Podcast
Questions and Answers
Which feeding method involves rapid delivery of a large volume of formula into the stomach in less than 20 minutes?
Which feeding method involves rapid delivery of a large volume of formula into the stomach in less than 20 minutes?
NJ tube placement is confirmed by testing the pH of aspirated enteric content with litmus paper which should be ____.
NJ tube placement is confirmed by testing the pH of aspirated enteric content with litmus paper which should be ____.
alkaline
Gastric feedings are recommended for all patients regardless of aspiration risk.
Gastric feedings are recommended for all patients regardless of aspiration risk.
False
What must be maintained above 30 degrees to prevent aspiration during feeding?
What must be maintained above 30 degrees to prevent aspiration during feeding?
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Match the enteral feeding terms with their descriptions:
Match the enteral feeding terms with their descriptions:
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What is the recommended French scale diameter for small bore tubes?
What is the recommended French scale diameter for small bore tubes?
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Polyurethane feeding tubes become more rigid at body temperature for patient comfort.
Polyurethane feeding tubes become more rigid at body temperature for patient comfort.
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What is a benefit of bolus feeding compared to continuous feeding?
What is a benefit of bolus feeding compared to continuous feeding?
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Continuous feeding requires a feeding pump for delivery.
Continuous feeding requires a feeding pump for delivery.
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What type of feeding is considered best when delivered into the stomach?
What type of feeding is considered best when delivered into the stomach?
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Which of the following is true regarding elemental formulas?
Which of the following is true regarding elemental formulas?
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What is a major disadvantage of continuous feeding related to patient mobility?
What is a major disadvantage of continuous feeding related to patient mobility?
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High energy density formulas meet energy needs in larger volumes of fluids.
High energy density formulas meet energy needs in larger volumes of fluids.
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Which feeding method may increase the risk of aspiration the most?
Which feeding method may increase the risk of aspiration the most?
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Match the following feeding methods with their characteristics:
Match the following feeding methods with their characteristics:
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What is one advantage of using a transnasal feeding route?
What is one advantage of using a transnasal feeding route?
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The method that utilizes a gravity drip and allows for 4-6 feeds a day is called __________ feeding.
The method that utilizes a gravity drip and allows for 4-6 feeds a day is called __________ feeding.
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Enteral formulae with around _______ mOs/kg are isotonic.
Enteral formulae with around _______ mOs/kg are isotonic.
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High volumes delivered during intermittent feeding can be hard for some patients to tolerate.
High volumes delivered during intermittent feeding can be hard for some patients to tolerate.
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Match the feeding routes with their descriptions:
Match the feeding routes with their descriptions:
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Which feeding route is typically recommended for long-term enteral feeding?
Which feeding route is typically recommended for long-term enteral feeding?
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Identify one risk associated with bolus feeding.
Identify one risk associated with bolus feeding.
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Continuous feeding may promote __________ growth due to elevated intragastric pH levels.
Continuous feeding may promote __________ growth due to elevated intragastric pH levels.
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Elemental formulas should be avoided for patients with acute intestinal conditions.
Elemental formulas should be avoided for patients with acute intestinal conditions.
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What is the primary advantage of using a feeding pump for continuous feeding?
What is the primary advantage of using a feeding pump for continuous feeding?
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What is a potential disadvantage of a nasogastric feeding route?
What is a potential disadvantage of a nasogastric feeding route?
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_________ products can be added to formulas if specific nutrient needs are identified.
_________ products can be added to formulas if specific nutrient needs are identified.
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Which statement about fiber-enriched formulas is correct?
Which statement about fiber-enriched formulas is correct?
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The Nasojejunal (NJ) feeding route is primarily designed for short-term use.
The Nasojejunal (NJ) feeding route is primarily designed for short-term use.
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What is the primary reason to avoid a nasogastric tube in patients with high aspiration risk?
