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22 Cards in this Set
- Front
- Back
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EN |
Nutrition providedthrough the gastrointestinal (GI) tract via tube, catheter, or stomach thatdelivers nutrients distal to the oral cavity. |
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PN |
Administrationof nutrients and fluids intravenously, centrally (delivered into alarge-diameter vein, usually the superior vena cava adjacent to the rightatrium) or peripherally (delivered into a peripheral vein, usually of the handor forearm). |
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EN Indications |
"If GI works use it" Oral intake isimpossible Oral intake isinadequate Oral intake isunsafe |
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EN contradictions |
small bowel obstructions vomiting/diarrhea severe short bowel (literally length) GI paralysis (ileus) GI acid leaking in other areas of the body (uDistalhigh-output fistulas) GI bleed GI malabsorption Needs greater than 5-7 days for malnourished Needs greater than 7-9 days if normal Hemodynamicinstability (blood pressure) |
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Hemodynamic stability |
forces whichcirculate blood through the body, adequate bloodcirculation (blood flow) is a necessary condition for adequate supply of oxygento all tissues BP Heart rate Urine output Arterial Pressure Tissue oxygenation |
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When to start enteral nutrition? |
Medically stable: patient hasnt been adequate for 7-14 days or expected to be so Critically ill: 24-28 hrs after surgery or critical injury |
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EN: Nasogastric tube where? indications? advantages/disadvantages |
Where? nasal passage into the stomach Indications? short term feedings required Intact gag reflex GI function not compromised Low risk for aspiration Advantages: Easy to place no surgery easy to check residuals Disadvantages: Increased aspiration GI not intact? cant do it may promote necrosis and esophagitis |
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EN: Nasoduodenal/jejunal (NJT) Where? Indications? Advantages/Disadvantages |
Where? Into nose through stomach to Duod/Jejun Indications? High risk of aspiration, gastric function compromised Advantages? May decrease risk of aspiration, no surgery Disadvantages? More difficult to place, limited to continuous infusion, ALSO increases necrosis/esophagitis |
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EN: Orogastric |
only used for premature babies through the mouth can effect teeth |
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EN: Gastrostomy Where? Indications? Disadvantages? |
Where? Into stomach through abdominal wall Indications: Long term support planned, gastric function is no compromised Disadvantages: Stoma care required (hole on outside of body) Surgery "PEG" Problems leaking or tube dislodgment |
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EN: Jejunostomy Where? Indications? Advantages? Disadvantages? |
Where? into jejunum through abdominal wall Indications? Long-termfeeding option for patients at high risk for aspiration or with compromisedgastric function Advantages: Quick post op feeding initiation decreased aspiration suitable for compromised gastric function stable patients can handle intermittent feedings Disadvantages Requires stoma care tube leakage or dislodgment may restrict ambulation (to walk or move) bolus inapropriate |
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Tube sizes |
Larger (>10)= short term and are uncomfortable for patient Smaller (<8) used for EN usually 1F= 33 mm diameter |
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Formula Selection (6 reasons) |
1. Gi working? 2. Physical characteristics (osmolarity & viscosity) 3. Energy and nutrient content 4. Digestion/absorption capability 5. Fluid and electrolyte status 6. Cost effectiveness |
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Formula Selection: Protein Standard formula what % of energy from protein |
10-20% of energy from protein |
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Formula Selection: Protein Elemental formula composed of? |
Some combination of free amino acids, dipeptides and tripeptides, and some oligopeptides |
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Formula Selection: Protein Higher nitrogen formula (high protein) implies higher ______ requirements |
Fluid requirements are higher |
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Formula Selection: Protein Glutamine formula potential role in preserving ____ and _____ |
Potential role in preserving GI integrity and immunity |
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Formula Selection: Protein Arginine formula can be beneficial for.... |
wound healing, immune enhancing properties and role in collagen synthesis |
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What percentage of protein in a formula is usual and what is high? |
14-16% usual 18-26% high |
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___- ____ % calories provided as CHO in EN formulas |
30-90% |
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Standard formulas provide ___ -___ % of their energy from carbohydrates. What are the sources? |
30-60% of their energy from carbohydrates in standard formula, sources can be from corn syrup, sucrose, fructose, and sugar alcohols fiber can be added |
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Elemental formulas, carbohydrates come from? |
hydrolyzed cornstarch or malodextrin, SOME use sucrose and fructose |
