Unit 9 - Supplemental Nutrition Flashcards
Who benefits from vitamin supplements?
- Those who fail to obtain the recommended amounts of vitamins and minerals from their diet
- Those w/ special needs
Who benefits from vitamin B12 supplements?
- Vegetarians who eat all-plant diets
- Other adults w/ atrophic gastritis
What numbers are assigned to natural health products and what does this mean?
- Assigned a Natural Product Number (NPN) or Drug Identification Number - Homeopathic Medicine (DIN-HM)
- Means that product underwent and passed review of formulation, labelling, and instructions for use, so it is safe
What is enteral nutrition?
Giving nutrients using the GI tract either orally or via tube feedings
What is parenteral nutrition?
Giving nutrients intravenously
Which feeding method should be chosen for a patient that has adequate nutrition status?
- Oral diet and have their nutrition status reassessed regularly
- Can use a simple IV to maintain hydration if necessary
Which feeding method should be chosen for a patient that has a functional GI tract, satisfactory appetite, and is physically able to eat?
Oral diet
Which feeding method should be chosen for a patient that has a functional GI tract, but not a satisfactory appetite or is physically unable to eat?
Enteral nutrition
Which feeding method should be chosen for a patient that does not have a functional GI tract and short-term support is anticipated?
Parenteral nutrition by peripheral vein
Which feeding method should be chosen for a patient that does not have a functional GI tract and long-term support is anticipated or they are severely malnourished?
Parenteral nutrition by central vein
When should tube feedings be used?
If an individual is unable to meet their nutrient needs orally, but must have a functioning GI tract
What route should be used when a patient is expected to be tube fed for less than 4 weeks?
Nasogastric or nasointestinal route
What route should be used when a patient is expected to be tube fed for more than 4 weeks or if the nasointestinal route is inaccessible?
Direct route to stomach or intestine may be created by passing a tube through an enterostomy
What is a gastrostomy?
Opening in abdominal wall that leads to stomach
What is a jejunostomy?
Opening in abdominal wall that leads to jejunum
____ feedings are preferred whenever possible
Gastric (nasogastric and gastrostomy)
When are gastric feedings avoided?
Patients at high risk of aspiration
What is aspiration?
Fluid entering the lungs either from backflow of stomach contents or secretions from mouth and pharynx
Which patients are at high risk of aspiration?
- Patients w/ esophageal disorders
- Neuromuscular diseases
- Conditions that reduce consciousness or cause dementia
What are advantages and disadvantages to transnasal route?
- Does not require surgery or incisions for placement
- Long-term use may irritate nasal passages, throat, and esophagus
What are advantages and disadvantages to nasogastric route?
- Easiest to insert and confirm placement
- Highest risk of aspiration
What are advantages and disadvantages to nasoduodenal and nasojejunal route?
- Lower risk of aspiration
- More difficult to insert and risk of tube migration to stomach
What are advantages and disadvantages to tube enterostomies?
- Allow lower esophageal sphincter to remain closed, reducing risk of aspiration
- Tubes must be placed by physician or sugeon
What are advantages and disadvantages to a gastrostomy?
- Feedings can be given intermittently and w/o a pump
- Moderate risk of aspiration
What are advantages and disadvantages to a jejunostomy?
- Lowest risk of aspiration
- Most difficult insertion process
When are standard enteral formulas used?
Individuals who can digest and absorb nutrients w/o difficulty
What do standard enteral formulas contain?
- Intact proteins extracted from milk or soybeans
- Carbohydrate sources from hydrolyzed corn starch, glucose polymers, and sugars
What are other names for elemental formulas?
- Hydrolyzed
- Chemically defined
- Monomeric
When are elemental enteral formulas used?
Patients who have compromised digestive or absorptive functions
What do elemental enteral formulas contain?
Proteins and carbs that have been partially or fully broken down that require little, if any, digestion
When are specialized enteral formulas used?
Patients w/ particular illnesses w/ specific nutrient needs
When are modular enteral formulas used?
Patients who require specific nutrient combinations to treat illnesses
When are intermittent feedings best tolerated?
When delivered into the stomach
What is bolus feeding?
Rapid delivery of a large volume of formula into the stomach (250-500 mL over 5-15 mins)
What are advantages to bolus feeding?
- Convenient for patient and staff
- Allow greater independence of patients
What are disadvantages to bolus feeding?
- Can cause abdominal discomfort, nausea, and cramping
- Risk of aspiration is higher
When is bolus feeding used?
For patients who are not critically ill
What are continuous feedings?
Delivered slowly and at a constant rate over 8-24 hours
When are continuous feedings used?
Critically ill patients b/c slower delivery is easier to tolerate
What are disadvantages to continuous feedings?
- Limit patient’s freedom of movement
- More costly
What are contraindications to parenteral nutrition?
- GI tract is functioning and accessible
- Short-term treatment anticipated (less than 7 days)
- Risks outweigh benefits
- Palliative care
- Patient not stable
- Inability to obtain venous access
Who is parenteral nutrition used for?
Patients who are unable to digest or absorb nutrients and who are either malnourished or likely to be
What is peripheral parenteral nutrition?
- Nutrients delivered using only peripheral veins
- Used short term (7-14 days)
- Solutions must be less concentrated to prevent damage to peripheral veins, so higher volumes are needed
What is central peripheral nutrition?
- Aka total parenteral nutrition
- Nutrients are delivered using the central veins located near the heart
- Used longer term
- Solutions can be more concentrated, so volume is lower
What is 2-in-1 parenteral solution?
Contains dextrose and amino acids; lipid emulsion is administered separately
What is 3-in-1 parenteral solution?
Contains dextrose, amino acids, and lipids
How can parenteral nutrition be administered?
- Continuously (24-hour period)
- Cyclic (8-16 hour period)
When can refeeding syndrome occur?
When feedings are overly aggressive for severely malnourished individuals
What are symptoms of refeeding syndrome?
- Fluid and electrolyte imbalance
- Hyperglycemia
What is dysphagia?
Difficulty swallowing
What are symptoms of dysphagia?
- Drooling
- Choking or coughing during or after meals
- Pocketing food
- Absent gag reflex
- Inability to suck on straw
- Chronic upper respiratory infections
What does oropharyngeal dysphagia inhibit?
Transfer of food from mouth and pharynx to esophagus
What does esophageal dysphagia inhibit?
Passage of materials through esophageal lumen and into stomach
What usually causes esophageal dysphagia?
Obstruction in esophagus or motility disorder
What are some complications w/ dysphagia?
- Aspiration
- Dehydration
- Loss of enjoyment for eating
- Weight loss
What is the difference between a soft diet and soft/minced diet?
- Both are a standard diet modified w/ soft to chew foods
- Soft/minced includes some plain minced meats when soft textured meat is not suitable
Is nectar or honey thicker?
Honey
