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OU PharmCare Fall 2017 > Test 2 Enteral Nutrition > Flashcards

Test 2 Enteral Nutrition Flashcards

1
Q

Contraindications for EN

A
  • Mechanical obstruction
  • Necrotizing enterocolitis
  • Severe diarrhea/vomiting
  • Enteric fistulas
  • Severe GI hemorrhage
  • Intestinal dysmotility
  • Short bowel syndrome
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2
Q

Nasogastric (NG)

A

from nose to stomach

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3
Q

Orogastric (OG)

A

from mouth to stomach

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4
Q

Nasoduodenal

ND

A
  • from nose to duodenum

- aka “transpyloric”

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5
Q

Nasojejunal (NJ)

A
  • from nose to jejunum

- “transpyloric”

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6
Q

Gastrostomy (G-tube)

A

straight into the stomach

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7
Q

Jejunostomy (J-tube)

A

directly into jejunum

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8
Q

indications for NG or OG

A
  • Intact gag reflex
  • Normal gastric emptying
  • for short term 4-6 weeks
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9
Q

advantages for NG or OG

A
  • Ease of placement

- Inexpensive

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10
Q

disadvantages for NG or OG

A
  • Potential tube displacement

- Potential ↑ aspiration risk

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11
Q

indications for ND or NJ

A
  • Impaired gastric motility or emptying
  • High risk of reflux or aspiration
  • for short term 4-6 weeks
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12
Q

advantages for ND or NJ

A
  • Reduced aspiration risk

- Early feeding

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13
Q

disadvantages for ND or NJ

A
  • Skill needed for placement - Potential tube displacement or clogging
  • Bolus or intermittent feeding not tolerated
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14
Q

indications for G-tube

A
  • Normal gastric emptying

- long term use

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15
Q

advantages for G-tube

A
  • Tubes less likely to clog

- Low profile buttons available

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16
Q

disadvantages for G-tube

A
  • Surgical placement
  • Potential aspiration risk
  • Requires stoma site care
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17
Q

indications for J-tube

A
  • Impaired gastric motility or emptying
  • High risk of reflux or aspiration
  • long term use
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18
Q

advantages of J-tube

A
  • Early feeding

- Potential ↓ aspiration risk

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19
Q

disadvantages of J-tube

A
  • Surgical placement
  • Bolus or intermittent feeding not tolerated
  • Requires stoma site care
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20
Q

EN methods of admin: bolus

A
  • Commonly used in long-term care settings in patients with G-tube
  • Delivered over 5-10 minutes
  • Administered via syringe
  • Not recommended in patients with delayed gastric emptying, with duodenal/jenunal tubes, and/or at high risk of aspiration.
21
Q

EN methods of admin: intermittent

A
  • Delivered over 20-60 minutes
  • Used in G-tube, NG/OG tube
  • Administered by enteral pump
  • Not recommended in patients with duodenal/jejunal tubes
22
Q

EN methods of admin: continuous

A
  • used in transpyloric tube
  • Delivered over 24 hours (mL/hour)
  • Administered by enteral pump
23
Q

EN methods of admin: cyclic

A
  • Used in patients not eating well because of lack of appetite
  • Administered by enteral pump over nighttime hours (e.g., 12 hours)
  • Patient must be relatively stable to tolerate
  • used G-tube and J-tube
24
Q

Carbohydrates

A
  • major source of calories
  • polymeric or intact
  • hydrolyzed
  • caloric contribution: 4kcal/gram
25
Q

Protein

A
  • polymeric or intact
  • partially hydrolyzed
  • caloric contribution: 4kcal/gram
26
Q

Fat

A
  • polymeric or intact
  • partially hydrolyzed
  • concentrated source of kcal = 9kcal/gram
27
Q

Standard EN formula

A
  • polymeric
  • balanced mix of carb, fat, protein
  • isotonic ~ 300mOsm/L
  • 1-1.2kcal/mL
  • tube admin only
28
Q

