parenteral and TF nutrition

Question 1

general supplements

Answer 1

boost
Carnation instant breakfast
Ensure
MightyShakes
Med Pass

Question 2

purpose of supplements

Answer 2

Contain vitamins and minerals
To help with nutritional deficiencies

Question 3

enteral nutriton indications

Answer 3

• Impaired swallowing
• Major nutritional deficits
• Decreased LOC (level of consciousness)

Question 3

in order to have enteral nutrition pt MUST…

Answer 3

have a working GI tract

Question 4

which feeding tube has higher aspiration risk

Answer 4

gastric

Question 4

protein supplements

Answer 4

• Glucerna: low carb - - - Beneprotein: high PRO
• Benefiber: high fiber
• Juven: aids tissue repair/wound healing

Question 5

types of feeding tubes

Answer 5

NG (nasogastric)
ND (nasoduodenal)
NJ (nasojejunal)
gastrostomy

Question 6

rare contraindication to NG tube?

Answer 6

basilar skull fracture

Question 6

which is faster gastric or enteric

Answer 6

gastric

Question 7

what type of bolus feeding is commonly used on critically ill pts

Answer 7

continuous

Question 7

methods to check placement

Answer 7

gastric pH
air bolus
checking lines on tube

Question 8

when might you hold TF

Answer 8

if amount of residual able to be pulled is high

Question 9

free water flush

Answer 9

set amount of water that pt will get every couple hours

Question 10

what TF pump works by peristalsis

Answer 10

kangaroo pump

Question 11

universal connector for enteral feeding devises

Answer 11

enfit connector

Question 12

kind of TF that is safe for gluten free and lactose intolerant

Answer 12

elemental formulas

Question 13

types of elemental formulas

Answer 13

ensure: high cal and protein
jevity: high protein and fiber
promote: very high protein
osmolite: high protein and cal, low residue
two cal: protein and cal dense

Question 14

specialty TF formulas

Answer 14

glucerna
nutrihep
pulmocare
oxepa
peptamen
suplena
nepro
pivot
vital

Question 15

glucerna TF

Answer 15

• good for DM
• high protein/fiber, low CHO and fat

Question 16

nutrihep

Answer 16

• good for hepatic pts
• high carbs/low protein (because ammonia is bad for liver)

Question 17

pulmocare

Answer 17

• good for pulmonary
• low CHO –> to get less CO2 buildup

Question 18

oxepa

Answer 18

• good for ICU pts, sepsis, ARDS
• antioxidants to help modulate infection

Question 19

peptamen

Answer 19

• good for pts with stress (high cortisol), and inflammation
• contains omega 3 fatty acids

Question 20

suplena

Answer 20

• good for renal disease not on HDY
• low protein/P/K+/Na+

Question 21

nepro

Answer 21

- good for renal pts on HDY - high protein, low P/K+/Na+

Question 22

pivot

Answer 22

- good for trauma and immunosupression pts - very high protein, prebiotics

Question 23

vital

Answer 23

- good for GI inflammation or malabsorption - vitamins C and E

Question 24

most common TF complication

Answer 24

diarrhea

Question 24

daily monitoring for TF

Answer 24

residual (Q4H) fluid volume status I&O weight BG (Q6-8H)

Question 25

sources of problems w TF

Answer 25

protein too concentrated bacterial contamination volume too high antibiotic therapy clogged tube aspiration refeeding syndrome dumping syndrome

Question 26

how to prevent aspiration with TF

Answer 26

- keep HOB>30 degrees - pause TF when lying flat - manage high residual

Question 27

metoclopramide is given to manage high residual why

Answer 27

it enhances gastric emptying

Question 28

refeeding syndrome

Answer 28

happens when a malnourished individual begins feeding too quickly - leads to fluid and electrolyte imbalances - can lead to fatal cardiac arrhythmias

Question 29

dumping syndrome

Answer 29

happens when food moves from your stomach to intestines too quickly - early (10-30 mins): osmotic diarrhea - late (2-3 hours): hypoglycemia, diaphoresis, hypotension

Question 30

what is hyperalimentation

Answer 30

the parenteral administration of nutrients - bypasses GI tract - is a last resort

Question 31

indications for hyperalimentation

Answer 31

unable to injest, digest, or absorb nutrients non functional GI tract for more than 7 days excessive metabolic needs

Question 32

types of PN

Answer 32

central total PN (TPN) -- more hypertonic peripheral PN (PPN)-- less hypertonic

Question 33

components of TPN

Answer 33

amino acids and proteins dextrose electrolytes trace minerals vitamins (optional) lipids-- gives a white appearance insulin/medications

Question 34

what may be given separately

Answer 34

intralipids

Question 35

2 in 1

Answer 35

dextrose and amino acids

Question 36

3 in 1

Answer 36

dextrose, amino acids, lipids

Question 37

complications with TF