BI 304: Chapter 15 Identifying Nutrition Risk and Feeding Clients | Chapter 16 Enteral and Parenteral Nutrition

Standard Formula

1. Standard form:

   1. Polymer . intact 

   2. Whole proteins or protein isolates

   3. Complex forms

   4. Clients with normal digestion nd absorption 

   5. Special types: high-protein, high-caloric, fiber enriched, Disease specific, belnderize 

Hydrolyzed formula

1. Elemtal, Predigested 

2. Partially or fully broken down into protein 

3. Simple forms that require little or no digestion 

4. Clinets with impaired digestion or absorption 

5. Semi-elemental or elemental

6. Used for tube feeding

Monitoring Client on Parenteral Nutrition: Determine what to monitor in a client on parenteral nutrition for a specific complication.

1. Refeeding syndrome: 

   1. A potentially fatal complication from suddenly switching from a catabolic (breaking down) to an anabolic (building) state

   2. Triggered by abrupt increase in carbohydrate intake → spike in insulin

2. Mechanism: 

   1. Cells rapidly take up potassium (K), phosphate (P), magnesium (Mg) → decreases serum levels

   2. Leads to fluid shifts, edema, heart failure, and respiratory failure

3. Symptoms:

   1. Edema

   2. Cardiac arrhythmias

   3. Muscle weakness

   4. Confusion

Indications for Parenteral Nutrition: Recognize an indication for the use of parenteral nutrition (PN) in a client.

1. Used when:

   1. Client is malnourished or at risk and cannot use enteral nutrition (EN).

   2. Client cannot tolerate adequate EN or has insufficient bowel function.

   3. Conditions that may require PN:

   4. Impaired nutrient absorption or loss: e.g., short bowel syndrome, radiation enteritis

   5. Mechanical bowel obstruction: e.g., strictures, stenosis

   6. Need for bowel rest: e.g., ischemic bowel, severe pancreatitis

   7. Motility disorders: e.g., prolonged ileus

   8. Inability to maintain enteral access: e.g., active GI bleeding

Parenteral Nutrition Infusion Rate: Understand why there is a gradual increase in the infusion rate for parental nutrition.

Prevent rebound hypoglycemia

Feeding Routes for Clinical Situations — Calorie Density

1. Determines the volume of formula needed to meet estimated energy needs.

2. Routine: 1.0–1.2 cal/mL → adequate for most clients.

3. High-calorie: 1.5–2.0 cal/mL → for fluid restriction or volume intolerance.

Feeding Routes for Clinical Situations — Macronutrient Content

1. Tailored to the client’s condition:

   1. Diabetes-specific: lower carbs, added fiber

   2. Respiratory insufficiency: high fat → lowers respiratory quotien

   3. Malabsorption: low/negligible fat (MCTs) → may affect essential fatty acids

Feeding Routes for Clinical Situations —Water Content

1. Standard (1.0 cal/mL): ~850 mL water/L

2. High-calorie: 690–720 mL water/L → may need extra free water

3. Adults need ~30 mL/kg/day; free water can be given via flushes or boluse

Feeding Routes for Clinical Situations — Micronutrient Density

1. Formula volume to meet 100% of adult DRIs: ~1000–1500 mL/day

2. Ensure adequacy if EN is sole nutrition source

Feeding Routes for Clinical Situations —Residue Content

1. Standard formulas: low-residue or fiber-enriche

2. Hydrolyzed formulas: essentially residue-free → fully absorbed content

Feeding Routes for Clinical Situations — Fiber Content

1. Stimulates peristalsis, increases stool bulk, produces short-chain fatty acids → gut health

2. Fiber-enriched standard: 10–15 g/L (oat, soy, pea, guar gum, etc.)
   Blenderized: ~4 g/L from whole foods

Side Effects of Hypertonic Enteral Formula: Identify a side effect from a hypertonic enteral formula.

1. Potential Side Effect:

   1. Vein irritation or damage if infused into small peripheral veins

      1. Can cause phlebitis (inflammation of the vein)

      2. Can cause thrombosis or discomfort

   2. Central venous catheters (CVCs) are used for hypertonic formulas because large central veins dilute the solution quickly, preventing irritation.

Enteral Nutrition Method for ICU Clients: Know why a specific enteral feeding method is ordered for ICU clients at risk for certain problems.

1. Disease-specific formulas are designed to meet altered nutrient needs for clients with illnesses such as:

   1. Diabetes / glucose intolerance

   2. Immunocompromised states

   3. Kidney disease

   4. Respiratory insufficiency

2. ICU Considerations:

   1. Critically ill clients in a medical ICU: Avoid routine use of specialty formulas.

   2. Surgical ICU clients: Avoid routine disease-specific formulas.

   3. Exception: Immune-modulating formulas containing arginine may be beneficial for clients with:

      1. Severe trauma

      2. Postoperative care

Troubleshooting Diarrhea in Tube-Fed Patients: Determine the first step to troubleshoot diarrhea in a tube-fed patient.

1. Assess the pt’s normal stooling pattern 

2. Medication are cause 

3. Infections: e.g., Clostridium difficile

4. Underlying diseases: inflammatory bowel disease, pancreatic insufficiency, diabetes-related enteropathy

5. Monitor: stool frequency, volume, and consistency

BMI Classification: Understand the BMI classification for an individual with a BMI of 27 kg/m^2.

BMI of 27 = overweight