enteral nutrition support
DESCRIPTION
Enteral Nutrition Support. Fluid and electrolyte requirements. Calculate enteral and parenteral nutrition formulations. ENS. Selecting the formula Integrity of GI system Type of protein, fat, CHO, fiber in formula Kcal & protein density of formula. ENS. Selecting the formula - PowerPoint PPT PresentationTRANSCRIPT
Enteral Nutrition Support
• Fluid and electrolyte requirements.
• Calculate enteral and parenteral nutrition formulations.
ENS
• Selecting the formula– Integrity of GI system– Type of protein, fat, CHO, fiber in
formula– Kcal & protein density of formula
ENS
• Selecting the formula– Ability of formula as taken to meet pt
nutrient needs– Viscosity of formula and TF equipment– Cost of formula
ENS Components
• Intact or polymeric formulas
• Hydrolyzed or elemental formulas
ENS Components
• Molality and molarity– number of free particles/unit wt or
volume– the higher the number the more free
particles– the higher the number more osmotic
force–mOsm
ENS Components
• Isotonic - – 350 mOsm/kg or less
• Intact formulas– 300 - 500 mOsm/kg
• Hydrolyzed nutrient formulas - hyperosmolar– 900 mOsm/kg
ENS Components
• Density of formulas–more nutrients or kcal/ml the more
dense– less free water
• Dense formulas used– restrict water– other source of water
ENS Components
• Protein– polymeric formulas - intact HBV protein
• What if small intestine can’t digest protein?
ENS Components
• CHO– starch hydrolysates–maltodextrins– sucrose– fructose– glucose
ENS Components
• CHO– osmolality increases as mover towards
simple sugars
ENS Components
• Fat– corn, soy, safflower, canola– need 4% of total kcal as linoleic– some have MCT
ENS Components
• Fluid– need to check free water– standard formulas - 80 - 85%– calorie dense - 60%
ENS Components
• Fiber– soy polysaccaharide– fructooligosaccharides– 10 - 12 g/L
• Chart showing narrowing the choice of formulas next
Narrowing the choice of formulas
ENS
• Things to consider when selecting– ability to digest– absorption– colonic residue– length of time on TF– risk of aspiration
ENS Routes of Admin
• Nasogastric
• Nasoduodenal or jasojejunal
• Enterostomies– percutaneous endoscopic gastrostomy
(PEG)– percutaneous endoscopic jejunostomy
(PEJ)
ENS Admin
• Bolus administration–maximum bolus - 400-450 ml– 4 - 6 times/day
• Check gastric residual
• Contraindications?
• Describe pt this might work?
ENS Admin
• Continuous drip– infusion 18 - 24 hours– start 30 - 50 ml/hr– advance 8 - 12 hr as tolerate– flush with water
• What steps would you take in planning a tube feeding?
Starting ENS
• 300 mOsm - full strength, full rate
• >600 mOsm - full strength, low rate & as tolerated advance
Monitoring ENS
• Table 22-5 Mahan
• What would you monitor?
Monitoring ENS
• Gastric residuals– >150-200 ml without feeding–maintain elevation– wait 30-60 min– check again
Monitoring ENS
• Gastric residuals– if always 150-200 ml– find out why– if have this and greater with feeding -
stop feeding or slow rate
Complications ENS
• Dehydration– why dehydrated– increase fluid– lower protein intake
Complications ENS
• Signs of excessive protein– dehydration– inadequate fluid intake– hypernatremia– hypercholremia
Complications ENS
• Signs of excessive protein– azotemia– pt appears confused
Complications ENS
• Aspiration pneumonia–make sure correct tube and placement
of end of tube– elevate head 30 degrees– continuous drip 22-24 hrs
Complications ENS
• Diarrhea– lactose intolerance– bacterial contamination– hyperosmolar formula– low serum alb–medication
END ENS
• Questions?
• Calculations next