NBCD - Nutri Support (copy)

1. Functioning GIT

2. Length of Feeding

3. Presence of Risk ofAspiration

Considerations in TF (3)

True

True or False: EN is preferred over PN because it is safer, economical, and maintains gut structure and integrity

1. Complete intestinal/colonic obstruction

2. Intractable vomiting

3. Active GIT bleeding and shock

Contraindications of enteral feeding (3)

1. PEM with inadeq oral intake previous 5 days OR normal NS but with inadeq oral intake previous 7-10 days

2. CNS disorders: coma, CVA, Parkinson's

3. GIT diseases: Chron's, gastroparesis, short bowel syndrome, chronic pancreatitis

4. Psych disorders: severe depression, anorexia nervosa

Indications for enteral feeding (4)

Polymeric Formula

Composed of CPF in high molecular wt form and therefore lower osmolality; require normal digestive and lipolytic activity

Elemental formula

Low residue and use free AAs or peptides as a protein source; oligosacch or monosacch provide the CHO source nd most contain medium/long chain trigylcerides

Modular Formula

Not nutritionally complete because they contain single nutrients: C/P/F. Can be added to std enteral prod

Specialty Formula

Available for use in px with a variety of clinical conditions including renal, respiratory, hepatic, insuff, DM, immunocompromised, and fat or CHO malasbsorption

1. Immunocompromised px

2. For infusion through tubes smaller than 10 French

3. For continuous feeding (unless formula hangs for ≤ 2rs

4 if fluid restriction of < 900 mL/day is required

5. In cases of multiple food allergies

6. If a jejunostomy tube is used

BTF contraindications (6)

1 mL/kcal

Recommended daily water requirement in the absence of hepatic, renal, or cardiac disease

Isotonic

The ideal formula is ______

1 kcal per 1 mL

ideal nutrient density for adults

2/3 kcal per 1 mL

ideal nutrient density for infants

at least 25% of the total formula vol which can be adminstered in 2-3 separate doses

How much additional free water should patients without fluid restriction should receive?

30-45˚

Degree of elevation of px' head and neck for 1 hr after feeding to prevent aspiration

At least 3x weekly

Weighing and recording of the px wt should be done at least ____

Bolus Feeding

Rapid delivery by syringe of 240-400 mL o formula every 4-6 hrs; simulates normal food intake in terms of gallbladder motility

Timed Intermittent

Provision of 100-400 mL of enteral formula with an interval of 2-4 hrs; can be used if there is no hx of malabsorption

Continuous Drip

Requires infusion of the formula using a pump or gravity drip over a period of 16-24 hrs

Cyclic Administration

Infuses the formula for 8-16 hrs, usu overnight, using an infusion pump

IV (intravenous)

called Total Parenteral Nutrition (TPN)

TPN

Given when the condition is expected to continue on a minimum of 7 days

1. Intractable vomiting (acute pancreatitis)

2. Severe diarrhea of > 500 mL/day stool, or malabsorption

3. Several trauma/ major abdominal surgery, when EN including jejunostomy cannot be used for at least 7 days

4. Small bowel or colon obstruction

Indications of TPN (4)

1. Hemodynamically unstable px

2. Px with severe pulmonary edema or fluid overload

3. Px with anuria w/o dialysis

4. Px with profound metabolic or electrolyte disturbances

Contraindication of TPN

~2-3 L/day and should not exceed 4 L

Fluid intake of PN solutions

3.4 kcal/g

E yield of dextrose (glucose monohydrate)

Soybean or safflower oil

Lipid emulsions of PN solutions come in 10% or 20% of _______ which may be available in 100, 200, 250 and 500 mL bottles

Serum electrolyte concentration

Parenteral electrolyte content must be adjusted according to

Vit K (contraindication for heparin)

Multivitamins except ______ are provided in concentrated PN formulations based on std recommendations

Insulin and heparin (anticoagulant)

Additives such as ______ are used only when necessary

Simple IV Infusion

Delivered through a peripheral IV catheter inserted into a small diameter peripheral vein

PPN (peripheral parenteral nutrition)

Used for px with mild nutri deficiencies; uses the small diameter veins that carry blood from the arms and legs; lipid emulsions are commonly used to provide short term nutrition (11-2 wks)

CPN (central parenteral nutrition)

Infusion of concentrated solutions delivered through the central veins for longer period period

Pneumothorax

presence of air in the pleural cavity/chest

Air embolism

Presence of air in the tube or in the blood vessel that obstructs the parenteral flow

Sepsis

Presence of the disease-causing micorogranisms of the blood

Hemothorax

presence of blood in the chest cavity

EFA Deficiency Symptoms

Failure to grow, dermal problems, poor immune fxn

Metabolic imbalance

Characterized by an increase or a decrease of nutrients in the blood

Refeeding Syndrome

Precipitates when there is aggressive administration of nutrition particularly via IV route

Hypocaloric high protein nutrition

Safest, most physiologically rational feeding for px whose body fat store is adeq BMI>18

Existing low muscle mass and/or major protein catabolism

Highest prio px

1.2 kg/kg ABW or 2 - 2.5g/kg IBW with adjustment of goal protein intake by the results of N-balance studies

High protein feeding may be started with ______

50-70% of estimated E-needs or

Hypocaloric feeding be started with ______

2 - 2.5g/kg/day

Critically ill px should receive ______ protein

Gastrostomy and Jejunostomy

Long Term EN (>6-8 wks)

nasogastric, nasoduodenal, nasojejunal (NGT and NJT

tube feeding less than 4 weeks (Short Term EN)

CPN

Long Term PN

PPN

short term therapy, usually post-surgery (when enteral is resumed in 5-7 days) mild/moderate malnutrition, or as a supplement to enteral

0.33 mm

1 french =

8-12 Fr

Size of tube for NGT and Naseoenteric

18 - 28 Fr

Size of tube for gastrostomy

Avoid

For pedia cases, ______ big syringe bec of risk of aspiration

Bolus Feeding

Most likely to generate high residual volumes

True

True or False: In critically ill adult and children, continuous feeding has been reported superior to gravity feeding in terms of less diarrhea, and more wt gain due to improved absorption

Gastric residuals

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

Not to exceed 50% of the amount infused

Volume of gastric residuals

False: Often, diarrhea is not caused by EN, and while investigating the cause, nutrition support should not be withheld

True or false: nutrition support should be withheld while investigating the cause of diarrhea

FEES - Functional Endoscopic Evaluation of Swallowing

Test for px with difficulty of swallowing ; to test their swallowing ability, foods with green dye are given. Sample foods: pureed food, thick liquid, thin liquid, crackers, ice chips

Pureed

Dysphagia Level 1

Minced

Dysphagia Level 2

Ground and Chopped

Dysphagia Level 3

25%

To prevent refeeding syndrome, start nutri support at _____; advance requirements slowly over 3-5 or 5-7 days until goals are reached