Nutrition Support: EN

Question 1

What are the indications for nutrition support?

Answer 1

• 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

Question 2

What are the indications for EN?

Answer 2

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

Question 3

What are the contraindications for EN?

Answer 3

• mechanical GI obstruction
• intractable vomiting/diarrhea
• SBS
• paralytic ileus
• high output fistulas
• severe GI bleed or malabsorption
• short supply period

Question 4

What are the benefits of EN?

Answer 4

• 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

Question 5

What is the indication for PEG?

Answer 5

patients who are unable to move food from their mouth to stomach such as those with neurological disorders

Question 6

What are the contraindications for PEG?

Answer 6

• severe ascites
• severe gastroparesis
• coagulopathy
• gastric varices
• neoplastic or inflammatory disease of gastric wall

Question 7

What are the 3 types of formulas?

Answer 7

• standard (polymeric)
• elemental
• disease specific

Question 8

What are the 3 types of STANDARD formulas?

Answer 8

• fiber-containing
• high protein
• energy dense

Question 9

Compare the 2 types of feeding container.

Answer 9

• open system (ready to serve)

- closed system (ready to hang)

Question 10

Describe the 3 delivery methods.

Answer 10

• intermittent
• continuous
• cyclic

Question 11

When should feeding be stopped due to GRV?

Answer 11

when > 500ml or signs of feeding intolerance

Question 12

How to manage GRV?

Answer 12

• prokinetic agent
• change to high density formula
• narcotic antagonists
• switch from gastric to post-pyloric feed

Question 13

How do you minimize risk of aspiration (2 things)?

Answer 13

Tilt HOB to 30-45

Change the terminal of the tube to mid-duodenum or lower

Question 14

What are some possible EN complications?

Answer 14

• refeeding syndrome
• GI complications
• aspiration
• metabolic alterations
• dehydration
• tube related complications

Question 15

What are the 3 hallmark signs for refeeding syndrome?

Answer 15

hypophosphatemia
hypomagnesemia
hypokalemia

Question 16

What are the energy and dextrose intake at the start to avoid refeeding syndrome?

Answer 16

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

Question 17

Who is at risk of refeeding syndrome?

Answer 17

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

Question 18

What are the 5 possible treatments for refeeding syndrome?

Answer 18

• thiamin
• phosphorus
• phosphate
• folate
• magnesium

Question 19

What are the 3 possible values for thiamin treatment?

Answer 19

5-20 mg/d
50-300 mg/d
100mg x 5d

Question 20

What value does potassium have to be at for it to drop below normal?

Answer 20

80 mEq/h

Question 21

What are the 3 EN-related reasons that cause nausea and vomiting?

Answer 21

• rapid infusion
• cold formula
• delayed emptying

Question 22

What is the management of nausea and vomiting?

Answer 22

• meds (narcotics)
• lower fat EN
• room temperature
• isotonic solution
• reduce rate by 20-25 ml/h

Question 23

What is the definition of abdominal distension?

Answer 23

8-10 cm increase in abdominal girth

Question 24

What are the 4 possible causes (not EN-related) of abdominal distension?

Answer 24

• ileus
• obstruction
• ascites
• diarrhea

Question 25

What are 3 possible EN-related causes of abdominal distension?

Answer 25

• rapid administration
• cold EN
• fiber-containing EN

Question 26

What is the main thing that done to verify if a person has maldigestion/malabsorption? Why?

Answer 26

stool sampling - if the stool is fatty, the person is having malabsorption of fat

Question 27

What is the definition of diarrhea?

Answer 27

> 750ml/d or >3 stools/d for 2 days

Question 28

What are the 3 possible causes of diarrhea?

Answer 28

• meds (sorbitol-containing)
• infection
• EN formula (osmolarity, fat, lactose)

Question 29

What are 4 things that can be done to manage constipation?

Answer 29

• adequate hydration
• check flush volumes
• reduce to lower energy formula
• too little or too much fiber

Question 30

What is intestinal ischemia?

Answer 30

necrotizing enterocolitis = bowel necrosis

Question 31

What are the metabolic alterations and complications that can occur due to EN?

Answer 31

dehydration
overhydration
hypokalemia
hypophosphatemia
hypercapnia
vit K deficiency
EFA deficiency
hyperglycemia

Question 32

What can be done to help with hyperglycemia?

Answer 32

Give EN with higher fat and fiber to slow gastric emptying

Question 33

What are some of the risks of G/J tube placement?

Answer 33

• peristomal infections
• necrotizing fasciitis
• leakage
• buried bumper
• pulling tubes