Specific feeding needs

Question 1

Esophagostomy (EN)

Answer 1

surgical opening into the neck for feeding tube into the stomach

Question 2

Standard Formula

Answer 2

Functional GI tract; 1.0 kcal/mL or 1.5 kcal/mL for wt gain

Question 3

Fiber containing formula

Answer 3

Constipation or bowel disorders

Question 4

High protein/nitrogen formula

Answer 4

catabolic state, wound healing, etc.

Question 5

Calorie dense formula

Answer 5

fluid restriction

Question 6

Elemental formula

Answer 6

partially functional GI tract

Question 7

Disease specific formula

Answer 7

Diabetes, hepatic, immune support, metabolic stress, pulmonary, renal, etc.

Question 8

EN complications

Answer 8

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

Question 9

TPN Sol’n breakdown

Answer 9

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

Question 10

Glucose oxidation rate

Answer 10

GIR OR CHO load; ~5 mg/kg/min for catabolic state; 5-7 mg/kg/min for stable patients.

Question 11

Glucose oxidation rate: calculations

Answer 11

Grams of Dextrose per day = (kg x desired GOR x 1440 min)/1000

GOR = [(grams CHO x 1000 mg/g)/kg]/1440 min

Question 12

Calculating mEq

Answer 12

(mg/atomic weight) x valence

Ca, 40, 2
Cl, 35.4, 1
K, 39, 1
Na, 23, 1

Question 13

EN: Meds of concern

Answer 13

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.

Question 14

Low residue diet

Answer 14

High fiber foods plus milk and potatoes

Question 15

Fecal fat test (meals)

Answer 15

Eat 100 g of fat per day for 3 days before stool collection. Collect for 3 days while maintaining the 100 g intake.

Question 16

Glucose tolerance test

Answer 16

Blood sample; 75 g CHO, blood sample

Question 17

Adaptive equipment: Angled utensils

Answer 17

limited arm or wrist movement; spoon or fork is angled toward the mouth

Question 18

Adaptive equipment: Built-up handles (utensils)

Answer 18

decreased hand strength; handles are larger than normal sized utensils

Question 19

Adaptive equipment: weighted utensils

Answer 19

poor hand and arm movement away from the body

Question 20

Adaptive equipment: scoop dishes

Answer 20

raised sides on plate assisted with scooping motion

Question 21

Adaptive equipment: dycem place mat

Answer 21

poorly controlled arm and hand coordination; skid resistant material useful for adaptive utensils

Question 22

ADIME: Evaluating outcomes

Answer 22

Direct nutrition outcomes

clinical and health status outcomes

Patient centered outcomes

Health care utilization outcomes