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Enteral Nutrition Support

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

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Enteral Nutrition Support

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  1. Enteral Nutrition Support • Fluid and electrolyte requirements. • Calculate enteral and parenteral nutrition formulations.

  2. ENS • Selecting the formula • Integrity of GI system • Type of protein, fat, CHO, fiber in formula • Kcal & protein density of formula

  3. ENS • Selecting the formula • Ability of formula as taken to meet pt nutrient needs • Viscosity of formula and TF equipment • Cost of formula

  4. ENS Components • Intact or polymeric formulas • Hydrolyzed or elemental formulas

  5. 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

  6. ENS Components • Isotonic - • 350 mOsm/kg or less • Intact formulas • 300 - 500 mOsm/kg • Hydrolyzed nutrient formulas - hyperosmolar • 900 mOsm/kg

  7. 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

  8. ENS Components • Protein • polymeric formulas - intact HBV protein • What if small intestine can’t digest protein?

  9. ENS Components • CHO • starch hydrolysates • maltodextrins • sucrose • fructose • glucose

  10. ENS Components • CHO • osmolality increases as mover towards simple sugars

  11. ENS Components • Fat • corn, soy, safflower, canola • need 4% of total kcal as linoleic • some have MCT

  12. ENS Components • Fluid • need to check free water • standard formulas - 80 - 85% • calorie dense - 60%

  13. ENS Components • Fiber • soy polysaccaharide • fructooligosaccharides • 10 - 12 g/L

  14. Chart showing narrowing the choice of formulas next

  15. Narrowing the choice of formulas

  16. ENS • Things to consider when selecting • ability to digest • absorption • colonic residue • length of time on TF • risk of aspiration

  17. ENS Routes of Admin • Nasogastric • Nasoduodenal or jasojejunal • Enterostomies • percutaneous endoscopic gastrostomy (PEG) • percutaneous endoscopic jejunostomy (PEJ)

  18. ENS Admin • Bolus administration • maximum bolus - 400-450 ml • 4 - 6 times/day • Check gastric residual • Contraindications? • Describe pt this might work?

  19. ENS Admin • Continuous drip • infusion 18 - 24 hours • start 30 - 50 ml/hr • advance 8 - 12 hr as tolerate • flush with water

  20. What steps would you take in planning a tube feeding?

  21. Starting ENS • 300 mOsm - full strength, full rate • >600 mOsm - full strength, low rate & as tolerated advance

  22. Monitoring ENS • Table 22-5 Mahan • What would you monitor?

  23. Monitoring ENS • Gastric residuals • >150-200 ml without feeding • maintain elevation • wait 30-60 min • check again

  24. Monitoring ENS • Gastric residuals • if always 150-200 ml • find out why • if have this and greater with feeding - stop feeding or slow rate

  25. Complications ENS • Dehydration • why dehydrated • increase fluid • lower protein intake

  26. Complications ENS • Signs of excessive protein • dehydration • inadequate fluid intake • hypernatremia • hypercholremia

  27. Complications ENS • Signs of excessive protein • azotemia • pt appears confused

  28. Complications ENS • Aspiration pneumonia • make sure correct tube and placement of end of tube • elevate head 30 degrees • continuous drip 22-24 hrs

  29. Complications ENS • Diarrhea • lactose intolerance • bacterial contamination • hyperosmolar formula • low serum alb • medication

  30. END ENS • Questions? • Calculations next

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