Term
| What is enteral nutrition? |
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Definition
Delivery of nutrients via mouth or feeding tube into the GI tract.
**Macro nutrients - protein, fats, carbs
**Micro nutrients - vitamins and minerals |
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Term
| When is enteral feeding considered? |
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Definition
- Inable to ingest food normally - dysphagia (stroke, cancer, acalasia), comatose, or ventilation
- Inadequate nutrition due to a disease state
- Inadequate oral intake after 5-7 days
**Hypermetabolic states such as burns may require enteral feeding. |
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Term
| What is the advantage of enteral nutrition? |
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Definition
If the gut is used, it does not atrophy. Atrophy leads to bacterial translocation.
Reduced infection compared to parenteral. |
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Term
| Why is protein essential in EN? |
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Definition
Although it is the 3rd line for energy, some amino acids are ESSENTIAL.
Albumin maintains fluid balance. |
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Term
| What macronutrient is the 1st line for energy in EN? |
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Definition
| Carbs! Specifically glucose |
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Term
| What fats are used for EN? |
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Definition
Omega-3 (linoleic) and omega-6 (alpha linolenic acid) b/c these are not produced by the body
Combo of middle and long chain TGs |
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Term
| What different enteric feeding formulas are available? |
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Definition
- Standard polymeric - for general patient population
- High protein - wounds and burns
- High calorie - fluid restriction
- Elemental - intolerance to standard formula
- Peptide base - intolerance to standard formula
- Renal - renal failure
- Hepatic - hepatic failure
- Respiratory - ARDS and ALI
- DM - hyperglycemia
- Immune-modulating - trauma or stress |
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Term
| Why is ensure not preferred for EN? |
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Definition
| It is sweetened for oral use, thus it is hypertonic |
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Term
| What routes are available for short term EN? |
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Definition
First line: Orogastric or nasogastric
Not preferred: nasoduodenal or nasojejunal
**Small bore more prone to occlusion |
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Term
| What routes are available for long term EN? |
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Definition
- Percutaneous endoscopic gastronomy - large bore
- Percutaneous endoscopic jejunostomy
- Percutaneous gastrojejunostomy |
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Term
| When is small bowel access appropriate for EN? |
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Definition
- Gastric obstruction
- Gastroparesis
- Pancreatitis
- Fistulas
- Aspiration |
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Term
| What is the difference between open and closed systems for EN? |
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Definition
- Open system - transfer to a refillable bag. Risks contamination
- Closed system - ready to hang
**Use sterile liquid formulations whenever possible. Use sterile water for hydration |
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Term
| When should and enteral tube be flushed? |
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Definition
| With 30 mL every 4 hours, or before and after feeding or medication administration |
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Term
| How is a protein goal determined? |
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Definition
Goal will be Protein g/kg --> dependent upon weight and status
Volume: Protein/55.5 * 1000 mL = volume in 24 hours
**Volume/24 = rate per hour. |
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Term
| How is free water volume determined? |
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Definition
TF rate * 24 = total TF volume
Total volume * % free water of formula = free water
**Water for hydration --> Total calories of formula - free water. May divide by shifts. |
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Term
| What are barriers to enteral nutrition delivery? |
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Definition
- Tests, surgery, procedures
- Hypotension
- Access
- Hypocaloric orders (watch propofol)
- GI intolerance
- Drug-nutrient interactions. |
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Term
| What are signs of enteral feeding intolerance? |
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Definition
Electrolyte abnormalities
GI intolerance - N/V
High lactic acid
Abdomninal distention
Metabolic acidosis
GRV > 250
Constipation or aspiration |
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Term
| What drugs can be used to treat GI dysmotility? |
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Definition
- Metoclopramide/Reglan - DA2 antagonist
- Erythromycin - has motilin activity.
- Opioid antagonists - naloxone and methylnaltrexone |
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Term
| How is constipation treated with enteral feeding? |
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Definition
Fluids
Prune juice
Fiber
Correct K/Mg levels
Laxatives: Docusate for maintenence, use in combo w/ bisacodyl or sennosides. Mineral oil last line. |
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Term
| How is diarrhea treated in enteral feeding? |
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Definition
- Loperamide
- Lomotil
- Tincture of opium |
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Term
| When should enteral feedings be started in the critically ill? |
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Definition
within 24-48 hours, withhold until hemodynamically stable
**Watch for signs of bowel ischemia, especially in patients on fiber formulas |
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