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enteral nutrition
- uses HI tract
- oral & tube feedings
- preferred route if pt has adequate GI function
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perenteral nutrition
- uses the VEINS
- for persons wih inadequate GI function
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what are the different types of ENTERAL nutrition support?
- standard: persons who can digest and absorb without difficulty
- elemental/hydrolyzed: partially or fully broken down foods; persons with compression GI function
- specialized/disease-specific
- modular: contain single macronutrients
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what is osmolarity?
- a solution's tendency to shift from one fluid compartment to another across a semipermeable membrane
- range: 300-700 mOsm/kg
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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
- lowest cost
- nutrient & energy needs
- fluid requirements
- fiber needs
- individual tolerances
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tube feedings
- require functional GI tract
- patient is unable to consume enough nutrients; pt is nutritionally incomplete
- tube goes to stomach or intestine
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what type of patients are canidates for tube feedings?
- severe swallowing problems
- little or no appetite
- GI obstructions, impaired GI motility
- intestinal resections
- mentally incapacitated, coma
- extremely high nutrient requirements
- mechanical ventilators
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what feeding routes can be used if a tube feeding will last less than 4 weeks?
- nasogastric
- nasoduodenal
- nasojejunal
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what type of patients are best for an orogastric tube feeding route?
infants
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what type of feeding routes are used if a patient will have a tube feeding that lasts longer than 4 weeks?
enterostomy: gastrostomy, jejunostomy
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why are gastric feedings the preferred route?
- easily tolerated & less complicated
- not good for patients at risk for aspiration
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in regards to tube feedings, what is an OPEN system?
formula needs to be transferred from original pckaging to feeding container
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in regard to tube feedings, what is a CLOSED system?
formula is prepackaged
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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
- open system: hang no more than 8 hours
- closed system: hang no more than 24-48 hours
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intermittent formula delivery
- gastric
- 250-400 mL over 20-40 minutes
- risk of aspiration *
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bolus formula delivery
- gastric
- delivery of large volume every 3-4 hours
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continuous formula delivery
- slowly at constant rate
- 8-24 hours
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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
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checking gastric residuals
- withdraw contents through feeding tube with syringe
- intermittent before each feeding
- continuous 4-6 hours
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supplemental water
- 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
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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
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when delivering medications with a continuous tube feed, when should the feeding be stopped?
15 minutes BEFORE & 15 minutes AFTER medication administration
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what are some complications that can occur when delivery medications with tube feeds?
- diarrhea
- mechanical problems
- metacolic problems
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what must be monitored when delivering medications and tube feedings together?
patients weight, hydration status, lab test results
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what are the indications for parenteral nutrition?
- intestional obstructions or fistulas
- paralytic ileus
- short bowel syndrome
- intractable vomiting or diarrhea
- severe pancreatitis
- bone marrow transplants
- severe malnutrition
- intolerance to enteral nutrition
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peripheral parenteral nutrition (PPN)
- uses peripheral veins
- short-term support
- patients with average nutrient needs & NO fluid restictions
- veins can be damaged by concentrated solutions
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total parenteral nutrition (TPN)
- larger, central veins
- long-term support
- patients with high nutrient needs or with fluid restrictions
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what amino acids are contained in parenteral solutions?
all essential plus combinations of non-essential
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what is the role of carbohydrates in paraenteral solutions
- type - dextrose, 3.4 kcalories/gram
- 2.5-70% concentrations
- > 12.5% only for TPN
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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
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which vitamins do parenteral solutions contain?
- all water soluble PLUS A, D, E
- K must be added seprately
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what are the trace minerals found in parenteral solutions?
- zinc
- copper
- chromium
- selenium
- maganese
iron is excluded
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how many mL of paraenteral fluids must adults consume per day
1500-2500 mL/day
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what are the types of parenteral solutions
- total nutrient admixture (TNA)
- 2-in-1 solution
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total nutrient admixture (TNA)
- 3-in-1 solution
- also called "all-in-one" solution
- contains dextrose, amino acids, & lipids
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2-in-1 solution
- dextrose & amino acids
- lipids administered seperately to provide essential fatty acids
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what is the criteria for administering parenteral solutions for continuous and cyclic orders?
- continuous: for critically ill, or malnourished patients
- cyclic: 10-16 hours; often provided at night
- both: check tubing and solution daily for contamination
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when can parenteral IVs be discontinued?
when 2/3-3/4 of nutrient needs are provided by enteral feedings
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hyperglycemia
- patients who are glucose intolerant or in severe metabolic stress
- provide insulin with feedings or decrease dextrose
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hypoglycemia
- occurs when feedis are itnerrupted or discontinued
- taper slowly
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hypertriglyceridemia
- critically ill cant tolerate lipid infusions
- impaired lipid clearance
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refeeding syndrome
- re-feed slowly
- life-threatening
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abnormal liver function
- long-term can lead to liver failure
- cause unclear
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gallbladder disease
- paraenteral for more than 4 weeks
- sludge builds up leading to gallstones
- cholecystokinin injections or remove gallbladder
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metabolic bone disease
- long-term parenteral lowers bone density
- alteration in calcium, phosphorus, and vitamin D metabolism
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who are canidates for ENTERAL feeding support at home?
- head and neck cancers
- neurological impairments affecting swallowing
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who are canidates for parenteral nutritional support at home?
- short bowel syndrome
- IBS
- intestinal obstructions
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quality of life issues associated with enteral and parenteral feedings
- economic impact
- time-consuming
- inconvenient
- disturbed sleep
- activities & work must be planned around feedings
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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
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what is inborn error of metabolism?
- an inherited trait caused by genetic mutation
- results in absence, deficiency, or malfunction of a critical protein
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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
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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
- treatment: diet restricting phenylananine, life-long diet
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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
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