Enteral and Parenteral Nutrition Support

Ch. 15

Specialized Nutritional support

the delivery of nutrients using a feeding tube or intravenous infusions, often referred to simply as nutrition support.

Enteral Nutrition.

the provision of nutrients using the GI tract; usually refers to the use of tube feedings

Parenteral Nutrition

provides nutrients intravenously to patients who do not have adequate GI function to handle enteral feedings.

Oral Nutrition Support

nutrition care that allows a malnourished patient to meet nutritional requirements by mouth; may include oral nutritional supplements, nutrient-dense foods and snacks, or fortified foods

FIstula

abnormal passages between organs or tissues that allow the passage of fluids or secretiona

Intractible

not easily managed or controlled.

transnasal

through the nose. A transnasal feeding tube is one that is inserted through the nose.

nasogastric

through the nose. A transnasal feeding tube is one that is inserted through the nose.

nasointestinal

tube feeding placement in which the tube is placed into the GI tract via the nose; refers to nasoduodenal and nasojejunal feeding routes (also known as nasoenteric feeding routes).

• nasoduodenal (ND):

the tube is placed into the duodenum via the nose.

nasojejunal (NJ):

tube feeding placement in which the tube is placed into the jejunum via the nose

orogastric

tube feeding placement in which the tube is inserted into the stomach through the mouth. This method is often used to feed infants because a nasogastric tube may hinder the infant’s breathing.

enterostomy (EN-ter-AH-stoe-mee):

an opening into the GI tract through the abdominal wall.

• gastrostomy (gah-STRAH-stoe-mee):

an opening into the stomach through which a feeding tube can be passed. A nonsurgical technique for creating a gastrostomy under local anesthesia is called percutaneous endoscopic gastrostomy (PEG).

• jejunostomy (JEH-ju-NAH-stoe-mee):

an opening into the jejunum through which a feeding tube can be passed. A nonsurgical technique for creating a jejunostomy is called percutaneous endoscopic jejunostomy (PEJ). The tube can either be guided into the jejunum via a gastrostomy or passed directly into the jejunum (direct PEJ).

aspiration

drawing in by suction or inhalation; a common complication of enteral feedings in which substances from the GI tract are drawn into the lungs. Aspiration risk is high in patients with esophageal disorders, neuromuscular diseases, and conditions that reduce consciousness or cause dementia.

aspiration pneumonia

pneumonia that results from the abnormal entry of foreign material; may be caused by either bacterial infection or irritation of the lower airways.

French units

units of measure for a feeding tube’s outer diameter; 1 French equals ⅓ millimeter.

gastric decompression

the removal of stomach contents (such as GI secretions, air, or blood) in patients with motility problems or obstructions that prevent stomach emptying; the procedure may be used to reduce discomfort, vomiting, or various complications during critical illness or after certain surgeries.

Standard formulas

enteral formulas that contain mostly intact proteins and polysaccharides; also called polymeric formulas.

protein isolates

proteins that have been isolated from foods.

blenderized formulas

enteral formulas that are prepared by using a food blender to mix and puree whole foods.

elemental formulas

enteral formulas that contain proteins and carbohydrates that are partially or fully hydrolyzed; also called hydrolyzed, chemically defined, or monomeric formulas.

Specialized formulas

enteral formulas for patients with specific illnesses; also called disease-specific formulas or specialty formulas

modular formulas

enteral formulas prepared in the hospital from modules that contain single macronutrients; used for people with unique nutrient needs.

osmality

the concentration of osmotically active solutes in a solution, expressed as milliosmoles (mOsm) per kilogram of solvent. Osmotically active solutes affect osmosis, the movement of water across semipermeable membranes.

isotonic formula

a formula with an osmolality similar to that of blood serum (about 300 milliosmoles per kilogram).

hypertonic formula

formula with an osmolality greater than that of blood serum.

