nutrition ch 15
Card Set Information
nutrition ch 15
enteral parenteral nutrition
enteral and parenteral tube feedings
uses HI tract
oral & tube feedings
preferred route if pt has adequate GI function
uses the VEINS
for persons wih inadequate GI function
what are the different types of ENTERAL nutrition support?
: persons who can digest and absorb without difficulty
: partially or fully broken down foods; persons with compression GI function
: contain single macronutrients
what is osmolarity?
a solution's tendency to shift from one fluid compartment to another across a semipermeable membrane
: 300-700 mOsm/kg
when selecting an enteric formula, what are some of the factors that one's decisions depends on?
patient's medical condition
fluid and nutrition status
ability to digest and absorb nutrients
lowest risk of complications
nutrient & energy needs
require functional GI tract
patient is unable to consume enough nutrients; pt is nutritionally incomplete
tube goes to stomach or intestine
what type of patients are canidates for tube feedings?
severe swallowing problems
little or no appetite
GI obstructions, impaired GI motility
mentally incapacitated, coma
extremely high nutrient requirements
what feeding routes can be used if a tube feeding will last less than 4 weeks?
what type of patients are best for an orogastric tube feeding route?
what type of feeding routes are used if a patient will have a tube feeding that lasts longer than 4 weeks?
enterostomy: gastrostomy, jejunostomy
why are gastric feedings the preferred route?
easily tolerated & less complicated
not good for patients at risk for aspiration
in regards to tube feedings, what is an OPEN system?
formula needs to be transferred from original pckaging to feeding container
in regard to tube feedings, what is a CLOSED system?
formula is prepackaged
what are the safety guidelines for administering tube feedings?
clean can opener & lid
refrigerate unused portions in clean, closed containers
discard unlabeled or unused within 24 hours
: hang no more than 8 hours
: hang no more than 24-48 hours
intermittent formula delivery
250-400 mL over 20-40 minutes
risk of aspiration *
bolus formula delivery
delivery of large volume every 3-4 hours
continuous formula delivery
slowly at constant rate
what are some of the factors that affect formula volume and strength?
varies among institutions
concentrated fluids - usually started slowly & volume is gradually increased
assess patient tolerance
checking gastric residuals
withdraw contents through feeding tube with syringe
intermittent before each feeding
continuous 4-6 hours
formulas are 75-80% water
more water comes from flushes via feeding tubes
flush BEFORE & AFTER bolus or intermittent feeding
flush every 4 hours for CONTINUOUS
count flushes as intake
transition from tube feedings to table foods
gradually shift to oral diet
oral needs to be 2/3 of nutrient intake before discontinuing the tube
when delivering medications with a continuous tube feed, when should the feeding be stopped?
15 minutes BEFORE & 15 minutes AFTER medication administration
what are some complications that can occur when delivery medications with tube feeds?
what must be monitored when delivering medications and tube feedings together?
patients weight, hydration status, lab test results
what are the indications for parenteral nutrition?
intestional obstructions or fistulas
short bowel syndrome
intractable vomiting or diarrhea
bone marrow transplants
intolerance to enteral nutrition
peripheral parenteral nutrition (PPN)
uses peripheral veins
patients with average nutrient needs & NO fluid restictions
veins can be damaged by concentrated solutions
total parenteral nutrition (TPN)
larger, central veins
patients with high nutrient needs or with fluid restrictions
what amino acids are contained in parenteral solutions?
all essential plus combinations of non-essential
what is the role of carbohydrates in paraenteral solutions
type - dextrose, 3.4 kcalories/gram
> 12.5% only for TPN
what is the role of lipids in paraenteral solutions
10, 20, & 30% solutions
significant source of energy
often provided daily = 20-30% total kcals
decreased risk of hyperglycemia
which vitamins do parenteral solutions contain?
all water soluble PLUS A, D, E
K must be added seprately
what are the trace minerals found in parenteral solutions?
iron is excluded
how many mL of paraenteral fluids must adults consume per day
what are the types of parenteral solutions
total nutrient admixture (TNA)
total nutrient admixture (TNA)
also called "all-in-one" solution
contains dextrose, amino acids, & lipids
dextrose & amino acids
lipids administered seperately to provide essential fatty acids
what is the criteria for administering parenteral solutions for continuous and cyclic orders?
: for critically ill, or malnourished patients
: 10-16 hours; often provided at night
: check tubing and solution daily for contamination
when can parenteral IVs be discontinued?
when 2/3-3/4 of nutrient needs are provided by enteral feedings
patients who are glucose intolerant or in severe metabolic stress
provide insulin with feedings or decrease dextrose
occurs when feedis are itnerrupted or discontinued
critically ill cant tolerate lipid infusions
impaired lipid clearance
abnormal liver function
long-term can lead to liver failure
paraenteral for more than 4 weeks
sludge builds up leading to gallstones
cholecystokinin injections or remove gallbladder
metabolic bone disease
long-term parenteral lowers bone density
alteration in calcium, phosphorus, and vitamin D metabolism
who are canidates for ENTERAL feeding support at home?
head and neck cancers
neurological impairments affecting swallowing
who are canidates for parenteral nutritional support at home?
short bowel syndrome
quality of life issues associated with enteral and parenteral feedings
activities & work must be planned around feedings
social issues associated with enteral and parenteral feedings
inabiliy to consume meals with friends and family
unable to go to restaraunts and social events
fear, anxiety, and depression
what is inborn error of metabolism?
an inherited trait caused by genetic mutation
results in absence, deficiency, or malfunction of a critical protein
what is the primary treatment for inborn error of metabolism?
MEDICAL NUTRITION THERAPY
prevent accumilation of toxic metabolites
replace nutrients that are deficient
provide a diet to support growth and development and health
what is phenylketonuria (PKU)?
affects amino acid metabolism - missing liver enzyme that converts the essential amino acid phenylalanine to the amino acid tyrosine
accumulating products damage the nervous system
newborns routinely screened in all 50 states
: diet restricting phenylananine, life-long diet
what is galactosemia?
error of carbohydrate metabolism
need to exclude
: milk & milk products; organ meats; some legumes, fruits, and vegetables
accumulation of carbohydrates can prodouce
: liver damage, kidney damage, cataracts, or brain damage