*Module 10: Enteral Flashcards
What is food?
Any nutritious substance that people or animals eat or drink, or that plants absorb, in order to maintain life and growth.
What is a dietary supplement?
A product that contains an ingredient intended to supplement the diet, including vitamins, minerals, herbs, or other botanicals.
What is food for special dietary use (FSDU)?
Food that’s specifically processed to meet a specific dietary needs of a person.
What is medical food?
Specially formulated food that’s intended to meet the nutritional needs of a specific disease or condition.
What is enteral nutrition delivery?
Feeding tube.
What is parenteral nutrition delivery?
Intravenous catheter.
What are the benefits of enteral nutrition (EN)?
Maintains gut integrity/normal function, efficient nutrient utilization, maintains normal gallbladder function (CCK), immune functions, reduced infectious complications, cost.
What are the indications for enteral nutrition (EN)?
Oral intake is impossible, inadequate or unsafe (ex: intubation), poor appetite associated with chronic medical condition or treatment, dysphagia, major trauma, burns, wounds and/or critical illness, preoperative patients who are severely malnourished.
What are the gastrointestinal risks of enteral nutrition (EN)?
Nausea/Vomiting/Diarrhea, abdominal distention, constipation.
What are the pulmonary aspiration risks of enteral nutrition (EN)?
Supine position, reduced level of consciousness, gastroparesis.
What are the metabolic complications risks of enteral nutrition (EN)?
Refeeding syndrome, hyperglycemia-glucose intolerance, dehydration.
What are the contraindications of enteral nutrition (EN)?
Bowel obstruction, bowel in discontinuity, active resuscitation, severe malabsorption syndromes, intestinal ischemia or bowel necrosis.
What is active resuscitation?
MAP <50 mmHg, worsening acidosis on vasopressor, ischemic bowel concerns, HOB <30 degrees, increasing or addition of vasopressor.
What is short-term enteral nutrition therapy?
< 4-6 weeks, using nasogastric (NG), nasoduodenal (ND), nasojejunal (NJ), or orogastric (OG) tubes.
What is long-term enteral nutrition therapy?
> 4-6 weeks, using percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic jejunostomy (PEJ), or gastrojejunostomy (G-J).
What is continuous feeding?
Administered with an enteral feeding pump over a set period of time with a constant rate, preferred in patients who are critically ill or have poor metabolic stability.
What is bolus feeding?
Administered via gastrostomy with a syringe or via gravity in <30 min, more physiologic because it resembles an oral diet.
What is intermittent feeding?
Delivered from an EN container or bag over 30 minutes to an hour, may benefit patients who do not tolerate bolus feeds.
What are cyclic enteral feedings?
Can be utilized to administer over <24 hour time period, allowing patients to attempt some oral intake during the day and minimize inconveniences associated with the pump and continuous feeds.
What are immediate release oral preparations and formulation advice for enteral administration devices (EAD)?
Film and enteric-coated tablets can be immediate release preparations but coatings can hinder the ability to crush the tablet into a fine powder.
What are modified release preparations and formulation advice for EAD?
Crushing a modified release preparation can release a total daily dose instantly, leading to toxicity and a lack of therapeutic coverage later on.
What are solutions and formulation advice for EAD?
Solutions are homogenous liquid mixtures wherein active medication is uniformly dissolved in a diluent, at risk for instability when given via EAD because of hydrolysis or oxidation.
What are suspensions and formulation advice for EAD?
Suspensions are heterogenous liquids that contain active medications floating in a liquid medium, can have med particles settle out, causing inadequate delivery.
What are the implications of tube type for drug administration?
Site of drug delivery, size of lumen and length of tube, function of the enteral tube, multilumen tubes, confirmation of position.
What are the tube feed classifications: standard, polymeric?
Contain intact macronutrients and require normal digestive and absorptive function.
What are the tube feeding classifications: elemental and semi-elemental?
Partially or fully hydrolyzed macronutrients.
What are the tube feed classifications: disease specific?
Renal-low in electrolytes, hepatic-modified amino acids, diabetic-low in carbs, high in fiber.
What are the tube feed classifications: blenderized?
Made from real, whole foods and blended together.
What are the tube feed classifications: modular?
Contain individual macronutrient components; customizing nutrition.
What are standard enteral nutrition (EN) formulas?
First-line therapy, contain 70-85% water by volume, examples include Jevity 1.5 (1.5 kcal/mL, fiber containing), Osmolite 1.5 (no fiber), Ensure Plus (home) or equivalent, Pivot 1.5.
What is Pivot 1.5?
A specialized EN formula, immune modulating formula with Arginine, Glutamine, Omega-3 FA, scFOS (prebiotic), 94 g/L.
What is Vital AF 1.2?
A specialized EN formula, contains Omega-3 (EPA/DHA), 75 g/L.
What is Vital High Protein?
A specialized EN formula, 1 kcal/mL with 35% of calories from protein, low fat formula, 87 g/L.
What is the free water calculation for <10 kg?
100 mL/kg/day.
What is the free water calculation for 10-20 kg?
1000 mL + 50 mL/kg/day.
What is the free water calculation for >20 kg?
1500 mL + 20 mL/kg/day.
Why should you not crush certain medications?
Modified release, enteric or protective coating, local mouth dosages, unappealing in taste, carcinogenic or teratogenic meds, meds with specific technology to prevent misuse/abuse.
What are the steps for unblocking nasogastric feeding tubes?
Use 15-30 mL water in a 50 mL syringe (push/pull), do not use cola or acidic beverages, use smaller syringe with caution, mechanical de-clogging device, pancreatic enzymes activated to correct pH and deliver close to occlusion.