open feeding system

formula delivery system that requires the transfer of the formula from its original packaging to a feeding container.

closed feeding system

a formula delivery system in which the sterile formula is packaged in a container that can be attached directly to the feeding tube for administration.

intermittent feedings

tube feedings with delivery rates of about 250 to 400 milliliters of formula over 30 to 45 minutes.

bolus feedings

feeding: tube feedings with delivery rates of about 250 to 500 milliliters of formula over a 5- to 15-minute period.

continous feedings

tube feedings that are delivered slowly and at a constant rate over an 8- to 24-hour period.

cyclic feeding

continuous tube feedings conducted for 8 to 18 hours daily, allowing for patient mobility and bowel rest during the remaining hours of the day.

gastric residual feeding

the volume of formula and GI secretions remaining in the stomach after a previous feeding.

Candidates for Parenteral Nutrition

• Intractable vomiting or diarrhea

• Severe GI bleeding

• Intestinal obstructions or fistulas

• Paralytic ileus (intestinal paralysis)

• Short bowel syndrome (a substantial portion of the small intestine has been removed)

• Bone marrow transplants

• Severe malnutrition and intolerance to enteral nutrition

peripheral parenteral nutrition (PPN)

the infusion of nutrient solutions into peripheral veins, usually a vein in the arm or back of the hand.

phlebitis

inflammation of the veins

osmolarity

the concentration of osmotically active solutes in a solution, expressed as milliosmoles per liter of solution (mOsm/L)

central parenteral nutrition

the infusion of nutrient solutions into a central vein, also called total parenteral nutrition (TPN).

total nutrition adamixture

a parenteral solution that contains dextrose, amino acids, and lipids; also called a 3-in-1 solution or an all-in-one solution.

2-in-one solution

a parenteral solution that contains dextrose and amino acids, but excludes lipids.

refeeding syndrome

condition that sometimes develops when a severely malnourished person is aggressively fed; characterized by electrolyte and fluid imbalances and hyperglycemia.

galactosemia (ga-LAK-toe-SEE-me-ah)

an inherited disorder that impairs galactose metabolism; may cause damage to the brain, liver, kidneys, and lens of the eye in untreated patients.

gene therapy

treatment for inherited disorders in which DNA sequences are introduced into the chromosomes of affected cells, prompting the cells to express the protein needed to correct the disease.

genetic counseling

support for families at risk of genetic disorders; involves diagnosis of disease, identification of inheritance patterns within the family, and review of reproductive options.

inborn error of metabolism

an inherited trait (one that is present at birth) that causes the absence, deficiency, or malfunction of a protein that has a critical metabolic role.

phenylketonuria (FEN-il-KEY-toe-NU-ree-ah) (PKU):

an inherited disorder characterized by a defect in the enzyme phenylalanine hydroxylase, which normally converts the essential amino acid phenylalanine to the amino acid tyrosine. The condition is named after the phenylalanine metabolites—called phenylketones—that are excreted in the urine of individuals who have the disorder.

metabolites

products of metabolism; compounds produced by a biochemical pathway.

Which inborn error of metabolism affects the transport of chloride across epithelial cell membranes, primarily causing problems in the gastrointestinal and respiratory systems?

cystic fibrosis

Which nutrition-related metabolic disorder impairs the conversion of a specific carbohydrate primarily found in milk products into glucose?

galactosemia

Enteral formulas that contain protein and medium-chain triglycerides Is known as what type of formula?

elemental formulas

What is a potential complication of administering parenteral nutrition via a catheter

infection

Carbohydrate is added to the parenteral nutrition solution in what form?

dextrose monohydrate

A 1000-mL container of a 10 percent lipid emulsion would provide how many calories?_______.

1100

Patients requiring home nutrition support may struggle to maintain their quality of life. How can the health care provider assist in improving the patient's quality of life

offer support through the Oley foundation

High-protein foods are omitted in the diets of individuals with which disorder?

phenylketonuria