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28 Cards in this Set
- Front
- Back
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Selecting tube feeding formula basis
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Patient issues
formula issues |
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possible patient issues
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medical condition
nutrient needs gastric emptying digestive and absorptive capacity metabolic abnormalities |
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possible formula issues
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physical properties (osmolality & viscosity)
caloric density ingredient/ nutrient content |
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physical properties of formula (osmolality)
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osmolality: concentration of free particles in a kg of water
osmolality of body fluids~270-300 mOsm/kg water tube feeding formulas are 270-700 mOsm/kg (tolerance varies based on location of tube & patient's condition) |
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physical properties of formula (viscosity)
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larger molecules (fiber, high caloric density) increase viscocity require a large diameter feeding tube
standard: 1000 kcal/ L, but still runny |
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caloric density of formula
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range 1-2kcal/ mL
typical patient 1kcal/mL higher caloric density formulas: volume or fluid restricted & high energy needs |
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ingredients/ nutrient content of formula[protein]
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range: 35-95g/L
intact digestive/ absorptive functions- whole proteins e.g or casein or soy protein impaired digestive/ absorptive function-hydrolyzed protein (pre digested) peptides, or free amino acids, & increases osmolality |
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ingredients/ nutrient content of formula [carbohydrates]
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range: 28-70% kcals of available carbohydrates
some contain fiber fiber enriched formulas are for long term feeding to prevent constipation, controls diarrhea, & assists w/ blood sugar control sources of carbs polysaccharides (corn starch, dextrins) disaccharides (eg sucrose) monosaccharides (glucose FOS (fructooligosaccharides aka fiber), or soy fiber |
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Ingredients/ nutrient content of formula [fat] what is bile for
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range 3-55% of kcals
LCT or LCT and MCT only MCT afect osmolality don't need bile LCT needed for EFA LCTs are immunosuppresive: increased use of omega 3 fatty acids |
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ingredients/ nutrient content of vitamins & minerals sa well as specialized components
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most formulas provide RDA for vitamins & minerals if enough kcals are given
supplements for additional needs speciality formulas may differ [renal formulas, wound healing] specialized: glutamine: improve gut function, arginine: may boost immune system but not recommended, Omega 3 fatty acids: prevent suppression of immune system |
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Categories of formula
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standard formula
standard formula with fiber blenderized formula elemental two calorie disease specific |
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standard formula
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for intact digestive & absorptive capacity
delivers to stomach or duodenum |
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standard formula w fiber
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ifor intact digestive and absorptive capactiy
delivers to stomach & duodenum long term feeding useful w diabetes |
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blenderized formula
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hamburger, papaya, etc. mixed in blender so much that it won't clog the tube
for intact digestive and absorptive capacity |
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elemental formula and where it's delivered
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minimal digestive and absorptive capacity
deliver to duodenum or jejunum hydrolyzed protein, peptides amino acids may be low in fat or contain medium chain triglycerides high cost unpalatable |
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two calorie formula
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thicker bc it has double fat
2000kcal/ L aka 2 kcal/mL high in protein [75-90 g/L] full digestive and absorptive capacity very viscous deliver to stomach/ duodenum used w fluid restriction or high needs |
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disease specific formula
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vary depending on nutritional needs for disease
diabetic for example would have low glucose renal |
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selection factors
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digestive, absorptive, & metabolic status of patient
calorie & protein needs of patient feeding site duration of feeding fluid restriction cost |
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modular components of formula
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concentrated sources of nutrients
custom formula or added to regular formula promod, bene protein polycose mct composed of macronutrients, protein, fat, & sugar |
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complications [gastrointestinal]
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nausea/ vomiting
diarrhea/ constipation inadequate gastric emptying |
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complications [mechanical]
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obstructed/ clogged tube
aspiration pneumonia |
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complications [metabolic]
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dehydration
electrolytic imbalance hyperglycemia |
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administering tube feeding
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peristalsis must be present except w jejunostomy
confirmed tube placement observe hang time policy [how long formula has been sitting out at room temperature] monitor tolerance pump or gravity drip administration |
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administering continuous drip:
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administered continuously at set rate
important w ND, NJ, or jejunostomy feeding use if patient hasn't been fed for several days[ because it may have been atrophied & it is better to put in a little rather than a ton] pump or gravity drip administration |
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administering intermittent/ bolus feeding
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20 to 60 min/ feeding
usual volume ~200 to 350 mL; 4-8 x daily flush tube w water beforea nd after feedings used w gastrostomy tube total volume infused is set rather than rate |
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advantages of intermittent bolus feeding
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inexpensive
self administer greater mobility more physiologic |
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disadvantages of intermittent bolus feeding
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time consuming for staff
residuals must be checked [residual is the amount left in the stomach after a certain period of time |
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administering a cyclic schedule
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feed only at night
allow patient to develop appetite for meals during the day night feedings help meet needs |
