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39 Cards in this Set
- Front
- Back
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What is enteral nutrition?
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via the gut, but not oral
via stomach or small bowel |
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What are the advantages of enteral nutrition?
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maintain gut mucosa, impeded bacteria/endotoxin translocation, physiologic nutrient presentation, lower risk, cost effective
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What are the indications for enteral nutrition?
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100cm small bowel, NPO for 5 days
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What are the contraindications of enteral nutrition?
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patient refusal, GI ischemia, intractable vomiting, diarrhea, intestinal obstruction, diffuse peritonitis, intolerance
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How do you place an NG tube?
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confirm by x-ray, auscultation, aspiration of gastric contents
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How do you place a gastrostomy tube?
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open tube placement
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What is standard polymeric formula?
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whole protein nitrogen source
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What is elemental formula?
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predigested nutrients, low fat
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How much protein is in enteral formula?
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6-26%
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How much fat is in enteral formula?
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1-55%
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How much CHO is in enteral formula?
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28-90%
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What do you check with enteral nutrition?
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labs, B/G, volume status, gastric residuals, abdomin distension, diarrhea, constipation
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What are the big risks of enteral nutrition?
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aspiration pneumonia, aspiration pneumonitis
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What can cause diarrhea with enteral feeding?
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medications, infection, hypoalbuminemia, organ failure, fat content of feeds, osmolarity of feeds
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How do you give enteral nutrition?
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pump or intermittent
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Why would you give continuous enteral infusion?
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critically ill or psot-op
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How do you do continuous enteral feedings?
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NG tube, standard formulas, full-strength at 30-50% of goal
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How do you give intermittent feedings?
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4-6/day, gastric feeding, not critically ill, infuse over 20-30 min
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What is the advantage of intermittent feeding?
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easier, less expensive
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What are the goals of parenteral nutrition?
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provide bowel rest, maintain lean body mass
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What are the indications for parenteral nutrition?
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short bowel, IBD, pancreatitis, GI surgery, NPO, bone marrow transplant, hyperemesis gravidarum
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What is in parenteral nutrition?
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dextrose, AAs, lipids
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How much dextrose in parenteral nutrition?
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3.4 kcal/g
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How much AAs in parenteral nutrition?
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4 kcal/g
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How much lipids in parenteral nutrition?
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9 kcal/g
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What electrolytes are in parenteral nutrition?
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Na, K, Ca, PO4, Mg, acetate, Cl
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What trace elements are in parenteral nutrition?
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Zn, Cu, Mn, Cr, Se
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What are the issues with compounding?
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Ca and PO4 limitations, filtration, stability at room temp
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What is compounding?
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1 bag/24 h
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What are the technical complications of PN?
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pneumothorax, hemothorax, brachial plexus, arrhythmia
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What are the hepatobiliary complications of parenteral nutrition?
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hepatic steatosis, cholestasis
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What is hepatic steatosis?
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hepatic fat accumulation, first 1-3 weeks of PN
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What do you see with hepatic steatosis?
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moderate increases in AST, ALT, alkaline phosphate
benign and reversible when PN is stopped |
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What is cholestasis?
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impaired secretion of bile
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What do you see with cholestasis?
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elevated GGT, alk phos, conjugated bilirubin
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What are the results of cholestasis?
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can be serious, progress to cirrhosis or liver failure
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What is refeeding syndrome?
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depletion, repletion, compartment shifts of PO4, K, Mg, alteration in glucose metabolism and fluid status
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What are diseases are associated with refeeding syndrome?
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anorexia, cancer, alcoholism, hyperemesis gravidarium, cardiac insufficiency, edema, convulsions, coma
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What do you monitor with PN?
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nutritional requirements, therapy efficacy, weight, wound healing
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