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31 Cards in this Set
- Front
- Back
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what are benefits of EN
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maintains normal GI pH and flora
immune enhancement via IgA secretion |
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what happens to the villi if you don't stimulate the GI tract for sometime, this is seen in PN
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villi are no longer finger like
have less SA and will be leaky (this means GI flora can go from bowel into blood and cause sepsis) |
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what are indications for EN
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functional GI tract
conditions where oral intake is: -impossible (obstruction/intubated) -inadequate (poor appetite, high metabolic demands, severely malnurished pre op) unsafe (confused, altered mental status) |
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what is seen in the assessment of a pt that indicates they can receive EN
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positive bowel sounds
adequate perfusion soft, NT, ND abdomen hemodynamically stable |
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what are CI of EN
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hemodynamically unstable
some forms of pancreatitis intractable Vomitting or Diarrhea (this is an indication for PN) malfunctioning GI tract obstruction or paralytic ileus |
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when do you initiate EN based on ASPEN guidelines
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patients with inadequate PO intake x 7-14 days
patients expected to have inadequate PO intake x 7-14 days |
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when would you start EN in critically ill pts
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start Early EN within first 24-48hrs in ICU
this is due to the antiinflammatory and immune enhancing properties of EN |
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what is considered hemodynamically unstable
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MAP <60mmHg
SBP<90 DBP<50 |
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what happens when you feed a pt that is not hemodynamically stable
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non occlusive bowel necrosis
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what are signs of intolerance that make you Withhold EN
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abdominal distension
increase NG output decrease bowel sounds increase metabolic acidosis |
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what EN formula mimics a typical diet for a healthy person
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Polymeric
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what EN formula is reserved for pt with underlying GI conditions associated with malabsorption
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Elemental/Semi-elemental
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what are the properties of EN nutrition designed for Renal disease
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decrease protein, K, Phos, Mg
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what are the properties of EN nutrition designed for hepatic disease
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increase BCAA (LIV)
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what are the properties of EN nutrition designed for diabetic disease
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increase in fiber and monounstaturated fats
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continuous feeding can be done where
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stomach or small bowel(small intestine) due to it being a small volume
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intermittent feeding can be done where
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GASTRIC ONLY (stomach)
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bolus feeding can be done where
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stomach only since its such a large volume otherwise it would irritate the small intestine
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what are the Dobbhoff tube
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nasoenteric tube
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is the nasoenteric tube for short term or long term feeding
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short term
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what must you do prior to using nasoenteric tubes
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confirm its placement via X ray
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is enterostomies long or short term feedings
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long term >30 days
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what are the complications of EN
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GI complications
Constipation Diarrhea Mechanical Aspiration Metabolic |
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what are the GI complications a pt may experience on EN
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N/V - due to delayed gastric emptying
Malbsorption - celiac disease, crohn's disease, pancreatic insufficiency |
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what kind of EN would you use in a pt with celiac disease, crohn's disease, or pancreatic insufficiency
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elemental/semielemental
all of these things cause malabsorption |
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how do you manage N/V in EN pts
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slower EN advancement rates
limit use of constipating drugs use antiemetics |
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what is considered normal bowel function
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4 BM to 1 BM every 4-5 days
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what are some causes of constipation in EN patients
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dehydration
excessive dietary fiber opiates, anticholinergics inadequates physical activity |
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what is defined as Diarrhea in EN pts
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>500ml q 8hrs
OR more than 3 stoools per day for 2 consecutive days |
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what is the main cause of diarrhea in EN
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pharmacotherapy, EN is rarely the cause
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what are the metabolic complications in EN
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fluid/electrolyte imbalance
vitamin/mineral deficiency acid base imbalance hyperglycemia - less common with EN refeeding syndrome |
