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Flashcards in Specific feeding needs Deck (22)
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1

Esophagostomy (EN)

surgical opening into the neck for feeding tube into the stomach

2

Standard Formula

Functional GI tract; 1.0 kcal/mL or 1.5 kcal/mL for wt gain

3

Fiber containing formula

Constipation or bowel disorders

4

High protein/nitrogen formula

catabolic state, wound healing, etc.

5

Calorie dense formula

fluid restriction

6

Elemental formula

partially functional GI tract

7

Disease specific formula

Diabetes, hepatic, immune support, metabolic stress, pulmonary, renal, etc.

8

EN complications

Diarrhea - vol overload (change to drip if doing bolus)

Nausea - too fast delivery (decrease rate, advance as tolerated) or positioning (position on R side to aid in passage through the pylorus); positioning: aspiration (elevate pt head)

Constipation - dehydration (increase fluids) or lack of fiber (consider higher fiber formula)

Bacterial contamination risk - reduced by using a closed enteral formula system

9

TPN Sol'n breakdown

Dextrose - 3.4 kcal/g

AA (~12-15% kcal) = 4 kcal/g

Lipids (~30% kcals) = 10% fat = 1.1 kcal/mL; 20% fat = 2 kcal/mL; 30% = 3 kcal/mL

Electrolytes
Ca = 0.2-0.3 mEq/kg
Cl = equal to Na
K = 1 mEq/kg
Na = 1-2 mEq/kg

10

Glucose oxidation rate

GIR OR CHO load; ~5 mg/kg/min for catabolic state; 5-7 mg/kg/min for stable patients.

11

Glucose oxidation rate: calculations

Grams of Dextrose per day = (kg x desired GOR x 1440 min)/1000

GOR = [(grams CHO x 1000 mg/g)/kg]/1440 min

12

Calculating mEq

(mg/atomic weight) x valence

Ca, 40, 2
Cl, 35.4, 1
K, 39, 1
Na, 23, 1

13

EN: Meds of concern

Fluoroquinolones: bioavailability reduced. Feeding held for one hour before and two hours after medication.

Phenytoin - possible food/drug interaction. Feedings held 1-2 hours before and after meds.

Propofol - used for sedation; 10% fat emulsion.

14

Low residue diet

High fiber foods plus milk and potatoes

15

Fecal fat test (meals)

Eat 100 g of fat per day for 3 days before stool collection. Collect for 3 days while maintaining the 100 g intake.

16

Glucose tolerance test

Blood sample; 75 g CHO, blood sample

17

Adaptive equipment: Angled utensils

limited arm or wrist movement; spoon or fork is angled toward the mouth

18

Adaptive equipment: Built-up handles (utensils)

decreased hand strength; handles are larger than normal sized utensils

19

Adaptive equipment: weighted utensils

poor hand and arm movement away from the body

20

Adaptive equipment: scoop dishes

raised sides on plate assisted with scooping motion

21

Adaptive equipment: dycem place mat

poorly controlled arm and hand coordination; skid resistant material useful for adaptive utensils

22

ADIME: Evaluating outcomes

Direct nutrition outcomes

clinical and health status outcomes

Patient centered outcomes

Health care utilization outcomes