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72 Cards in this Set
- Front
- Back
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Colostrum: when is it produced? how much fat/protein content?
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-3-5 days postpartum
-low fat, high protein |
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Mature milk: when is it produced? how much fat content? what are the two types?
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-15 days postpartum
-high fat -foremilk: lower fat -hindmilk: higher fat |
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Transitional milk: when is it produced?
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5-15 days postpartum
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Protein in human milk contain ___ and ___. What is the ratio?
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whey: casein
80:20 |
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How many kcal/oz in human milk?
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20 kcal/oz (calories)
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What is the main source of carbohydrate in human milk?
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lactose
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Recommended supplements for breastfed infants (2).
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Vit D: begin at 2 mos; D-Vi-Sol
Iron: begin at 4-6 mos; Poly-Vi-Sol |
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Types of infant formulas (6).
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1. cow's milk protein based
2. soy protein based 3. hydrolyzed protein 4. amino acid 5. lactose free 6. specialized |
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Whey:casein ratio in cow's milk.
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18:82
-some add more whey to mimic human milk |
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Indication for cow's milk protein.
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healthy term infants
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Similac Advance and Enfamil Lipil (cow's milk protein) do not need to be supplemented with what?
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iron - already added in formula
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DHA
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omega-3 f.a.
-imp for brain, eye, and nervous sys development -recommend min of 0.2% (can inc to 0.5%) -primarily oily fish |
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ARA
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-omega-6
-brain and heart -precursor of eicosanoid -primarily meat , eggs, milk -recommend min of 0.2% (can inc to 0.5%) |
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What is the fat and carbohydrate source of soy formulas?
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f: veg oils
c: corn syrup, sucrose |
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Cow's milk allergy may also have a ___ milk allergy.
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soy - try something else
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Indications for soy formulas.
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lactose intolerant, vegan diet
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Examples of soy formulas
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-enfamil proSObee
-similac SOY isomil -good start SOY plus |
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Which infant formula is hypoallergenic?
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hydrolyzed
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Indications for hydrolyzed protein formulas.
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-cow's or soy allergy
-failure to thrive -feeding problems -malabsorption syndrome |
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Examples of hydrolyzed protein formulas.
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-enfamil nutramigen
-similac alimentum |
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Which infant formula is predigested?
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amino acid based formula
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Indications for a.a. based formulas.
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protein hypersensitivity intolerant to hydrolyzed protein formulas
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Examples of a.a. based formulas.
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-neocate
-elecare |
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Indications for premature infant formulas.
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-preemie <2kg
-fluid restriction |
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How many cal/oz in premature infant formulas?
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20-24 cal/oz
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Examples of premature infant formulas.
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-premature lipil
-similac special care -good start premature |
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What is the carbohydrate source of premature infant formulas?
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lactose and glucose
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Fat, protein content of premature infant formulas.
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higher (Na, Ca, P, vitamins, and trace elements too)
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Premature infant formulas, dec or inc: cys, phe, tyr
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cys: increased
phe: decreased tyr: decreased |
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Indications for pediatric formulas
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>6 mos of age, tube feedings
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Which formula has increased protein and minerals?
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pediatric formula
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Examples of pediatric formulas.
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-milk based: pediasure, kindercal
-soy: bright beginnings -protein: peptamin jr., peptinex -a.a.: neocate jr., vivonex |
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3 calorie enhancement products.
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1. polycose (inc carbs); 1 tsp=8 cal
2. veg/MCT oil; 1 ml=8 cal 3. beneprotein/promod (inc protein); 1 scoop (5g)=28 cal |
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Benefits of prebiotics? probiotics?
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pre: anti-infective & allergy preventive; "premium"
pro: prevent diarrhea & NEC; "enflora" "immuniprotect" |
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When does powder, ready to use, and [] liquid formulas expire at RT?
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2 hrs
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When does powder formula expire in fridge?
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24 hrs
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When does ready to use and [] liquid expire in fridge?
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48 hrs
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After a bottle has been warmed or feeding has begun, when should formula be discarded?
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after 1 hr; do not refridge for later feedings
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Solid initiation @ 4-6 mos?
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Fe rich fortified cereal
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Solid initiation @ 6-9 mos?
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-baby food (1 at a time)
veggies, fruits, meats, fish, poultry, egg YOLK, dried breads, yogurt, cottage cheese |
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Solid initiation @ 9-12 mos?
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table foods, whole milk, 100% fruit juice
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What foods should be avoided in babies?
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honey, syrups, raw eggs, unpasteurized milks, egg whites, peanuts
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What are the short term routes of EN for infants?
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NG or OG
-NG avoided bc infants are obligate nose breathers |
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What are the long term routes of EN for infants?
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G-tube, PEG, GJ
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What are the indications for adult EN?
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1. functional GI tract
2. absence of mech. obstruction 3. PO not possible |
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T/F. EN is preferred over TPN.
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True
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EN should be started within ___ to ___ hrs following admission.
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first 24-48 hrs
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T/F. You should not administer EN in the absence of bowel sounds.
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False - BS is not an absolute
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In the ICU, EN should be placed in ___ or ___ to prevent aspiration or intolerance.
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gastric or small bowel (post-pyloric)
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What are absolute CI of EN? (2)
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1. mechanical int obstruction
2. necrotizing enterocolitis |
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Which is the preferred adult short term access, oral v nasal?
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nasal - many ppl already have a trach going down their throat
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What is the ligament of Treitz?
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ligament that hold the bowels in place
-placing a tube past this lig will not allow pancreatic stimulation |
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Why would a patient be on a cyclic EN?
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-pt cannot eat at all or
-they can eat on their own but is not consuming enough calories; liq during day and feedings overnight |
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Why would a patient be on bolus EN?
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pt can't eat but can swallow; meals throughout day
-also intermittent |
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Which EN formulation mimics standard diet?
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polymeric
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Adult elemental formulations.
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-partially hydrolyzed or elemental substrates
-free f.a./low fat -for pt w/ malabsorption issues e.g. HIV pts |
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Adult immune-enhancing formulations.
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glutamine, arginine, omega-3
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Adult organ specific formulations.
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lung, renal, hepatic
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Renal formulations.
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-high caloric density
-low protein -low electrolytes |
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Hepatic formulations.
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branched-chain a.a.
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Lung formulations.
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high fat, low CHO
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High caloric density formulations.
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1.5-2 kcal/mL
-pts needing fluid restriction |
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High protein formulations.
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NPC:N <125:1
-pts needing >1.5 g/kg/day |
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Standard adult formulation (kcal/ml).
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1-1.2 kcal/ml
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Prokinetic agents (2).
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-consider change to post-pyloric
-metoclopramide 10 mg q6h -erythromycin 125-250 mg IV q6h |
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What labs should you monitor for w/ adult EN?
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Chem 10 daily and LFT weekly
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What daily clinical monitoring should you do for adult EN?
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wt, I/O, stool output, N/V, ab assessment
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What is the goal of gastric residuals?
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<300 mL; check q6h
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How do you initiate EN (rate)?
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-start at 20-40 ml/hr
-advance 10-20 ml/hr q4h as tolerated |
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3 main complications with adult EN.
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1. hyperglycemia
2. GI 3. mechanical |
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T/F. Soda, cranberry juice, and/or meat tenderizers can be used for unclogging tubes.
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False - never use --> acidity can increase clogging
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Clogged tubes can be irrigated using what?
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2 tabs sodium bicarb + 1 tab pancrelipase finely crushed and dissolved in 10 ml H2O
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