Modified EN formula: high protein

A
  • for critically-ill adults

- adults that require > 1.5g/kg/day

29
Q

Modified EN formula: high calorie

A
  • concentrated to decrease fluid intake

- provides 2kcal/mL

30
Q

Hydrolyzed EN formula

A
  • “pre-digested”
  • hydrolyzed protein and/or fat
  • for pts who are intolerant to standard formula
  • higher osmotic load which can lead to diarrhea
31
Q

Disease-specific formulations

A
  • Renal – calorie dense, low electrolyte content
  • Hepatic – increased branched chain and decreased aromatic amino acids
  • Pulmonary – High fat, low carbohydrate
  • Diabetic – High fat, low carbohydrate
  • Immune-modulating – supplemented with glutamine, arginine, nucleotides, and/or omega-3 fatty acids
32
Q

Oral supplements

A
  • Used to enhance oral diet - Sweetened, meant to be taken by mouth
  • Hypertonic (450-700 mOsm/kg)
33
Q

Complications: Diarrhea

A
  • Causes: malabsorption, tube-feeding related, drug related
  • Management: decrease rate of feeding, try different formula, check osmolality and sorbitol content of liquid medications
34
Q

Complications: Nausea/vomiting

A
  • Causes: Gastric dysmotility, rapid infusion of hyperosmolar formula
  • Management: Decrease rate of feedings
35
Q

Complications: Constipation

A
  • Causes: Tube-feeding related, drug related, patient specific
  • Management: change to high fiber formula, increase fluid intake, review pt profile for meds associated with constip.
36
Q

Complications: Abdominal distention

A
  • Causes: Too rapid formula administration, too large volume per feeding
  • Management: decrease rate of continuous feedings, decrease volume of intermittent feedings
37
Q

Complications: Occluded feeding tube

A
  • Insoluble complex of enteral formula and medication, inadequate flushing of feeding tube, kinking of tube
  • Management: Flush tube before and after medication administration, Avoid use of syrups and medications with thick consistency
38
Q

Complications: Tube displacement

A
  • Inadvertent removal, vomiting or coughing, inadequate fixation
39
Q

Complications: Aspiration

A
  • Improper patient position, gastroparesis, feeding tube not positioned properly, compromised lower esophageal sphincter, diminished gag reflex
  • Management: Maintain appropriate positioning, Consider change to transpyloric feedings
40
Q

Complications: Peri-stomal excoriation

A
  • Improper skin and tube care, GI secretions leaking onto area
  • Management: Apply topical barrier creams
41
Q

Complications: Increased infection risk

A

Aspiration of gastric contents, sinusitis (NG tube), cellulitis (G-tube)

42
Q

issues with syrups in tubes

A
  • syrup has pH of about 4

- acidic solutions bind to the feeding and clump it up

43
Q

Which medications can clog the tube?

A
  • Phenytoin
  • Fluoroquinolones
  • Tetracyclines
  • Omeprazole, lansoprazole
  • Warfarin
44
Q

Phenytoin

A
  • bind to Ca or protein feeds
  • solution: hold feed 1-2 hrs before and after phenytoin; monitor phen. concentration and clinical response, increase dose
45
Q

Fluoroquinolones

A
  • binds with divalent and trivalent cations in feeds

- solution: hold feed 1 hr before and after fluor., avoid j-tube administration of cipro

46
Q

Tetracyclines

A
  • binds with divalent and trivalent cations in feeds

- solution: hold feed 1 hour before and after tetracycline

47
Q

Omeprazole, lansoprazole

A
  • Granules become sticky and clog tube

- solution: prepare extemporaneous preparation

48
Q

Warfarin

A
  • binds with proteins in enteral feeds

- solution: monitor INR, increase dose, hold feed 1 hr before and after warfarin

OU PharmCare Fall 2017 (22 decks)

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