What is the primary reason to avoid a nasogastric tube in patients with high aspiration risk?
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There is a high risk of _________ in patients using the nasogastric feeding route.
There is a high risk of _________ in patients using the nasogastric feeding route.
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Which option is NOT a characteristic of modular products in enteral feeding?
Which option is NOT a characteristic of modular products in enteral feeding?
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Study Notes
Feeding Route
- Gastric feedings (NG or gastrostomy/PEG) are preferred due to better tolerance and simpl er delivery.
- Avoid gastric feedings in high-risk aspiration patients, including those over 60, with impaired consciousness, gastroesophageal reflux, or neurological deficits.
- To prevent aspiration, maintain head of bed > 30°, verify tube placement routinely, and assess GI tolerance.
Enteral Tube Placement
- NG tube placement is confirmed by aspirating gastric contents and testing pH (acidic), or through air insufflation and auscultation.
- NJ tube placement confirms by aspirating enteric contents and testing pH (alkaline).
- X-ray confirmation is required when in doubt about tube placements.
Enteral Feeding Tubes
- Made from materials like PVC, polyurethane (softens at body temperature), or silicone.
- Available in various diameters and lengths measured by the French scale; small bore (8-12 Fr), large bore (>14 Fr), gastrostomy tubes (<32 Fr), and jejunostomy tubes (7-12 Fr).
- Radiopaque for confirmation of placement; weighted bolus aids in placement and prevents migration.
Formula Delivery Method
- Bolus feeding: Rapid delivery (250-500 ml) into the stomach in <20 minutes, best for stable patients.
- Intermittent feeding: 250-400 ml delivered over 20-60 minutes, several times per day, simulating normal eating.
- Continuous feeding: Slow, constant delivery over 24 hours, often preferred for critically ill patients.
Bolus Feeding
- Suitable for clinically stable patients with functioning stomachs; uses syringes for 6-8 feeds every 3-4 hours.
- Convenient for caregivers but may lead to nausea and discomfort, with a higher aspiration risk.
Intermittent Feeding
- Best tolerated in the stomach using gravity drip or feeding pumps.
- Mimics normal eating patterns, enhancing quality of life but may not suit all patients due to volume.
Continuous Feeding
- Used for post-pyloric feeding in critically ill patients; requires feeding pump, potentially limiting movement.
- While it allows overnight feeding, it can raise insulin levels and may increase aspiration risk overnight.
Feeding Pump
- Electric/battery-operated, provides accurate volume delivery and alerts for flow issues.
- Facilitates use of more viscous feeds.
Hang Time for Adult EN
- Fiber-enriched, higher energy density formulas can meet nutritional needs with less volume.
- Isotonic formulas (~300 mOs/kg) are similar to blood serum; hypertonic formulas may increase osmotic load when combined with medications, causing diarrhea.
Formula Selection
- Choice between regular and disease-specific formulas based on digestion and absorption capabilities, with options for modular products as needed.
Feeding Routes Overview
- Options include orogastric, transnasal (NG, ND, NJ), and enterostomy (gastrostomy/PEG, jejunostomy/PEJ).
- Non-surgical enterostomy is achieved via local anesthesia, using endoscopy and a needle puncture.
Advantages and Disadvantages of Feeding Routes
- Transnasal (NG, ND, NJ): Easy placement but can irritate nasal passages; NG has the highest aspiration risk.
- Enterostomy (PEG, PEJ): Reduced aspiration risk, more comfortable long-term, but requires surgical placement and has infection risks.
Route Selection Factors
- Dependent on expected duration of feeding: transnasal for short-term, enterostomy for long-term.
- Consider risk of aspiration and the need for gastric integrity in specific procedures.
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Explore the essential feeding routes for cancer patients, focusing on gastric feedings via NG or gastrostomy. Understand the factors influencing these methods, including patient age and aspiration risk. This quiz will enhance your knowledge of proper nutritional support in oncology.
