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describe refeeding syndrome
- -complication of EN or TPN due to rapid administration of high-kcal formula, resulting hyperglycemia, which leads to shift in phosphorus, Mg, K+
- -can cause GI (dec gastric motility) & cardiopulmonary complications
- -rapid vol expansion places high demands on CV system--> CHF, resp distress, hypercapnia, azotemia
- -inc O2 consumption--> resp & cardiac failure
how to prevent refeeding syndrome
- assess serum Na, P, Mg, K+ and replete before feeding
- slowly rehydrate & watch for signs of HF
- EN or TPN start at 50% of needs, gradually inc to goal over 3 dys
- monitor minerals, fluid I & O's, wt for 7 dys
- consider thiamine supp w/initiation of feeds
- pain, inflammation, and ulcer formation on the lining of the digestive tract, often a side effect of chemotherapy and radiation. Can
- occur anywhere along GI tract.
- · surgically created opening in the abdomen to allow
- stool or urine to exit the body
- · administration of a treatment prior to the main
- treatment, usually a surgery
- use of drugs, radiation therapy, or other treatment following
- the main treatment (usually surgery) in order to enhance results & reduce
- risk of cancer coming back
HNC surgeries that require G-tube for life
- total glossectomy
- tongue jaw and neck (TJN)
What is it?
If so, how long?
What type of device?
- -Removal of base of tongue, which is a
- strong muscle that helps pull up epiglottis when swallowing. Risk for aspiration.
- -NG tube short-term, but may need G-tube if more than midline is taken.
- -Some pts may be able to have PO
- diet if other muscles adapt to allow normal swallowing.
Total Laryngectomy: Test Question
What is it? Nutritional consequences?EN required?If so, how long?What type of device?
- -Removal of larynx and formation of tracheostomy so there so no longer a connection to esophagus. Lower risk for
- aspiration. If a TES is created, there is a greater risk for aspiration.
- -NG tube 7-14 days, but sometimes get G-tube if post-op RT is planned
- -If fistula is present and a TEP has been made, can go thru TEP
HNC surgery(s) that doesn't require EN
- Total maxillectomy (as long as prosthesis fits)
- Partial mandibulectomy- EN not needed but sometimes NG tube 7-14 days
Describe function of the XII Hypoglossal cranial nerve. If damage occurs, what affect may it have on chewing or swallowing? (TEst)
- -Function: tongue movements for speech, food
- manipulation, and swallowing
- -If damaged: difficulty in speech and
- swallowing; atrophy of tongue; inability to stick out tongue
For a PEG via push method, describe indications, contraindications, recommended duration
- -Indications: Need for long-term EN; usually
- due to upper GI disorders in which oral intake isn’t possible or high risk for aspiration
- -Contraindications: Significant obstruction and unable to pass scope
- -Duration: No time limit, but tube and/or
- fixation devices may need to be replaced periodically
For a PEG via push method, describe common internal and external fixation devices, and method of feeding
- -Internal: Most use balloon fixation
- device; or Cope-loop type locked PIG-tail, or a foldable mechanical bumper
- -External: Disk style external device or
- external crossbar; sutures
- -Feeding method: bolus usually, but can also do continuous or intermittent
Describe chylous fistula
leak of lymphatic fluid (chyle) that occrs from lymphatic vessels to the thoracic or abdominal cavity but occasionally manifesting as an external fistula
Intermittent feedings: volume and time
method of feed
delivery of larger volume of nutrients over a shorter period of time (volumes up to 480 mL several times per day, usually over a 20-60 min period); requires no pump, needs gravity drip bag (although a pump can be used)
Bolus feedings: volume and time and method of feeding
large volume delivered over a short period of time with fasting b/w feedings (volumes 240-480 mL several times per day, usually over 10 min or less); supplies include syringe (no pump)
How to determine what type of replacement fluids are needed when a pt has excessive losses?
- Consider the amount and where (organ) it's coming from
- To choose rehydration solution, see chart to assess organ, then try to match up the electrolytes to a rehydration solution that is similar
Clinical signs of electrolyte losses?
Dizziness, headache, nausea
Clinical signs to assess fluid status?
- weight changes
- symptoms of dehydration: dry mouth, concentrated urine
hang time of cans, powder, breast milk, and ready to hang formulas?
- cans: 8 hrs
- powder: 4 hrs
- breast milk: 4 hrs
- ready to hang: 48 hrs
what to consider when writing a TF formula form home enteral nutrition?
- patient's schedule
- hang time
- # of cans each feeding and times
- (so if a pt is using cans and feeding over 8 hrs at 100 mL/hr, max he could put in bag would be 3 cans [720 mL] to keep him under needs goals at that feeding)