Nutrition support

Question 1

Standard formulas

Answer 1

• Normal GI function
• lecithin may be added as emulsifier
• 10-40ml/hour start
• least expensive, intact protein and isotonic

Question 2

Elemental formulas

Answer 2

• Malabsorption: crohns, fistula, SBS
• Pre-digested
• compromised GI function and inability to digest/absorb

Question 3

Specialized formulas

Answer 3

The more specialized, the more expensive

-Ex: glucerna, pulmocare, nepro

Question 4

Short-Term EN Access

Answer 4

• 3-4 weeks
• NG tube, or ND/NJ tube if not tolerating gastric feedings
• Bolus: functional stomach and clinically stable
• Continuous: pt with compromised GI fx or volume intolerance
• Transpyloric: comatose or not gag reflex; formula enters directly into stomach

Question 5

Long-Term EN Access

Answer 5

> 3-4 weeks

• Gastrostomy or jejunosotmy –> PEG or PEJ
• don’t use blue die to check placement

Question 6

Water Needs for Pt on EN

Answer 6

-1ml H2O/ 1 kcal ingested

1cal/cc = 80-86% water

Question 7

Peripheral PN

Answer 7

-Short term
-Post surgery when EN expected to resume within 5-7 days
PPN Solutions:
-IV dextrose – highest conc in PPN is 10%D
-Protein
-IV Fat (Intralipid) - 10% IL = 1kcal/cc IL
20% IL = 2kcal/cc IL

Question 8

Parenteral Nutrition

Answer 8

• Hypertonic solution delivered through central vein
• Used to reach an anabolic state while pt is NPO and EN isn’t possible
• Translocation of bacteria concern with PN –> gut wall breaks down and bacteria moves out –> sepsis due to not feeding the gut

Question 9

PN Solutions

Answer 9

Protein:

• Ratio for anabolism = 1 gm N2/150kcal
• %AA = #gm of pro in 100ml solution
• Max GIF = 4-5mg/kg/min to prevent hyperglycemia
• Fat: prevention of EFAD –> 500 cc of 10% IL 1-2x/week

Question 10

Transitional Formulas

Answer 10

• Initiate full strength EN at low rate to establish GI tolerance – decrease PN as EN rate increases
• Once tolerating 75% of need enterally – DC PN

Question 11

Re-Feeding Syndrome

Answer 11

• When aggressive nutrition is given to malnourished patients
• Starved cells take up nutrients –> K and phos shift intracellularly

**Hypokalemia, hypophosphatemia, hypomagnesemia due to shift inside cell for metabolism

Question 12

% water in 1kcal/cc enteral formula

Answer 12

80-86% water

Question 13

% water in 1.5kcal/cc formula

Answer 13

76-78% water

Question 14

% water in a 2kcal/cc enteral formula

Answer 14

69-71% water