Nutrition Support: EN Flashcards
What are the indications for nutrition support?
- inadequate oral intake for 7-14 days
- altered GI function
- impaired nutrient utilization
- swallowing and chewing difficulty
- PEM
- increased nutrient need that can’t be met orally
- significant weight loss
What are the indications for EN?
Functional GI +
- Unable to meet nutritional needs orally for 7-14 days
- Expected not to meet nutritional needs orally for 7-14 days
- Hemodynamically stable
What are the contraindications for EN?
- mechanical GI obstruction
- intractable vomiting/diarrhea
- SBS
- paralytic ileus
- high output fistulas
- severe GI bleed or malabsorption
- short supply period
What are the benefits of EN?
- Promotes efficient utilization of the nutrients
- Stimulate release of CCK
- Maintains GIT structure, integrity and function
- Enhances intestinal immune function
- Reduces risk of bacterial translocation
- Reduces length of stay
What is the indication for PEG?
patients who are unable to move food from their mouth to stomach such as those with neurological disorders
What are the contraindications for PEG?
- severe ascites
- severe gastroparesis
- coagulopathy
- gastric varices
- neoplastic or inflammatory disease of gastric wall
What are the 3 types of formulas?
- standard (polymeric)
- elemental
- disease specific
What are the 3 types of STANDARD formulas?
- fiber-containing
- high protein
- energy dense
Compare the 2 types of feeding container.
- open system (ready to serve)
- closed system (ready to hang)
Describe the 3 delivery methods.
- intermittent
- continuous
- cyclic
When should feeding be stopped due to GRV?
when > 500ml or signs of feeding intolerance
How to manage GRV?
- prokinetic agent
- change to high density formula
- narcotic antagonists
- switch from gastric to post-pyloric feed
How do you minimize risk of aspiration (2 things)?
Tilt HOB to 30-45
Change the terminal of the tube to mid-duodenum or lower
What are some possible EN complications?
- refeeding syndrome
- GI complications
- aspiration
- metabolic alterations
- dehydration
- tube related complications
What are the 3 hallmark signs for refeeding syndrome?
hypophosphatemia
hypomagnesemia
hypokalemia
What are the energy and dextrose intake at the start to avoid refeeding syndrome?
E: no more than 50% EER or ~15kcal in the first 24h
Dextrose: <1.5 g/kg/d or 100g/d if critically ill or 150-200g/d
Who is at risk of refeeding syndrome?
has 1 or more of the following:
- BMI <16
- unintentional weight loss >15% within 3-6 months
- little or no nutritional intake for more than 10 days
- low levels of potassium, phosphate or magnesium
has 2 or more of the following:
- BMI <18.5
- unintentional weight loss >10% within 3-6 months
- little or no nutritional intake for more than 5 days
What are the 5 possible treatments for refeeding syndrome?
- thiamin
- phosphorus
- phosphate
- folate
- magnesium
What are the 3 possible values for thiamin treatment?
5-20 mg/d
50-300 mg/d
100mg x 5d
What value does potassium have to be at for it to drop below normal?
80 mEq/h
What are the 3 EN-related reasons that cause nausea and vomiting?
- rapid infusion
- cold formula
- delayed emptying
What is the management of nausea and vomiting?
- meds (narcotics)
- lower fat EN
- room temperature
- isotonic solution
- reduce rate by 20-25 ml/h
What is the definition of abdominal distension?
8-10 cm increase in abdominal girth
What are the 4 possible causes (not EN-related) of abdominal distension?
- ileus
- obstruction
- ascites
- diarrhea
What are 3 possible EN-related causes of abdominal distension?
- rapid administration
- cold EN
- fiber-containing EN
What is the main thing that done to verify if a person has maldigestion/malabsorption? Why?
stool sampling - if the stool is fatty, the person is having malabsorption of fat
What is the definition of diarrhea?
> 750ml/d or >3 stools/d for 2 days
What are the 3 possible causes of diarrhea?
- meds (sorbitol-containing)
- infection
- EN formula (osmolarity, fat, lactose)
What are 4 things that can be done to manage constipation?
- adequate hydration
- check flush volumes
- reduce to lower energy formula
- too little or too much fiber
What is intestinal ischemia?
necrotizing enterocolitis = bowel necrosis
What are the metabolic alterations and complications that can occur due to EN?
dehydration overhydration hypokalemia hypophosphatemia hypercapnia vit K deficiency EFA deficiency hyperglycemia
What can be done to help with hyperglycemia?
Give EN with higher fat and fiber to slow gastric emptying
What are some of the risks of G/J tube placement?
- peristomal infections
- necrotizing fasciitis
- leakage
- buried bumper
- pulling tubes
