nutrition support Flashcards
1
Q
indications for PN
A
- bowel obstruction low in GI tract or ileus
- intractable diarrhea (GVHD) or n/v
- high output fistula & unable to feed distal
- extensive resection of small bowel
- severe necrotizing pancreatitis
2
Q
bowel length needed for EN
A
100cm jejunum
150cm ileum with ileocecal valve
3
Q
refeeding syndrome
A
- EN: start @ 25% of energy needs and increase over 3-5 days
- PN: start dextrose @ 25-50%
- monitor Ph, K, Mg
- fluid retention, cardiac dysfunction, respiratory failure
- high risk: chronic malnutrition, prolonged hypocaloric feeding, NPO>7d, chronic alcoholism, anorexia nervosa
4
Q
high gastric residual volume
A
- consider prokinetics
- consider post-pyloric tube
- consider change to concentrated feeding at lower rate
5
Q
aspiration/reflux
A
- elevate head of bead to 30-45 degrees
- use small bore feeding tube
- provide continuous infusion
- consider prokinetics
6
Q
nausea, vomiting, abdominal distention, bloating
A
- continuous feed with low fat and/or isotonic formula
- consider prokinetics
- consider change to post-pyloric
- minimize narcotics, if able
- provide anti-emetics
- initiate feedings at low rate + advance slowly
7
Q
diarrhea
A
- evaluate medications (sorbitol, magnesium-containing, laxatives, lactulose, etc)
- evaluate for usage of abx
- check stool for c.diff or infection
- provide anti-diarrheals if appropriate
- observe proper hang times, change tubing, use closed system (food safety)
- consider change in fiber content of formula
- consider change to elemental or semi-elemental formula
- adjust formula to lower fat or higher MCT content; consider panc enzymes
8
Q
constipation
A
- increase free water/fluid intake
- consider change in fiber content of formula
- increase activity, if able
- minimize narcotics, if able
- add stool softeners +/- laxatives
- trial of prune juice
- evaluate and address underlying cause - may need to hold EN
9
Q
dehydration
A
- increase free water
- monitor fluid losses; daily weights
- change to 1cal/ml formula
10
Q
overhydration
A
- decrease free water flush
- change to concentrated formula
- monitor fluid status/intake; daily weights
11
Q
hyperglycemia
A
- change to carb controlled or fiber containing formula
- recommend use of or adjust dose of insulin/hypoglycemic agents
12
Q
hyponatremia
A
- change to concentrated formula, restrict fluids
- supplement with sodium
- restrict fluids/free water; diuresis
- may be due to SIADH, excess Na losses
13
Q
hypokalemia
A
- may be due to refeeding
- decrease to 25% of goal rate + replete potassium
- may need to change formula
14
Q
hyperphosphatemia
A
- consider change to low Ph formula or recommend phos binders
- recommend potential change to meds
- may be due to renal function, tumor lysis, phosphate containing antacids
15
Q
hypophosphatemia
A
- may be due to refeeding
- decrease to 25% of goal rate + replete Ph
- discontinue phos binding antacids
