Nutrition Support Flashcards
dIn which cancers is EN especially beneficial?
Head and neck, gastric, esophageal, and pancreatic cancers
What type of EN formula is appropriate for most people with cancer?
Standard polymeric formula
List short-term access (up to 4-6 weeks) feeding tubes.
NG, OG, NJ, OJ, nasoduodenal, oroduodenal
List long-term access (months to years) feeding tubes.
PEG, G-tube, PEG-J, PEJ, J-tube, low-profile buttonWh
Which type of feeding tube requires use of an infusion pump?
Jejunal feeding tubes
How much and how often is water recommended to maintain tube patency during continuous and intermittent tube feeding?
Continuous: at least 30 mL every 4 hours
Intermittent: at least 30 mL before and after each feed
What are some issues with the preparation of home blenderized tube feeds?
- labor intensive
- increased occurrence of clogged tube
- uncertain nutritional value
- food safety concerns
What is the most common G-tube complication?
Peristomal infection
What conditions increase the risk for refeeding syndrome?
- chronic malnutrition
- prolonged hypocaloric feeding or fasting
- NPO for >7 days
- chronic alcoholism
- anorexia nervosa
What are characteristics of standard (polymeric) formulas?
- provided general nutrition needs
- nutrient density varies from 1-2 kcal/mL
- protein content varies from 14-25% of kcal
- may contain fiber and prebiotics
- ex: Nutren 1.5, Fibersource HN, Jevity 1.2, etc.
What are characteristics of semielemental (peptide-based) formulas?
- for malabsorption, maldigestion, and feeding intolerance
- nutrient density varies from 1-1.5 kcal/mL, some have higher MCT oil content
- protein content ranges from 16-25% of kcal
- may contain fiber, prebiotics, arginine, omega-3 FAs
- ex: Peptamen 1.5, Vital AF 1.2, Impact Peptide 1.5, Kate Farms Peptide 1.5, etc.
What are characteristics of elemental (monomeric) formulas?
- for severely compromised GI function
- provides protein as 100% free amino acids
- low fat, higher ratio of MCT oil
- ex: Vivonex, Tolerex
What are characteristics of commercially available blenderized formulas?
- formulated with real food ingredients
- may contain more traditional ingredients
- possibly suitable for those with food allergies
- ex: Compleat Organic Blends, Liquid Hope, Real Food Blends, etc.
What are characteristics of EN formulas formulated for diabetes?
- reduced carbohydrate content
- may provide fiber
- may be higher in fat and protein
- ex: Glucerna 1.2, Diabetisource AC
What are characteristics of EN formulas formulated for renal disease?
- reduced free water, Na, K, Phos, Ca
- Contains 1.8-2 kcal/mL
- protein content varies from 7-18% of kcal
- ex: Nepro, Novasource Renal, Suplena
What are characteristics of EN formulas formulated for immune modulating?
- may be higher in protein (peptide-based) and energy dense
- may contain arginine, glutamine, EPA, DHA, elevated amounts of vitamin C and E and beta carotene
- ex: Impact Peptide 1.5, Peptamen Intense VHP, Peptamen AF, Vital AF 1.2, Pivot 1.5
What are characteristics of EN formulas formulated for pulmonary diseases?
- reduced carbohydrate content, increase lipid content
- nutrient density ~1.5 kcal/mL
- protein content varies from 16-18% of kcal
- may provide EPA, gamma-linoleic acid (GLA), and added antioxidants
- ex: Pulmocare, Nutren Pulmonary
How much thiamine should be supplemented to help prevent refeeding syndrome and for how long?
100 mg/day for 5-7 days
State the feeding tube location, feed delivery time, initiation rate, advancement schedule and required equipment for syringe bolus feeds.
- gastric tube
- delivery ~15 min
- initiation rate 60-120 mL
- increase by 60-120 mL every 8-12 hrs (or every 1-2 feeds)
- catheter tip syringe needed
State the feeding tube location, feed delivery time, initiation rate, advancement schedule and required equipment for intermittent (or gravity) drip feeds.
- gastric tube
- delivery ~30-35 min
- initiation rate 60-120 mL
- increase by 60-120 mL every 8-12 hrs (or every 1-2 feeds)
- gravity bags and pole needed
State the feeding tube location, feed delivery time, initiation rate, advancement schedule and required equipment for cyclic feeds.
- gastric or small intestine tube
- often 12-18 hr infusion (<24 hrs)
- initiation rate 10-40 mL/hr
- increase by 10-20 mL/hr every 8-12 hrs
- infusion pump with pole or backpack needed
State the feeding tube location, feed delivery time, initiation rate, advancement schedule and required equipment for continuous feeds.
- gastric or small intestine tube
- 20-24 hr infusion
- initiation rate 10-40 mL/hr
- increase by 10-20 mL/hr every 4-24 hrs
- infusion pump with pole or backpack needed
True or False: Routine monitoring of gastric residual volumes (GRVs) for feeding intolerance is recommended.
False
Additionally, avoid holding EN for GRVs < 500 mL in the absence of other signs of intolerance
What are some possible corrections to help with aspiration for a patient receiving EN?
- elevate head of bead to 30-45 degrees
- consider changing to post-pyloric tube
- provide continuous feeds
- consider adding prokinetic agent
- consider changing to a concentrated formula at a lower rate
- consider a fiber-free formula to enhance gastric emptying
What does a patient need to have access to in order to have home EN?
- running water for hand washing
- electricity if using feeding pump
- adequate storage for formula and supplies
Which foundation provides community support, education, and outreach for patients receiving EN?
Oley Foundation
True or False: EN feedings used to manage malnutrition or anorexia are covered under Medicare Part B.
False
What are some oncology-specific indications for parenteral nutrition (PN)?
- Paralytic or post-op ileus
- Malignant bowel obstruction
- High output (>200 mL/d) distal GI fistula
- Inability to tolerate EN for 7-14 days
- Large volume diarrhea or high-output ostomies refractory to medication management
SMOFlipid should be avoided in patients with which food allergies or sensitivities?
- Soybean
- Fish
- Egg
- Peanut protein
What are standard PN electrolyte requirements for adults (Na, K, Phos, Mg, Ca, Cl, acetate)
- Na: 1-2 mEq/kg BW
- K: 1-2 mEq/kg BW
- Phos: 20-40 mmol
- Mg: 8-20 mEq
- Ca: 10-15 mEq
- Cl: as needed to maintain acid-base balance
- Acetate: as needed to maintain acid-base balance
What medications can be added directly to PN solution if needed?
- histamine H2-receptor antagonists (ex: Famotidine)
- Insulin
- Heparin
For Medicare to cover PN, which conditions must be documented in the medical record?
- Nonfunctional GI tract or failed EN trials
- At least 90-day need for PN therapy
