Nutrition Support (PN vs. EN) Flashcards
What are some conditions under which tube feeds may be necessary?
Swallowing problems/dysphagia
Nerve Disease
Trauma
Patient unconscious
Stroke - dysphagia/risk of aspiration
Severe burns - extreme hypermetabolism, unable to meet total needs through oral intake
Altered nutrient metabolism where requirements for specific macronutrients may be unique and cannot be met through diet alone
What are contraindications to ENS? WHEN WOULD YOU NOT USE IT.
Expected need is less than 5-10 days for adults and 1-2 days for children - in these cases, try an oral strategy first. If they can at least eat their BMR so they don’t lose weight then stick to oral. If not able to eat BMR then tube feed UNLESS Crohn’s.
Severe acute pancreatitis - may feed carefully below Ligament of Trietz
High output proximal fistulas
Intractable Diarrhea or vomiting
Complete bowel obstruction - with partial obstructions, can feed distal to the obstruction carefully
Severe coagulopathy where risk for GI bleeding is high
Severe Portal hypertension
Abdominal wall infection
Massive Ascites
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What is dumping syndrome? What are symptoms of dumping syndrome?
When large amounts of partially digested food reach the small intestine - the food is hyperosmolar which draws water into the small bowel. If the fluid shift is at a rapid rate, it can draw the fluid from the brain. Avoid hyperosmolar formulas
Nausea
Weakness
Sweating
Palpitations
Diarrhea
Syncope
How are Naso-enteral tubes placed?
Ng - gastric fluids
Nd - X-ray
Nj - X-ray
What is the aspiration risk of Naso-tubes?
Ng - medium
Nd - low
Nj - low
What is the dumping risk of Naso-enteral tubes?
Ng - medium if rate of feed is too high
Nd - medium if rate is too high or tube is moved
Nj - low
What is the aspiration risk of G-tubes?
Gastrostomy: low to medium
Gj: low
What is the dumping risk for G-tubes?
G: low
Gj: medium to high if high osmolarity formula administered
What are indications for a Gastrostomy?
Esophageal obstruction, longer term feeding
What are indications for a Gastro-jejunostomy?
Longer term feeding, high aspiration risk and severe delayed gastric emptying
When is a jejunostomy tube used?
Inserted if there is a blockage at the pylorus which precludes the ability to insert a GJ tube. Tubes are placed surgically, are thinner and can break more readily. Medium to high dumping risk if high osmolarity formula is administered and low aspiration risk.
What are the enteral feeding regimens?
Bolus feed - over 15-30 minutes
Intermittent - 1-2 hours
Continuous feeds > 2 hours
Why would you require 15-30 minutes for a bolus feed?
Feeding by tube bypasses cranial nerves and thus there are no neuronal signals that signal digestion in the stomach. Want to take the time for digestion to be signalled.
What are the advantages and disadvantages of each type of Enteral feeding regimen?
Bolus:
Advantage: short time, easy to administer, inexpensive
Disadvantage: potential GI intolerance
Continuous: Potentially increased GI tolerance, decreased risk of aspiration and gastric residual
Disadvantage: costly, requires pump and less freedom
What are the gastrointestinal complications of tube feeding?
Nausea, Vomiting:
large gastric residuals
improper tube location
rapid infusion rate
hyperosmolar formula
Large Gastric Residuals:
Hyper osmolar formula
High fat content of formula
Gastroparesis
Diarrhea:
medication
lactose intolerance
nutrient malabsorption
Bacterial overgrowth
inadequate fibre
rapid infusion rate
hyperosmolar formula
hypoalbuminemia - low albumin = GI tract not working well, sloughing off protein into the GI tract
Constipation:
Dehydration
fecal impaction
obstruction
inadequate fibre
decreased activity
medications
intestinal dysmotility
Aging
What are the metabolic complications of enteral feeding?
Dehydration: fever, infection inadequate fluid, excessive weight loss, drug therapy
Increased Serum Electrolytes: high content of formula, excess fluid losses, inadequate fluid intake, renal failure, drug therapy
Decreased Serum Electrolytes: excessive fluid intake, water retention, (SIADH = syndrome of inappropriate anti diuretic hormone), inadequate formula electrolytes, drug therapy
Hyperglycemia: metabolic stress, diabetes, excess glucose intake, drug therapy
Hypokalemia/Hypophosphatemia: refeeding syndrome, medications, excessive losses