13-1: 2/6 - Enteral And Parenteral Nutrition Support

Front 1

Signs of nutritional deficiency.

Back 1

Slow-healing wounds
Muscle wasting

Front 2

What are the benefits of early enteral nutrition?

Back 2

Maintains gut mucosa, preserves gut barrier function

Promotes peristalsis!

Front 3

Enteral nutrition:
Anatomic requirements
What is it?

Back 3

Need sufficient length of small bowel, and absorption

Used when oral intake inadequate or contraindicated

Delivered via tube into GI tract

Front 4

Enteral Nutrition:
Indications

Back 4

Growth failure, malnutrition
Dysphagia
Cognitive impairment
Prolonged intubation/sedation
Coma
Elevated needs due to trauma/stress

Front 5

When does pancreatitis warrant enteral nutrition?

Back 5

Severe pancreatitis with necrosis.

Front 6

Enteral Nutrition:
Absolute Contraindications

Back 6

Small bowel obstruction
Severe prolonged ileus (lack of motility--5 to 7 days)
Short bowel syndrome
Enterocutaneous fistula

Front 7

Nasogastric Tube:
Requirements
Length of Use

Back 7

Intact gag reflex
Normal gastric function
Low aspiration risk

Use <30 days

Front 8

Intra-Operative Enteral Access:
Indications

Back 8

Severe head, major thoracic, spinal injury
Facial injury requiring wiring
Gastric/esophageal injury

Front 9

What are the complications of enteral nutrition?

Back 9

Aspiration***--can lead to pneumonia
Reflux, gastroparesis
Dumping syndrome
Diarrhea

Infection at site of gastrostomy

Front 10

Who is most as risk of aspiration?
How is aspiration risk assessed?

Back 10

Pts with cognitive impairment most likely to aspirate.

Assess risk of aspiration via gastric residual--after a feeding, measure stomach contents; should be under 250 ml!

If >250, hold infusion.

Note: this can only be checked if feeding through stomach.

Front 11

What is parenteral nutrition?

Back 11

Delivery of nutrient directly into circulatory system through catheter inserted into vein.

Done when GI tract is non-nfal, inaccessible, or unsafe to use.

Front 12

Parenteral Nutrition:
Indications

Back 12

Short bowel syndrome
Bowel obstruction/cannot feed distally
Bowel ischemia
Tube feeding failure

Front 13

What are possible mechanisms of malabsorption?

Back 13

1) acid hypersecretion
2) rapid intestinal transit
3) impaired residual bowel; loss of surface area (short bowel syndrome)
4) bacterial overgrowth
5) bile acid wasting

Front 14

Preferred vasculature for parenteral nutrition tube placement.

Back 14

Subclavian vein can be done through arm (peripherally inserted central catheter--PICC)
Jugular vein

Front 15

What is PICC?

Back 15

Peripheraly inserted central catheter (catheter placement to subclavian vein)

Front 16

What access devices for parenteral nutrition are best for:
days
weeks
months
years

Back 16

Days: Peripheral IV, Non-tunneled CVC

Weeks: Non-tunneled CVC, PICC

Months: PICC

Months/Years: Tunneled CVC (central venous catheter), Implanted Port

Front 17

Carbohydrates are provided as ______ in parenteral nutrition formulations.

Back 17

Dextrose

Front 18

___________ can result in liver failure.

Back 18

Long-term parenteral nutrition

Mech not known why. May be due to high levels of lipids in infusions.

Front 19

Formula for calculating dietary (calorie) requirements.

Protein?

Back 19

25-30kcals/kg

Protein: 1gm/kg

Front 20

80 year-old male with hx regurgitation, aspiration pneumonia, coughing/choking, absent swallow.

Enteral or parenteral?

Back 20

Parenteral

Front 21

50-year old male with Crohn's s/p ileocolic resection, resection neoterminal ileum, complete right colectomy.

Currently 78% of usual body weight.

Enteric or parenteral?

Back 21

Parenteral

Front 22

Who is a candidate for weight-loss surgery?

Back 22

BMI >35 w/co-morbidities
BMI >40 w/o co-morbidities

Failed attempts at weight loss
No drug/EtOH problems
No uncontr'd psyc conds

Front 23

What bariatric procedure has the lowest rate of complications?

Back 23

Adjustable lap band (restrictive barrier)--creates small pouch to lmit amt of food eaten

Front 24

This bariatric procedure cannot be reversed.

Back 24

Gastric sleeve

Front 25

Describe an even that would:
-mildly increase BMR
-moderately increase BMR
-significantly increase BMR

Back 25

mild increase seen w/uncomplicated major surgery

mod inc seen w/major trauma or surgery w/illness

sig increase seen with burn

Front 26

Endoscopic feeding routes:
Examples

Back 26

Esophageal: RARELY USED

Gastrostomy (G tube)

Jejunostomy (J tube)

Front 27

Gastrostomy vs Combined Gastrostomy/Jejunostomy Tubes

Back 27

Gastrostomy: long-term use (>30 days); bolus, intermittent, or continuous feedings

Combined Tube allows gastric decompression and simultaneous feeding