Medical Nutrition Therapy - R. Enteral Nutrition (p. 30-31), S. Peripheral Parenteral Nutrition (p. 32), T. Parenteral Nutrition (p. 32-33)

Question 1

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).

Answer 1

Open-system

Question 2

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.

Answer 2

Closed-system

Question 3

The number of dissolved particles in a fluid. Concentration of substances ie. Na, K, Glucose…

Answer 3

Osmolality

Question 4

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).

Answer 4

Standard polymeric

Question 5

Elemental formulas are composed of:

_________ (pre-digested protein)

_______ or ______

Little ______

Vitamins, Minerals, and Electrolytes

Answer 5

Elemental formulas are composed of:

AMINO ACIDS (pre-digested protein)

GLUCOSE or SUCROSE

Little FAT

Vitamins, Minerals, and Electrolytes

Question 6

The more specialized the formula, the more $$

Nepro, Novasource Renal: ________

Nutre, Pumocare, Respalor (high fat, low carb): ________

Hepatic Aid II, NutriHep: _______

Glucerna, DiabetiSource: _________

Answer 6

Renal, Pulmonary, Liver, Diabetes

Question 7

Feeding tube ______, or opening size, is based on the __________, or thickness, of feeding.

Answer 7

Tube Bore (opening)

Based on viscosity (thickness) of feeding

Question 8

Tube bore sizes

Large #16 for __________ _______ _______

Small #8 for _____ _______ ________

Answer 8

Large #16 for blenderized, whole foods

Small #8 for ready-prepared formulas

Question 9

The length of time a formula is considered safe for delivery is _________ ________.

Answer 9

Hang time

Question 10

Hang time for:

Open systems: __ hours

Closed systems: ___ - __ hours

Answer 10

Hang time for:

Open systems: 4 hours

Closed systems: 24-48 hours

Question 11

Short-term EN access (3-4 wks) - use ___________ tube (normal GI function).

Answer 11

Nasogastric

Question 12

Short-term use, Normal GI function

If unable to tolerate gastric feedings, ___________ or ____________ feeds may be indicated.

Answer 12

If unable to tolerate gastric feedings, nasoduodenal or nasojejunal feeds may be indicated.

Question 13

Tube feed route that passes the pyloric valve in the stomach and into the SI.

Answer 13

Transpyloric

Question 14

The transpyloric route is used in patients who are __________ or have no ____ reflex.

Answer 14

Transpyloric - used in patients who are comatose or have no gag reflex

Question 15

If tube feed needed for more than 3-4 weeks, use _________ or __________.

Answer 15

Gastrostomy or Jejunostomy

(PEG/PEJ)

Question 16

[Do/Do not] use blue dye to check tube placement.

Answer 16

Do NOT use blue dye to check tube placement.

Question 17

EN: Provide __ cc water / calorie ingsested.

Answer 17

EN: Provide 1 cc water / calorie ingsested.

Question 18

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.

Answer 18

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.

Question 19

Short-term PN through peripheral veins. Minimal effect on nutritional status.

Answer 19

Peripheral Parenteral Nutrition (PPN)

Question 20

To determine calories in dextrose solution:

Answer 20

(mL) x (% dextrose) x (3.4)

Question 21

Intravenous Fat Emulsion (intralipid)

10%: __ cal/cc

20%: __ cal/cc

Answer 21

10%: 1.1 cal/cc

20%: 2 cal/cc

Question 22

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.

Answer 22

Parenteral Nutrition (TPN)

Question 23

TPN used for :

Altered __ function

Impaired ____ utilization

Answer 23

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)

Question 24

______ or _______ term infusion is via PICC (peripherally insetered central catheter).

________ term infusion through cephalic, subclavian, or internal jugular vein –> superior vena cava.

Answer 24

PICC used for short or moderate term infusion.

Long term through cephalic, subclavian, or internal jugular vein –> superior vena cava.

Question 25

__________ _______ _______ is a major concern with TPN.

Answer 25

*Translocation of bacteria

Question 26

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.

Answer 26

Bowel rest

Question 27

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.)

Answer 27

The protein ratio needed for anabolism (+ Nitrogen balance) is 1 g Nitrogen / 150 calories.

Question 28

TPN-

*Maximum rate of dextrose infusion should not exceed 4-5 mg/kg/min to prevent _______.

Answer 28

*Maximum rate of dextrose infusion should not exceed 4-5 mg/kg/min to prevent HYPERGLYCEMIA.

Question 29

TPN-

___ is needed for energy and to prevent essential fatty acid deficiency (EFAD).

Answer 29

Fat

Question 30

To prevent _____, give 500 cc 10% lipid emulsion 1-2x/week.

_____ symptom: petechiae (red spots)

Answer 30

EFAD

Question 31

*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

Answer 31

**

• 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

Question 32

Syndrome associated with aggressive adminstration of nutrition in the malnourished.

Ie. Anorexia, chronic alcoholism, prolonged fasting, significant weight loss, phosphorous deficient

Answer 32

Re-feeding syndrome

Question 33

In re-feeding syndrome, starved cells take up nutrients - _____ and _____ SHIFT into INTRACELLULAR COMPARTMENTS.

Electrolyte imbalance–>cardiac arrythmias.

Answer 33

POTASSIUM and PHOSPHOROUS

Question 34

**Re-feeding syndrome results in:

________

________

________

Answer 34

*HYPOKALEMIA

*HYPOPHOSPHATEMIA

*HYPOMAGNESEMIA

Question 35

Overfeeding and dextrose >5 mg/kg/d may lead to _____.

Answer 35

Hyperglycemia