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25 Cards in this Set
- Front
- Back
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What is nutrition support
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Provisions of nutrients and any necessary adjuntive theraputic agent, Orally/enteral/parenteral for the purpose of improving or maintaining a patients nutritional status
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Conditions that might require Enteral Nutrition?
EN |
Altered mental status-swallowing deficiencies- (functional GI but not able to feed themselves) disorders upper GI- malnutrition including energy expenditures-involuntary weight loss-Impaired nutrient utilization-medical disease-peritonitis (irritation or inflammation of peritoneal lining)
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Benefits of Enteral Nutrition
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Maintains integrity of intestinal mucosa: minimize bacterial trans-location: supports Gut Associated Lymphatic Tissue (GALT), Fewer infections and lower cost with EN compared to TPN. Utilizes normal physiologic action of digestion and absoptions.
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General conditions that Require EN support
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Impaired digestions
inability to consume adequate nutrition orally impaired digestion, absorption, metabolism Sever wasting or depressed growth |
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General conditions that require Parenteral
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Gastrointestinal incompetency (gut not working)
hyper-metabolic state with poor enteral tolerance or accessibility. |
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Contraindications of EN
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Ileus (poor motility or blocked)
Gastrointestinal bleeding intractable vomiting, malabsorption enterocutaneous fistula (abnormal connections between internal organ and surface of the body) |
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How to determine which formula to use
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functional status or GI tract
Physical characteristics of formula (osmolality, fiber, content, viscosity macro nutrient ratios, digestion and absorption capability of patient, specific metabolic needs, contribution of feeding to fluid and electrolyte needs or restrictions, cost effectivness |
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Calculate nutrition provided by the formula
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Energy = kcal per ml of formula x ml of formula provided
Protein = grams of protein per L of formula x L of formula provided fluid (free water) = Ml of water per l of formula x L of formula provided RDI ml to meet 100% of RDI ml of formula provided less or equal ml to meet 100% of RDI, formula meets RDI ml of formula provided greater ml to meet 100% of the RDI, formula does not meet RDI |
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EN Formulas are based on
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substrates, nutrient density, osmolality and viscosity
protein, carbohydrates, lipids, vitamins/minerals (use established fromulary or determined by clinician) |
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Provisions of oral nutrition (per OS/PO)
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General Diet
Modified Diet Oral supplimentation |
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Oral Suppliments (When and how)
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Between Meals
Added to foods Added to liquids for medications pass by nurse Enhances otherwise poor intake May be needed by children or tees to support growth |
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Enteral Nutrition Definition
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Nutrition support via placement of the nose, esophagus, stomach or intestines (dueodenum/Jejunum)
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Feeding Methods and max rates
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Bolus method = may give 240 to 480 ml several time a day (“push” is not desired)
Intermittent method =start with 100 to 150 ml and increase as tolerated, 20 to 60 minutes, several times/day via gravity drip or syringe Continuous method = slow rate of 50 to 150 ml/hr for 12 to 24 hours (max rate generally tolerated by critically ill is < 125 ml/hour) Cyclic method = delivered over 8-16 hour period, commonly at night |
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Disadvantages/Complications EN Metabolic
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metabolic
abnormal liver fxn tests (LFTs) excess CO2 production secondary to overfeeding kcal and/or CHO hyperglycemia dehydration electrolyte disorders—Na, K, P, Mg vitamin/trace mineral, EFA deficiency |
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Disadvantages/complications En feeding
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Administration problems (aspiration)
Gastrointestinal complications (diarrhea) Metabolic complications (overhydration) Access problems (tube obstruction) |
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Gastrointestinal problems of EN
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distention, cramps, nausea, vomiting (N&V) (Medications, osmolarity/feeding rate
high fat concentration, lack of fiber? contaminated formula or equipment Hypoalbuminemia) aspiration/high gastric residuals, Constipation |
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EN feeding Monitoring and evaluations? complications
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Tube related complications
GI complications Aspiration Dehydration Electrolyte Imbalances Under or Overfeeding Hyperglycemia Refeeding Syndrome |
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Conditions that might require PN
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GI non functioning
NPO >5 days GI fistula Acute pancreatitis Short bowel syndrome Malnutrition with >10% to 15 % weight loss Nutritional needs not met; patient refuses food |
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Parental Nutrition definition
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provision of some or all of nutrients by means other than GI tract, i.e., IV; used when the GI tract is unavailable
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Advantages PN
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Provides nutrients when less than 2 to 3 feet of small intestine remains
Allows nutrition support when GI intolerance prevents oral or enteral support |
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Contraindications of PN
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GI tract works
Terminally ill Only needed briefly (<14 days) |
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TPN-vs-PPN
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Total Parenteral Nutrition - When all nutrients come from feeding.. long term can handle hyperosmolar formula
Partial Parenteral Nutrition - Means patient is getting nutrition from another source. |
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Complications of TPN
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PPN, Site irritation
TPN 1. Catheter sepsis 2. Placement problems 3. Metabolic |
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Conversions
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Carbohydrate
glucose or dextrose monohydrate 3.4 kcal/g Max/5mg/kg/bw/per min Amino acids/proteins 3, 3.5, 5, 7, 8.5, 10% solutions 4 kcal/g Fat 10% emulsions = 1.1 kcal/ml 20% emulsions = 2 kcal/ml no more than 1g fat/kg max for stressed patients no more than 25-35% max |
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Re-feeding syndrome
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refeeding syndrome
serum levels of K, Mg, and P electrolyte concentrations result of rapid infusion of substrates (CHO) Causes insulin release and shift of electrolytes into intracellular space as glucose moves into the cells for oxidation and in salt and water excretion If not recognized and treated, can result in death. Physical signs and symptoms increased heart rate increased extracellular fluid volume dyspnea and/or tachypnea cardiac arrhythmias |
