Specific feeding needs Flashcards
Esophagostomy (EN)
surgical opening into the neck for feeding tube into the stomach
Standard Formula
Functional GI tract; 1.0 kcal/mL or 1.5 kcal/mL for wt gain
Fiber containing formula
Constipation or bowel disorders
High protein/nitrogen formula
catabolic state, wound healing, etc.
Calorie dense formula
fluid restriction
Elemental formula
partially functional GI tract
Disease specific formula
Diabetes, hepatic, immune support, metabolic stress, pulmonary, renal, etc.
EN complications
Diarrhea - vol overload (change to drip if doing bolus)
Nausea - too fast delivery (decrease rate, advance as tolerated) or positioning (position on R side to aid in passage through the pylorus); positioning: aspiration (elevate pt head)
Constipation - dehydration (increase fluids) or lack of fiber (consider higher fiber formula)
Bacterial contamination risk - reduced by using a closed enteral formula system
TPN Sol’n breakdown
Dextrose - 3.4 kcal/g
AA (~12-15% kcal) = 4 kcal/g
Lipids (~30% kcals) = 10% fat = 1.1 kcal/mL; 20% fat = 2 kcal/mL; 30% = 3 kcal/mL
Electrolytes Ca = 0.2-0.3 mEq/kg Cl = equal to Na K = 1 mEq/kg Na = 1-2 mEq/kg
Glucose oxidation rate
GIR OR CHO load; ~5 mg/kg/min for catabolic state; 5-7 mg/kg/min for stable patients.
Glucose oxidation rate: calculations
Grams of Dextrose per day = (kg x desired GOR x 1440 min)/1000
GOR = [(grams CHO x 1000 mg/g)/kg]/1440 min
Calculating mEq
(mg/atomic weight) x valence
Ca, 40, 2
Cl, 35.4, 1
K, 39, 1
Na, 23, 1
EN: Meds of concern
Fluoroquinolones: bioavailability reduced. Feeding held for one hour before and two hours after medication.
Phenytoin - possible food/drug interaction. Feedings held 1-2 hours before and after meds.
Propofol - used for sedation; 10% fat emulsion.
Low residue diet
High fiber foods plus milk and potatoes
Fecal fat test (meals)
Eat 100 g of fat per day for 3 days before stool collection. Collect for 3 days while maintaining the 100 g intake.
