ability to eat.
- Diagnosis and prognosis.
- Ability to adhere to the intervention.
What are the four generalized levels of protection for the GI tract?
- The stabilizing influence of the normal intestinal bacterial flora.
- Mechanical defenses.
- Immunologic defenses.
- The gut-liver axis.
What are the important advantages of enteral feeding?
- The stimulation of the intestinal cells to preserve its integrity and the gut barrier function.
- It is economic, safe, efficient and it has been found to improve the patient’s outcome.
- Maintains the barrier function to avoid the bacterial translocation.
What are the indications for enteral nutrition?
Patient with difficulty eating for whatever reason:
- Unconscious patient.
- Swallowing disorder.
- Partial intestinal failure.
- Physiological anorexia.
- Increased nutritional requirements.
- Psychological problems: Severe depression or anorexia nervosa.
Nutrition therapy given via a tube or stoma into the intestinal tract distal to the oral cavity, indicated when a patient has difficulty eating for whatever reason:
Enteral tube feeding.
What are the contraindications for enteral nutrition?
Insufficient gastrointestinal function, or severe metabolic and circulatory instability.
What are the different routes of enteral feeding?
- Nasoenteric tube.
- Gastrostomy tube.
- Jejunostomy tube.
How is short-term enteral nutrition usually defined as?
Use less than 4 weeks.
How is long-term enteral nutrition usually defined as?
As use for more than 4 weeks.
Which option for enteral access feeding would be best suited with normal gastric motility for short term?
Nasogastric
Which option for enteral access feeding would be best suited with normal gastric motility for long term?
Gastrostomy
Which option for enteral access feeding would be best suited without normal gastric motility for short term?
Nasoduodenal or nasojejunal.
Which option for enteral access feeding would be best suited without normal gastric motility for long term?
Jejunostomy
What are the different enteral feeding methods?
- Continuous
- Bolus
- Intermittent
- Overnight
Which enteral feeding method involves hourly administration of EN over 24 hours assisted by a feeding pump or by gravity?
Continuous
Which enteral feeding method involves the administration of EN over a 4-10 minute period using a syringe or gravity drip?
Bolus
Which enteral feeding method involves administration of EN over 20-60 minutes every 4-6 hours via pump assist or gravity assist?
Intermittent
In which enteral feeding method the feed is given overnight to allow freedom during the day, assisted by a feeding pump or by gravity?
Overnight
Which enteral feeding method may be more beneficial to critically ill patients?
Intermittent or bolus feeding.
Which enteral feeding method may be more beneficial to medically stable patients?
Bolus feeding: Is favored with respect to practical factors, such as cost, convenience, and patient mobility.
What are the three types of oral nutritional supplement (ONS) formulas for enteral nutrition (EN)?
- Nutritionally complete ONS.
- Nutritionally incomplete ONS.
- Disease-specific ONS.
What are the different categories of commercially prepared products for EN?
- Polymeric formulas.
- Oligomeric and monomeric formulas.
- Special formulas (disease specific).
- Modular diets.
- Other
Which type of commercially prepared EN product is the ‘‘standard’’ approach to enteral nutrition and nutritionally complete?
Polymeric formulas.
Which type of commercially prepared EN products contain macronutrients that have been enzymatically hydrolyzed to varying degrees, require minimal digestion and are almost completely absorbed?
Oligomeric and monomeric enteral formulas.
Which type of commercially prepared EN products contain free amino acids, glucose, oligosaccharides and small but variable amounts of lipids, usually medium chain triglycerides (MCTs) and/or essential fatty acids?
Monomeric formulas.
Which type of commercially prepared EN products contain nitrogen composed mainly by dipeptides and tripeptides with varying amounts of free amino acids, carbs provided by disaccharides and maltodextrins, and lipid content made up of long chain triglycerides (LCT), source of u-3 and u-6 essential fatty acids, in association with MCTs as a source of energy?
Oligomeric formulas.
For what diseases do special commercially prepared EN formulas (disease specific) exist?
For liver disease, renal disease, diabetes, pulmonary insufficiency, heart failure, GI dysfunction as well as situations of metabolic stress such as trauma or sepsis.
Which type of commercially prepared EN products contain macronutrients either as single agents or in combination?
Modular diets.
What concept refers to the use of blended foods and liquids given directly via the feeding tube?
Blenderized tube feeding (BTF).
It’s a safe, effective and generally well-tolerated means of administering nutritional therapy to patients with a normally functioning gastrointestinal system:
Enteral nutrition (EN).
How can the complications of EN be classified?
As primarily gastrointestinal, mechanical and metabolic.
*Most are avoidable or the result of errors in its application.
What are some complications of EN?
- Food entering the lungs.
- Constipation
- Diarrhea
- Improper absorption of nutrients.
- Nausea & vomiting.
- Dehydration
- Electrolyte abnormalities.
- High blood sugar, vitamin and mineral deficiencies, and decreased liver proteins.
What are some mechanical complications of EN?
- Pulmonary aspiration.
- Tube malposition.
- Tube clogging.
- Irritation of the skin.
What are some GI complications of EN?
- Nausea and vomiting.
- Diarrhea
- Constipation
- Distention
What are some metabolic complications of EN?
- Dehydration
- Hyperhydration
- Hyperglycemia
- Electrolyte imbalance.
- Refeeding syndrome.
Which is a clinical manifestation of a milder form of refeeding syndrome?
Hypophosphataemia
Who is at high risk of developing a refeeding syndrome?
- Patients with severe chronic malnutrition.
- Those with anorexia nervosa.
- Chronic alcoholics.
- After prolonged fasting (hunger strikers).
How can the refeeding syndrome be prevented?
- By close monitoring of vital functions, fluid balance, plasma and urinary electrolytes and blood gases.
- Before onset of nutritional support electrolyte and fluid deficiencies must be corrected.
What are some risks and disadvantages of BTF?
- Bacterial contamination.
- Mechanical issues.
- Nutritional deficiencies.
- Cost
- Greater labor.
Who makes a good candidate for BTF?
- Medically stable patient with stable growth.
- ≥ 14 Fr feeding tube.
- Bolus feeds
- Motivated family.
- Adequate resources and equipment (high-grade blender, refrigerator, electricity, access to clean water and food, storage containers).
- Access to knowledgeable medical providers.
What are some potential contraindications of BTF?
- Acute illness or immunosuppression: Greater risk of infection from contaminated food.
- Fluid restrictions: May be difficult to meet nutrient needs.
- Continuous feedings: Requires formula to be unrefrigerated for several hours.
