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What are the indications for enteral nutrition?
- must have functioning GI
- impaired swallowing and mental status
- cant meet 100% nutrient needs (GI problem)
- inadequate oral food intake
- chewing/ swalloing diffuculty (odynophagia, dysphagia)
- impaired nutrient abs (not working gut)
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What are contraindications for enteral nutrition?
- diffuse peritontitis (infection of stomach)
- GI bleeding
- ileus or other obstruction
- intractable nausea or vomiting
- intubation or extubation (cant breath on own, need tube)
- timing of medications
- patient does not want it
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What is the step process of enteral nurition prescription?
- 1. dosing weight: current (better), adjusted (overweight), ideal
- 2. energy estimation: kcal/kg or HB and activity or stress fac.
- 3. protein and CHO
- 4. electrolyte and vitamin/mineral needs
- 5. fluid
- 6. adminstration: where to feed
- 7. nutrition prescription
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what are adminstration methods and what do they stand for?
- OG: oral gastric
- NG: nasal gastiric
- ND: nasal duodenum (hard because go through sm valve
- NJ: nasal jejunum (harder because further)
- PEG tube: G tube (gastric)
- PEJ tube: J tube (jejunum)
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What are the delivery methods for enteral nutrition?
- continuous, bolus, or intermittent
- start rate at (10-50 ml/hr), progression (10-20 ml every 8 hrs, final rate (less than 250 ml/hr)
- usually less than 100 for continous
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What are some considerations regarding elemental formulas?
- Are for small bowel feeds, for PEJ (like peptamin 1.5)
- abs not required-good for it
- are chemically broken down, so lower gut use
- high osmolality
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What are some considerations regarding intact protein?
- low-moderate viscosity
- glueten free
- lactose free
- need working abs/digestion
- can use for sm bowel
- tube feeds or supplements
- ex: ensure
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what ar unique to modular formulas?
they are added to prepared formulas to meet unique requirements (powders)
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What is specific for lactose free intact formulas?
- osmolite(safe bet, no fiber)
- jevity 1.2 (has fiber)
- Jevity 1.5
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What is the difference between continuos an bolus/intermittent feeds?
continous: over 12-24 hrs, increase in vol delivered, increased nutrient abs
bolus: large amt over short period, ONLY with gastric feeds
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