Enteral Nutrition Lecture Flashcards

Comprehensive practice questions based on the enteral nutrition lecture, covering tube types, feed products, and administration protocols.

What is the definition of enteral feeding (tube feeding)?

The delivery of liquid feedings through a tube into the gastrointestinal tract of patients who have a functional GIT but cannot orally ingest adequate nutrients.

What are the indications for enteral feeding listed in the notes?

Gastrointestinal disorders, Neuromuscular disorders, Comatose patients, Cardiopulmonary disorders/hypermetabolism (e.g., Burns, Cancer), and Failure to thrive.

How are the goals of enteral feeding categorized?

Supportive therapy (supplies a portion of needed nutrients) and Primary therapy (delivers all necessary nutrients).

What is the duration classification for enteral feeding?

Short-term (for rehabilitation) and Long-term (for nutritional management).

How are feeding tubes named?

They are named with reference to the location of the terminal end of the feeding tube.

List three types of tubes passed through the nose.

Nasogastric, Nasoduodenal, and Nasojejunal.

What are the advantages of a Nasogastric tube?

It is inserted easily with no surgical involvement, is better tolerated, and is suitable for thicker feeds.

What are the disadvantages of a Nasogastric tube?

Aspiration risk, impacts the patient's QOL, and it is not suitable for patients with reflux or delayed gastric emptying.

Which tube types are recommended for patients with reflux or delayed gastric emptying?

Nasoduodenal, Nasojejunal, or PEJ (Percutaneous jejunostomy tube).

What is a disadvantage of Nasoduodenal and Nasojejunal tubes compared to Nasogastric tubes?

They have more difficult placement requiring endoscopy or radiography and are longer, leading to a higher risk of clogging.

What are PEG and PEJ tubes?

Percutaneous gastrostomy tube (PEG) and Percutaneous jejunostomy tube (PEJ), which are inserted through a small incision in the abdomen.

What is the primary indication for using PEG or PEJ tubes?

Longer term feeding.

What are the advantages of PEG/PEJ tubes?

Less time spent giving feedings, feedings can be done while asleep, does not interfere with daily activities, less chance of the tube coming out, and the tube is easy to replace.

What are the potential complications of PEG/PEJ insertion sites?

The site can become infected, leaky, irritated, or malfunction; placement also requires anaesthesia.

What is the conversion factor for 1 French Unit?

$1 \text{ French Unit} = 0.33 \text{ mm}$.

What are the characteristics of small bore tubes ($5-12 \text{ French}$)?

They are more comfortable but are blocked more easily.

What is the primary use for big bore tubes ($\ge 14 \text{ French}$)?

They are used more for the suctioning of stomach contents and may cause discomfort.

Name the three general types of enteral feed.

Polymeric (standard or disease specific), Modular (single nutrient), and Elemental.

What is the energy density and osmolarity of standard polymeric feed?

$1 \text{ kcal/mL}$ and $270 \text{ to } 375 \text{ mOsm/L}$.

What is the nutritional composition of standard polymeric feed?

$50\% \text{ to } 55\%$ carbohydrates, $15\% \text{ to } 20\%$ protein, and $30\%$ fat.

List four examples of standard polymeric feeds provided in the notes.

Isocal, Ensure, Impact, and Jevity (which contains fibre).

What are the specifications and indications for PULMOCARE?

It provides $1.5 \text{ kcal/mL}$, has an osmolarity of $475 \text{ mOsm/L}$, and is for patients with COPD or respiratory failure.

Why does PULMOCARE have a low carbohydrate to fat ratio?

It is designed to help reduce carbon dioxide production.

What are the energy density and target population for NEPRO and SUPLENA?

They are energy dense ($1.8-2 \text{ kcal/mL}$) and are for renal patients.

How is the protein and electrolyte content of NEPRO/SUPLENA modified?

It contains modified high quality protein and low electrolyte content (K, Na, P) to reduce toxic waste and maintain balance.

What are the specifications for GLUCERNA?

It provides $1 \text{ kcal/mL}$, has an osmolarity of $354 \text{ mOsm/L}$, and is low carbohydrate for diabetic patients.

What is a modular feed?

A preparation that provides a single nutrient, such as protein only or carbohydrate only.

Give examples of modular feeds for protein and carbohydrates.

Promod or Propass for protein, and Polycose for carbohydrates (CHO).

When is elemental feed indicated?

For patients with impaired digestion or malabsorption, as it requires minimal digestion.

How are proteins and fats being provided to patients using elemental feeds like Alitraq?

Protein is provided as peptides and free amino acids, and the fat source is MCT (medium-chain triglycerides).

What accessory is used to test for correct tube placement?

Litmus paper.

What is bolus feeding?

A mode of feeding that mimics usual eating patterns, involving the infusion of $200-400 \text{ mL}$ over $15-60 \text{ minutes}$ at specified intervals via gravity.

What are the potential side effects of bolus feeding?

It may cause bloating and diarrhoea.

When is continuous feeding via a pump system used?

For severely ill patients.

What are common insertion complications for nasal tubes?

Nasal damage, intracranial insertion, pharyngeal/oesophageal pouch perforation, bronchial placement, and variceal bleeding.

What complications are associated specifically with PEG/PEJ insertions?

Bleeding and intestinal/colonic perforation.

List the potential GI intolerance complications of tube feeding.

Nausea, bloating, pain, and diarrhoea.

What are the metabolic complications of tube feeding?

Refeeding syndrome, hyperglycaemia, fluid overload, and electrolyte disturbance.

What is the preferred route of administration for medication if the patient's oral route is viable?

The oral route is preferred over administration via the feeding tube.

How much sterile water should be used to flush the tube before and after medicine administration?

At least $30 \text{ mL}$.

What is the purpose of flushing the tube before and after medicine administration?

It clears the tube for drug delivery and facilitates drug transport to the intestine.

What is the protocol for administering multiple medications via tube?

They should be given separately, and the tube should be flushed with at least $5 \text{ mL}$ of water after each dose.

How should highly concentrated drug solutions be prepared for enteral administration?

They should be diluted with at least $60 \text{ mL}$ of water.

Why must highly concentrated solutions be diluted before tube administration?

To decrease gastric mucosal irritation and prevent osmotic diarrhoea.

Can solid medications be added directly to the feeding formulation?

No, because the potency, stability, and availability of the medication and formula cannot be ensured.

How should tablets be prepared for tube delivery?

Crushed to a fine powder using a mortar and pestle and mixed with $15–30 \text{ mL}$ of water.

Which types of capsules may be opened and emptied into the tube without crushing?

Some extended-release capsules containing beads or pellets and certain capsules filled with enteric-coated granules.

What type of medications should never be crushed due to risk to health care workers?

Medications with carcinogenic, teratogenic, or cytotoxic properties, as they may release aerosolized particles.

How long should enteral feeding be stopped before and after drug administration for most medications?

At least $15 \text{ minutes}$.

Why is feeding stopped for $15 \text{ minutes}$ before and after medication?

It reduces the risk of interaction between the medication and the feed.