nutrition support correct answers to maintain or restore nutritional status when oral feeding is not sufficient
enteral nutrition/ tube feeding correct answers feeding directly into the GI tract
parenteral nutrition correct answers 1. intravenous: nutrients into a vein
- peripheral (PPN)...
nutrition support correct answers to maintain or restore nutritional status when oral
feeding is not sufficient
enteral nutrition/ tube feeding correct answers feeding directly into the GI tract
parenteral nutrition correct answers 1. intravenous: nutrients into a vein
- peripheral (PPN)
- central (CPN or TPN)
nutrition support team correct answers MD, RN, Pharmacist, RDN- sometimes a
certified nutrition support clinician (CNSC)
guidelines for the provision and assessment of nutrition support therapy in the adult
critically ill patient correct answers 1. Assess patients on admission to the intensive
care unit (ICU) for nutrition risk, and calculate both energy and protein requirements to
determine goals of nutrition therapy
2. Initiate enteral nutrition (EN) within 24−48 hours following the onset of critical illness
and admission to the ICU, and increase to goals over the first week of ICU stay
3. Take steps as needed to reduce risk of aspiration or improve tolerance to gastric
feeding
4. Start parenteral nutrition early when EN is not feasible or sufficient in high-risk or
poorly nourished patients
ASPEN - American Society for Parenteral and Enteral Nutrition correct answers 1.
Interdisciplinary professional organization founded in 1976
2. Mission - to improve patient care by advancing the science and practice of clinical
nutrition and metabolism
3. Journal Publications: - Journal of Parenteral and Enteral Nutrition (JPEN) - Nutrition
in Clinical Practice (NCP)
Indications for EN correct answers 1. Functional GI tract
2. Inadequate oral intake for 7-14 days or inadequate oral intake expected to continue
over 7-14 days
3. Impaired nutrient ingestion
4. Swallowing dysfunction
5. Altered mental status
6. Inability to consume adequate nutrition orally - can't or won't
7. Disorders of the upper GI tract that can be bypassed
Contraindications to EN correct answers 1. Malfunctioning GI tract or bowel rest
2. specific conditions:
,- insufficient absorptive capacity (colitis, surgery resections)
- peritonitis (inflam of peritoneal lining)
- mechanical obstruction
- prolonged ileus (no motility in the GI tract)
- severe GI hemorrhage
- intractable vomiting or diarrhea
- high output fistula (>500 ml/d)
- severe enterocolitis
- need for complete bowel rest
- ethical contraindications (end of life, terminally ill)
Research Supports the Use of EN correct answers 1. cost effective
2. reduced hospital length of stay (LOS)
3. reduced rate of infections
4. improved wound healing
5. maintenance of GI function
Nutrition Support Guidelines: 2016 JPEN, ASPEN/SCCM Guidelines (EN v PN) correct
answers Compared to PN, EN reduces the risk of infectious complications by 44% in
ICU
EN preferred route correct answers 1. Avoids complications induced by PN (artificial
feeding)
- Reduces metabolic stress: insulin resistance and hyperglycemia, and hepatic
dysfunction
- EN maintains local and systemic immune function = less infections
2. Trophic effect on GI tract, stimulates mucosa:
- Direct: Contact of nutrients with villi, stimulates biliary and pancreatic secretion,
maintains healthy intestinal microbiota
- Indirect: Increases GI hormone secretions, stimulates autonomic nervous system,
increases blood flow
trophic correct answers 1. cant feed full calories and protein with EN, but trickle feed 10
ml/hour
2. ** small volumes to stimulate the gi tract and immune response, doesn;t actually
meet needs
Early Enteral Feeding correct answers 1. definition: Start within 24-48 hours (and
usually within 12 hours) post-op; or after admission
2. benefits:
- Reduces the hypermetabolic response to stress (view Dr. Ney's Lectures on metabolic
stress for review)
- Reduces weight loss
- Minimizes GI mucosal atrophy
- Reduces bacterial translocation
- Decreases incidence of sepsis and subsequent complications
bacterial translocation correct answers 1. Passage of viable indigenous bacteria from
the lumen to the lymph or portal blood that may cause systemic infection
2. EN will reduce bacterial translocation
when to switch correct answers meeting 60-75% of calories need
Nasal Sites for Enteral Tube Feeding Access correct answers 1. less than or equal to 6
weeks. short term!
2. Note: If critically ill and intubated, can place tube through the mouth - orogastric, etc.
3.
-nasogastric placement, -nasoduodenal placement,
-nasojejunal placement
tube placement of NG and ND correct answers 1. Nasogastic and Nasoduodenal
Feeding Tube Placement Using Cortrak System
2. want the tube to be midline
enterotomies correct answers 1. Long Term & Home Use
2. gastrostomy tube
3. jejunostomy tube
Note: Can also place a combination of the two with an extension onto the gastrostomy
tube which extends into the jejunum
percutaneous endoscopic gastrostomy, PEG correct answers 1. with endoscopic
assistance, a needle is used to puncture the abdominal wall into the stomach
2. a gastrostomy tube is inserted into the stomach thru the new opening
characteristics of enteral formula correct answers 1. Amount of substrate - CHO, fat,
protein
2. Osmolality (mOsm/kg water): number of water attracting particles per kg of water,
high osmolality formulas can cause GI distress
3. concentration of kcal/ protein (nutrient density)
4. percentage free water
5. lactose content- typically lactose free
6. amino acid composition
7. degree of hydrolysis of carbs and protein
8. fiber content and possibly FOS (fructo-oligosaccharides)
9. volume needed to meet DRI for vit/min
10. fat content and source
high osmolality correct answers water into gi tract quickly and will cause dumping
syndrome, increase output
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