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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
Protein
- polymeric or intact - partially hydrolyzed - caloric contribution: 4kcal/gram
26
Fat
- polymeric or intact - partially hydrolyzed - concentrated source of kcal = 9kcal/gram
27
Standard EN formula
- polymeric - balanced mix of carb, fat, protein - isotonic ~ 300mOsm/L - 1-1.2kcal/mL - tube admin only
28
Modified EN formula: high protein
- for critically-ill adults | - adults that require > 1.5g/kg/day
29
Modified EN formula: high calorie
- concentrated to decrease fluid intake | - provides 2kcal/mL
30
Hydrolyzed EN formula
- "pre-digested" - hydrolyzed protein and/or fat - for pts who are intolerant to standard formula - higher osmotic load which can lead to diarrhea
31
Disease-specific formulations
- 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
Oral supplements
- Used to enhance oral diet - Sweetened, meant to be taken by mouth - Hypertonic (450-700 mOsm/kg)
33
Complications: Diarrhea
- Causes: malabsorption, tube-feeding related, drug related - Management: decrease rate of feeding, try different formula, check osmolality and sorbitol content of liquid medications
34
Complications: Nausea/vomiting
- Causes: Gastric dysmotility, rapid infusion of hyperosmolar formula - Management: Decrease rate of feedings
35
Complications: Constipation
- 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
Complications: Abdominal distention
- Causes: Too rapid formula administration, too large volume per feeding - Management: decrease rate of continuous feedings, decrease volume of intermittent feedings
37
Complications: Occluded feeding tube
- 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
Complications: Tube displacement
- Inadvertent removal, vomiting or coughing, inadequate fixation
39
Complications: Aspiration
- 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
Complications: Peri-stomal excoriation
- Improper skin and tube care, GI secretions leaking onto area - Management: Apply topical barrier creams
41
Complications: Increased infection risk
Aspiration of gastric contents, sinusitis (NG tube), cellulitis (G-tube)
42
issues with syrups in tubes
- syrup has pH of about 4 | - acidic solutions bind to the feeding and clump it up
43
Which medications can clog the tube?
- Phenytoin - Fluoroquinolones - Tetracyclines - Omeprazole, lansoprazole - Warfarin
44
Phenytoin
- 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
Fluoroquinolones
- binds with divalent and trivalent cations in feeds | - solution: hold feed 1 hr before and after fluor., avoid j-tube administration of cipro
46
Tetracyclines
- binds with divalent and trivalent cations in feeds | - solution: hold feed 1 hour before and after tetracycline
47
Omeprazole, lansoprazole
- Granules become sticky and clog tube | - solution: prepare extemporaneous preparation
48
Warfarin
- 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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