Nutrition and IV Fluids Flashcards
For how long is it recommended to exclusively breastfeed?
exclusively for the first six months
What are contraindications to breastfeeding?
HIV, infectious tuberculosis
infant has galactosemia (cant convert galactose to glucose)
breastfeeding is RARELY contraindicated
What are the benefits of breastfeeding?
nutrition
immunologic protection
growth and development
What are alternatives if breastfeeding is not possible?
expressed breastmilk from the mother
-if baby cant latch or any other reason
pasteurized milk donor (from appropriate sources)
-limited to hospitalized infants who will benefit the most
-do not share or use unprocessed milk or unscreened human milk
commercial infant formula
In general, what does infant formula provide?
provides all nutrition
-no vitamin supplementation is required
What kind of formula is recommended?
cow milk-based
-always try and encourage this
Formulas low in which mineral should be avoided?
iron-low formula
-marketed as “easier digestion” but can lead to iron deficiency in some infants
Is lactose intolerance common in kids?
extremely rare
-lactose is the main carbohydrate source in breast milk
-most babies don’t need to switch to low-lactose formula
What is the consensus regarding the need for formula that contains probiotics?
not likely to be harmful but the evidence is weak and the products are expensive
-not a must have
What kind of infants should be referred to a physician before initiating a formula?
infants with medical conditions
-may require a special formula
What kind of formula should be discouraged from being used?
homemade formula or other milks (e.g. goat milk)
-wont contain the nutrition needed to grow
What is an important consideration to keep in mind regarding the caregiver and infant formula?
ensure the caregiver can properly prepare and administer the formula
-can they measure appropriately? sterilize water? etc.
instructions on formula are usually quite robust, follow them!
What should never be done while an infant is feeding?
leaving them alone
-choking hazard
Which vitamin should all breastfed infants be supplemented with and why?
all breastfed infants should be supplemented with 400 IU of vitamin D daily up to 1yr of life to prevent rickets
When do infants start to need iron supplementation?
most infants have sufficient stores until about 6 months of life, then they need to be supplemented for development
-meat, meat alternatives, iron-fortified cereals
What does it mean when food or drugs are delivered by an enteric route of administration?
feeding tubes deliver nutrition and medications directly into the intestines
Are pharmacists involved in the decision to initiate tube feeding?
no, decision to initiate is usually by a dietitian and/or medical team
-pharmacist is not generally involved except when medications are also given through the tube
What are the different types of feeding tubes?
nasogastric/orogastric
naso-jejunal
gastrostomy/jejunostomy
Describe a nasogastric/orogastric feeding tube.
inserted through the nasopharynx or mouth, ending in the stomach
used for short to medium term feeding (days to weeks)
Describe a naso-jejunal feeding tube.
inserted through the nasopharynx, ending in the jejunum
require endoscopy or radiology to ensure the tube is in the correct position
short to medium use
What are naso-jejunal feeding tubes prone to?
prone to blockage; evidence for using in drug administration is weaker
Describe gastrostomy/jejunostomy feeding tubes.
surgical placement into the stomach via the abdominal wall
long-term feeding (months to years)
What is the pharmacists role with feeding tubes?
assess for interactions
-drug-formula/food interactions
assess absorption
-most drug are absorbed in GIT, does the tube reach there?
assess for drug-tube compatibility
-can the drug and/or formulation be given via tube?
Why does it matter where the feeding tube ends in the GIT when administering drugs?
directly impacts overall exposure to the medication and consequently, effectiveness
-when medications go through a tube, the exit site of the tube is important to understand
What are two main problems with drug-tube compatibility?
tube occlusion
drug adhesion
What causes tube occlusion?
formula and/or medications
What needs to be done if a tube cannot be unblocked?
must be replaced
What is drug adhesion to a tube? What is the consequence?
drug interacts with the tube materials and binds
-results in decreased absorption of drug
What are some solutions if absorption is an issue with a tube?
alternate route of admin
-suppository, transdermal, IV, small amounts orally?
therapeutic alternatives
-would a different drug be better absorbed?
What are some solutions to tube occlusion?
solutions or soluble tablets are the formulation of choice
-crushing a soluble tablet and mixing into a small amount of water is generally preferred
-easier transport and cheaper for patients
families should have instructions on how to flush an occluded tube and when to seek care
What are some solutions if drug adhesion to a tube occurs?
alternate routes of therapy or other medications that could be used
What is the 4-2-1 Rule?
used to calculate maintenance fluid regimens (IV and enteral) in children
-maintenance fluid: amount of fluid needed to replace normal daily losses
-respiratory, urinary, GIT, skin losses
How do you calculate the 4-2-1 Rule?
first 10 kg: 4ml/kg/hr
second 10 kg: 2ml/kg/hr
remaining kg: 1ml/kg/hr
What is the pharmacists role with IV fluids?
electrolyte imbalance
-electrolyte dosage, administration safety
IV compatibility
-children usually have limited IV access
-need to understand chemistry and how to use references
TPN compounding
