- 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?
- standard: persons who can digest and absorb without difficulty
- elemental/hydrolyzed: partially or fully broken down foods; persons with compression GI function
- modular: contain single macronutrients
what is osmolarity?
- a solution's tendency to shift from one fluid compartment to another across a semipermeable membrane
- range: 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
- lowest cost
- nutrient & energy needs
- fluid requirements
- fiber needs
- individual tolerances
- 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
- intestinal resections
- mentally incapacitated, coma
- extremely high nutrient requirements
- mechanical ventilators
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
- open system: hang no more than 8 hours
- closed system: 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
- 8-24 hours
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?
- mechanical problems
- metacolic problems
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
- paralytic ileus
- short bowel syndrome
- intractable vomiting or diarrhea
- severe pancreatitis
- bone marrow transplants
- severe malnutrition
- intolerance to enteral nutrition
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
total parenteral nutrition (TPN)
- larger, central veins
- long-term support
- 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
- 2.5-70% concentrations
- > 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)
- 2-in-1 solution
total nutrient admixture (TNA)
- 3-in-1 solution
- 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?
- continuous: for critically ill, or malnourished patients
- cyclic: 10-16 hours; often provided at night
- both: 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
- taper slowly
- critically ill cant tolerate lipid infusions
- impaired lipid clearance
- re-feed slowly
abnormal liver function
- long-term can lead to liver failure
- cause unclear
- 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
- intestinal obstructions
quality of life issues associated with enteral and parenteral feedings
- economic impact
- disturbed sleep
- 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
- treatment: 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