Chapter 11: Enteral Nutrition Formulations with 100% correct answers
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Chapter 11: Enteral Nutrition Formulations
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Chapter 11: Enteral Nutrition Formulations
A 55 year old man presented to the hospital after a traumatic fall from a ladder while working at home. A CT scan of the head showed significant subdural hematoma with midline shift. After admission to the ICU, the patient was intubated and sedated, with an orogastric tube to suction and removal of...
A 55 year old man presented to the hospital after a traumatic fall from a ladder while working at home. A
CT scan of the head showed significant subdural hematoma with midline shift. After admission to the
ICU, the patient was intubated and sedated, with an orogastric tube to suction and removal of 200 mL
gastric content. The patient's abdomen was soft and nondistended. Nephrology was consulted and the
patient was started on CVVH. What type of enteral formula would best meet his needs?
A. a formula restricted in fluid, protein and electrolytes
B. a formula not restricted in protein but restricted in fluid and electrolytes
C. a formula restricted in fluid but not restricted in protein or electrolytes
D. a formula not restricted in fluid or protein but restricted in electrolytes correct answersC. a formula
restricted in fluid but not restricted in protein or electrolytes
Not all patients with acute renal failure require fluid restrictions, but of the answers provided a formula
restricted in fluid but not protein or electrolytes is the best option. There is no need to restrict protein in
patients that are dialyzed. Additionally, electrolytes such as potassium and phosphorus need only be
restricted when serum levels are chronically high.
A 60 year old, critically ill patient has been tolerating a standard 1 kcal/mL enteral feeding formula well
for the past week. She begins having frequent bouts of loose stools, requiring placement of rectal tube.
What should be the clinician's next suggestion?
A. change to a peptide based formula
B. determine the cause of the diarrhea
C. add pre and probiotics to the feeding regimen
D. change to fiber-supplemented formula correct answersB. determine the cause of the diarrhea
The feeding formula that she had been tolerating well during the past week is the least likely cause of
the diarrhea. Assessment to identify newly ordered medications that can cause diarrhea or possible
,infections such as Clostridium difficile may help to determine the cause of diarrhea. If no obvious cause
of diarrhea can be found, then a different feeding formula may be tried.
What should a clinician do when considering the use of enteral formulas marketed for specific disease
conditions?
A. Use formulas as indicated by the product manufacturer to meet patient's need
B. Use standard polymeric formulas for all patients
C. Use specialty formulas only when patients exhibit signs and symptoms of intolerance to standard
polymeric formulations
D. Evaluate the studies used to support the use of specialty formulas and apply clinical judgment to
select the appropriate enteral product for the individual patient correct answersD. Evaluate the studies
used to support the use of specialty formulas and apply clinical judgment to select the appropriate
enteral product for the individual patient
Standard polymeric formulas are indicated for most patients requiring enteral nutrition support.
Specialty products, clinician must use clinical judgement regarding the efficacy, tolerance and benefit.
Specifically evaluate the studies used to support these formulas, paying close attention to the quality,
patient population, clinical outcomes of the studies that are used to support their use.
How are enteral formulas classified by the FDA? correct answersEnteral formulations are considered
"medical foods" by the FDA
What is the definition for medical food? correct answersFDA defines medical foods as "a food which is
formulated to be consumed or administered enterally under the supervision of a physician and which is
intended for the specified dietary management of a disease or condition for which distinctive nutrition
requirements, based on recognized scientific principles, are established by medical evaluation"
What type of claims can enteral formula labels make without the approval of the FDA? correct
answersStructure and Function
What is a structure and function claim? Why does it pose a challenge for clinicians? correct
answersStructure and function claim - claim that a specific nutrient is intended to affect the normal
structure or function in humans
,Lack of clinical research to support structure and function claims pose challenges for clinicians
EN practice recommendations from ASPEN include what 3 statements? What are practice
recommendations based on? correct answers1. The veracity (accuracy, credibility) of adult enteral
formula labeling and product claims is dependent on formula vendors
2. Nutrition support clinicians and consumers are responsible for determining the veracity of information
about adult enteral formulations
3. Interpret enteral formulation content/labeling and health claims with caution until such time as more
specific regulations are in place
Practice recommendations were based on expert opinion and editorial consensus
What is a Standard polymeric formula? correct answersFormula containing macronutrients and
nonhydrolyzed protein, fat and carbohydrate
What are Elemental and semi-elemental enteral formulas? correct answersContains partially or
completely hydrolyzed nutrients (protein) and altered fats to maximize absorption
What are blenderized enteral formulas? correct answersFormulated with a mixture of blenderized whole
foods, with or without the addition of standard formula; best suited for patients with a healed feeding
site and for those who adhere to safe food practices and tube maintenance
What are disease-specific enteral formulas? correct answersTargeted for organ dysfunction or specific
metabolic conditions
What are modulars? correct answersUsed for supplementation to create a formula or enhance nutrient
content of a formula or diet
What is the primary macronutrient and principal energy source in most enteral formulations? correct
answersCarbohydrate
, What percentage of energy in enteral formulas are typically carbohydrate? correct answersEnteral
formulations typically offer 40% to 70% of the energy as carbohydrate
Carbohydrates contribute what 3 properties to enteral formulas? correct answers1. Osmolality
2. Digestibility
3. Sweetness
What form of carbohydrates are contained in most enteral formulations? correct answersMost
formulations contain oligosaccharides or polysaccharides
What source of carbohydrate is used in polymeric formulas? correct answersPolymeric formulas use
primarily corn syrup solids as their source of carbohydrate
What source of carbohydrate is used in hydrolyzed formulas? correct answersHydrolyzed formulas use
maltodextrin or hydrolyzed cornstarch
What source of carbohydrates are in oral products? correct answersOral products contain simpler or
less-complex carbohydrates, such as sucrose, to increase the palatability of the product
Do enteral and oral nutrition products contain lactose? correct answersDue to the prevalence of lactose
intolerance, most formulations do not contain lactose
What are the 6 sources of carbohydrate in polymeric formulas? correct answers1. Corn syrup solids
2. Hydrolyzed cornstarch
3. Maltodextrin
4. Sucrose
5. Fructose
6. Sugar alcohols
What are the 12 sources of fat in polymeric formulas? correct answers1. Borage oil
2. Canola oil
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