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Clin Med II - GI > Nutritional support > Flashcards

Nutritional support Flashcards

1
Q

Define enteral nutrition

A

Food supplementation using the gut

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2
Q

Define parenteral nutrition

A
  • Food supplementation using IV access
  • Peripheral access = a small vein
  • Central access = central line (CVC or PICC)
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3
Q

Indications for supplemental nutrition in adults

A
  • Non functional GI tract (bowel obstruction, severe diarrhea, malabsorption, etc.)
  • Critically ill pts (burn or multisystem organ failure)
  • Eating disorders
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4
Q

Indications for supplemental nutrition in pediatrics

A
  • Non functional GI tract
  • Critically ill
  • Inability to tolerate or deliver adequate nutrition
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5
Q

Pros of enteral nutrition

A
  • Lets the gut keep working

- Cost efficient

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6
Q

Cons of enteral nutrition

A
  • Diarrhea
  • Aspiration
  • Need GI function to use
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7
Q

Pros of parenteral nutrition

A

Does not need GI function for use

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8
Q

Cons of parenteral nutrition

A
  • Requires IV access

- Increased risk of infection, thrombosis, hyperglycemia, metabolic abnormalities, fluid overload

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9
Q

When should actual weight be used rather than ideal body weight?

A

When actual is lower than IBW

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10
Q

When should adjusted body weight be used?

A

If patient weighs more than IBW + 30%

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11
Q

What is the Harris-Benedict equation and what factors does it account for and in what units?

A

Adult caloric need calculation

-Uses weight (kg), height (cm), age (years)

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12
Q

What is the MC start and end point of enteral access?

A
  • Nasal passage to stomach

- NG tube

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13
Q

What type of enteral access is preferred in aspiration risk?

A

-Nasal passage to duodenum

Nasoduodenal

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14
Q

Types of nutrition supplement

A
  1. Complete
  2. Disease specific (renal impairment, malabsorption, respiratory failure, hepatic)
  3. Incomplete (supplement)
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15
Q

What does complete enteral supplement contain?

A
  • Macros (14% protein, 60% carbs, 30% fats)
  • Micros
  • May contain fiber
  • Energy supply 1 kcal/mL
  • Typical volume 1500 mL/day
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16
Q

What is the preferred administration method of enteral nutrition?

A

Continuous

17
Q

Can oral meds be given to someone on enteral support?

A
  • Most meds can be given through their tube
  • Liquid
  • Crush med mixed w/a little water in oral syringe
  • Check the “do not crush” medication list first though
18
Q

Complications of enteral nutrition

A
  • Diarrhea
  • Intolerance (start slow infusion, titrate up every 12 hrs)
  • Inadequate GI emptying (emesis and/or aspiration)
  • Esophagitis
  • GI bleeding (rare)
  • Tube dislodgement
  • Tube clogging
19
Q

Types of access for parenteral nutrition

A
  • Peripheral access (small vein)

- Central line (central venous catheter or PICC)

20
Q

What is the MC type of IV access in the hospital?

A

Peripheral

21
Q

Describe central line access

A
  • More invasive to establish (PICC at bedside w/sterile field, CVC surgically)
  • High levels of osmolality fluids are fine here (fast dilution) unlike peripheral access
22
Q

Complications of parenteral support

A
  • Hyperglycemia (sliding scale of regular insulin q6h)
  • Refeeding syndrome (start low and go slow, higher levels of phosphate needed)
  • Hypoglycemia w/abrupt discontinuation
  • Essential Fatty Acid Deficiency (EFAD, give essential linolenic and alpha linolenic at least 2x/week)
  • Hypertriglyceridemia (too much dextrose)
  • Azotemia (excessive protein)
  • Hepatobiliary
23
Q

Additives of parenteral nutrition

A
  • Electrolytes (based on our calculations)
  • MVI (standard set for all TPN)
  • Trace elements (standard Zinc, Copper, Manganese, Chromium, Selenium)
  • Thiamine
  • Folic acid
24
Q

Less common additives of parenteral nutrition in adults

A
  • Insulin (regular only)
  • Heparin
  • Iron dextran
  • Famotidine
  • Carnitine
  • Cysteine (pediatrics are a MUST)
25
Q

How should other meds be given along with TPN?

A
  • Most should NOT be run through same line as TPN

- Determine if another route of administration possible for that med

26
Q

Total daily energy (TDE) calculation

A

BEE x activity factor x stress factor

27
Q

Activity factors to calculate TDE

A
  • Confined to bed = 1.2

- Out of bed = 1.3

28
Q

Stress factors to calculate TDE

A
  • Surgery = 1.2
  • Infection = 1.4
  • Trauma = 1.5
  • Burns = 1.7

Clin Med II - GI (17 decks)

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