Medical Nutrition Therapy - R. Enteral Nutrition (p. 30-31), S. Peripheral Parenteral Nutrition (p. 32), T. Parenteral Nutrition (p. 32-33) Flashcards
Form of administration of tube feeding characterized by being produced in a specific area in which powder or liquid industrialized nutrients are mixed to obtain the desired composition. It allows the specification of EN in terms of diet composition (volume, calories, macronutrients, and micronutrients).
Open-system
Form of administration of tube feeding (AKA ready-to-use) consists of industrialized, sterile, liquid diets packed in bags ready to be administered. This eliminates critical stages of the preparation process in health facilities, which reduces the risk of contamination and, therefore, infection-if properly used. They are standardized in composition and volume, making it difficult to meet the specific dietary requirements of each patient.
Closed-system
The number of dissolved particles in a fluid. Concentration of substances ie. Na, K, Glucose…
Osmolality
A _______ ______ EN formula is used in patients with normal GI function.
They are initiated at full strength at rate of 10-40 mL/hr.
The least expensive formulas are made with intact protein (NOT pre-diested), and are isotonic (similar osmolality to blood).
Standard polymeric
Elemental formulas are composed of:
_________ (pre-digested protein)
_______ or ______
Little ______
Vitamins, Minerals, and Electrolytes
Elemental formulas are composed of:
AMINO ACIDS (pre-digested protein)
GLUCOSE or SUCROSE
Little FAT
Vitamins, Minerals, and Electrolytes
The more specialized the formula, the more $$
Nepro, Novasource Renal: ________
Nutre, Pumocare, Respalor (high fat, low carb): ________
Hepatic Aid II, NutriHep: _______
Glucerna, DiabetiSource: _________
Renal, Pulmonary, Liver, Diabetes
Feeding tube ______, or opening size, is based on the __________, or thickness, of feeding.
Tube Bore (opening)
Based on viscosity (thickness) of feeding
Tube bore sizes
Large #16 for __________ _______ _______
Small #8 for _____ _______ ________
Large #16 for blenderized, whole foods
Small #8 for ready-prepared formulas
The length of time a formula is considered safe for delivery is _________ ________.
Hang time
Hang time for:
Open systems: __ hours
Closed systems: ___ - __ hours
Hang time for:
Open systems: 4 hours
Closed systems: 24-48 hours
Short-term EN access (3-4 wks) - use ___________ tube (normal GI function).
Nasogastric
Short-term use, Normal GI function
If unable to tolerate gastric feedings, ___________ or ____________ feeds may be indicated.
If unable to tolerate gastric feedings, nasoduodenal or nasojejunal feeds may be indicated.
Tube feed route that passes the pyloric valve in the stomach and into the SI.
Transpyloric
The transpyloric route is used in patients who are __________ or have no ____ reflex.
Transpyloric - used in patients who are comatose or have no gag reflex
If tube feed needed for more than 3-4 weeks, use _________ or __________.
Gastrostomy or Jejunostomy
(PEG/PEJ)
[Do/Do not] use blue dye to check tube placement.
Do NOT use blue dye to check tube placement.
EN: Provide __ cc water / calorie ingsested.
EN: Provide 1 cc water / calorie ingsested.
With initiation of EN, check gastric residuals every __ hours for the first 24 hours.
If GRV >___, consider promotility agent.
If GRV >500 mL, hold TF and assess tolerance.
With initiation of EN, check gastric residuals every 4 hours for the first 24 hours.
If GRV >250, consider promotility agent.
If GRV >500 mL, hold TF and assess tolerance.
Short-term PN through peripheral veins. Minimal effect on nutritional status.
Peripheral Parenteral Nutrition (PPN)
To determine calories in dextrose solution:
(mL) x (% dextrose) x (3.4)
Intravenous Fat Emulsion (intralipid)
10%: __ cal/cc
20%: __ cal/cc
10%: 1.1 cal/cc
20%: 2 cal/cc
Infusion of a hypertonic solution delivered through a central venous catheter.
Used to achieve an anabolic state when patient is unable to eat PO and EN is not possible.
Parenteral Nutrition (TPN)
TPN used for :
Altered __ function
Impaired ____ utilization
Altered GI function
Impaired nutrient utilization
(inability to absorb nutrients, malabsorption, peritonitis, intestinal obstruction, short bowel syndrome, hypermetabolic states, cancer patients on therapy, fistulas, acute pancreatitis, critical care pts if NPO >4-5 days and EN not feasible)
______ or _______ term infusion is via PICC (peripherally insetered central catheter).
________ term infusion through cephalic, subclavian, or internal jugular vein –> superior vena cava.
PICC used for short or moderate term infusion.
Long term through cephalic, subclavian, or internal jugular vein –> superior vena cava.
__________ _______ _______ is a major concern with TPN.
*Translocation of bacteria
When the gut is not used, it breaks down. Bacteria leave the GI–>bloodstream, causing SEPSIS.
GALT (gut-associated lymphoid tissue) is ALSO COMPROMISED by ______ ______ as in TPN. It provides 50% of total body immunity.
Bowel rest
The protein ratio needed for ________ (+ Nitrogen balance) is 1 g Nitrogen / 150 calories.
(1.0-1.5 g/kg)
The protein % = the number of g protein / 100 mL solution.
(ie. 3% solution has 3 g AA / 100 mL.)
The protein ratio needed for anabolism (+ Nitrogen balance) is 1 g Nitrogen / 150 calories.
TPN-
*Maximum rate of dextrose infusion should not exceed 4-5 mg/kg/min to prevent _______.
*Maximum rate of dextrose infusion should not exceed 4-5 mg/kg/min to prevent HYPERGLYCEMIA.
TPN-
___ is needed for energy and to prevent essential fatty acid deficiency (EFAD).
Fat
To prevent _____, give 500 cc 10% lipid emulsion 1-2x/week.
_____ symptom: petechiae (red spots)
EFAD
*Transitional feeding from TPN–>EN
- Introduce a minimal amount of FULL STRENGTH EN at low rate (30-40 mL/hr) - to establish GI tolerance.
- Decrease PN as Increase EN, by 25 mL/hr increments every 8-24 hours - to maintain nutrient levels
- When patient tolerating 75% of EN, D/C PN
**
- Introduce a minimal amount of FULL STRENGTH EN at low rate (30-40 mL/hr) - to establish GI tolerance.
- Decrease PN as Increase EN, by 25 mL/hr increments every 8-24 hours - to maintain nutrient levels
- When patient tolerating 75% of EN, D/C PN
Syndrome associated with aggressive adminstration of nutrition in the malnourished.
Ie. Anorexia, chronic alcoholism, prolonged fasting, significant weight loss, phosphorous deficient
Re-feeding syndrome
In re-feeding syndrome, starved cells take up nutrients - _____ and _____ SHIFT into INTRACELLULAR COMPARTMENTS.
Electrolyte imbalance–>cardiac arrythmias.
POTASSIUM and PHOSPHOROUS
**Re-feeding syndrome results in:
________
________
________
*HYPOKALEMIA
*HYPOPHOSPHATEMIA
*HYPOMAGNESEMIA
Overfeeding and dextrose >5 mg/kg/d may lead to _____.
Hyperglycemia
