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22 Cards in this Set

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Nutrition providedthrough the gastrointestinal (GI) tract via tube, catheter, or stomach thatdelivers nutrients distal to the oral cavity.


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).

EN Indications

"If GI works use it"

Oral intake isimpossible

Oral intake isinadequate

Oral intake isunsafe

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)

Hemodynamic stability

forces whichcirculate blood through the body, adequate bloodcirculation (blood flow) is a necessary condition for adequate supply of oxygento all tissues


Heart rate

Urine output

Arterial Pressure

Tissue oxygenation

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

EN: Nasogastric tube




Where? nasal passage into the stomach


short term feedings required

Intact gag reflex

GI function not compromised

Low risk for aspiration


Easy to place

no surgery

easy to check residuals


Increased aspiration

GI not intact? cant do it

may promote necrosis and esophagitis

EN: Nasoduodenal/jejunal (NJT)




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

EN: Orogastric

only used for premature babies through the mouth can effect teeth

EN: Gastrostomy




Where? Into stomach through abdominal wall


Long term support planned,

gastric function is no compromised


Stoma care required (hole on outside of body)

Surgery "PEG"

Problems leaking or tube dislodgment

EN: Jejunostomy





Where? into jejunum through abdominal wall

Indications? Long-termfeeding option for patients at high risk for aspiration or with compromisedgastric function


Quick post op feeding initiation

decreased aspiration

suitable for compromised gastric function

stable patients can handle intermittent feedings


Requires stoma care

tube leakage or dislodgment

may restrict ambulation (to walk or move)

bolus inapropriate

Tube sizes

Larger (>10)= short term and are uncomfortable for patient

Smaller (<8) used for EN usually

1F= 33 mm diameter

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

Formula Selection: Protein

Standard formula what % of energy from protein

10-20% of energy from protein

Formula Selection: Protein

Elemental formula composed of?

Some combination of free amino acids, dipeptides and tripeptides, and some oligopeptides

Formula Selection: Protein

Higher nitrogen formula (high protein) implies higher ______ requirements

Fluid requirements are higher

Formula Selection: Protein

Glutamine formula potential role in preserving ____ and _____

Potential role in preserving GI integrity and immunity

Formula Selection: Protein

Arginine formula can be beneficial for....

wound healing, immune enhancing properties and role in collagen synthesis

What percentage of protein in a formula is usual and what is high?

14-16% usual

18-26% high

___- ____ % calories provided as CHO in EN formulas


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

Elemental formulas, carbohydrates come from?

hydrolyzed cornstarch or malodextrin, SOME use sucrose and fructose