Nutritional support Flashcards
Define enteral nutrition
Food supplementation using the gut
Define parenteral nutrition
- Food supplementation using IV access
- Peripheral access = a small vein
- Central access = central line (CVC or PICC)
Indications for supplemental nutrition in adults
- Non functional GI tract (bowel obstruction, severe diarrhea, malabsorption, etc.)
- Critically ill pts (burn or multisystem organ failure)
- Eating disorders
Indications for supplemental nutrition in pediatrics
- Non functional GI tract
- Critically ill
- Inability to tolerate or deliver adequate nutrition
Pros of enteral nutrition
- Lets the gut keep working
- Cost efficient
Cons of enteral nutrition
- Diarrhea
- Aspiration
- Need GI function to use
Pros of parenteral nutrition
Does not need GI function for use
Cons of parenteral nutrition
- Requires IV access
- Increased risk of infection, thrombosis, hyperglycemia, metabolic abnormalities, fluid overload
When should actual weight be used rather than ideal body weight?
When actual is lower than IBW
When should adjusted body weight be used?
If patient weighs more than IBW + 30%
What is the Harris-Benedict equation and what factors does it account for and in what units?
Adult caloric need calculation
-Uses weight (kg), height (cm), age (years)
What is the MC start and end point of enteral access?
- Nasal passage to stomach
- NG tube
What type of enteral access is preferred in aspiration risk?
-Nasal passage to duodenum
Nasoduodenal
Types of nutrition supplement
- Complete
- Disease specific (renal impairment, malabsorption, respiratory failure, hepatic)
- Incomplete (supplement)
What does complete enteral supplement contain?
- Macros (14% protein, 60% carbs, 30% fats)
- Micros
- May contain fiber
- Energy supply 1 kcal/mL
- Typical volume 1500 mL/day
What is the preferred administration method of enteral nutrition?
Continuous
Can oral meds be given to someone on enteral support?
- 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
Complications of enteral nutrition
- 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
Types of access for parenteral nutrition
- Peripheral access (small vein)
- Central line (central venous catheter or PICC)
What is the MC type of IV access in the hospital?
Peripheral
Describe central line access
- 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
Complications of parenteral support
- 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
Additives of parenteral nutrition
- Electrolytes (based on our calculations)
- MVI (standard set for all TPN)
- Trace elements (standard Zinc, Copper, Manganese, Chromium, Selenium)
- Thiamine
- Folic acid
Less common additives of parenteral nutrition in adults
- Insulin (regular only)
- Heparin
- Iron dextran
- Famotidine
- Carnitine
- Cysteine (pediatrics are a MUST)
How should other meds be given along with TPN?
- Most should NOT be run through same line as TPN
- Determine if another route of administration possible for that med
Total daily energy (TDE) calculation
BEE x activity factor x stress factor
Activity factors to calculate TDE
- Confined to bed = 1.2
- Out of bed = 1.3
Stress factors to calculate TDE
- Surgery = 1.2
- Infection = 1.4
- Trauma = 1.5
- Burns = 1.7
