30 Questions
Which type of medications may be beneficial in reducing or eliminating diarrhea in patients receiving enteral nutrition?
Antidiarrheal medications
What should be avoided to prevent clogging the feeding tube when using bulking agents or pectin?
Thickening the formula
Why might a predigested formula not be the best 'first line' option for managing diarrhea in patients?
It is rarely the cause of the diarrhea
What is a potential concern related to constipation in bedbound patients receiving long-term enteral feedings?
Fecal impaction
Which type of medications can cause constipation in patients receiving enteral nutrition?
Narcotic pain relievers
Under what conditions may diarrhea coexist with constipation in patients on enteral nutrition?
When there is a fecal impaction
What is the typical daily feeding schedule for formula administration?
90 to 125 ml per hour over 18 to 20 hours
What type of patients are most often successful with the formula administration regimen described?
Motivated, organized, alert, and mobile patients
When is cyclic feeding commonly used?
At night
Which patients are candidates for continuous feedings according to the text?
Patients with compromised gastrointestinal function due to various reasons
How should the feeding rate goal be determined for formula administration?
By dividing the total daily volume by the number of hours per day of administration
Why is dilution of formulas not recommended according to the text?
It can lead to underfeeding
What should patients receiving parenteral nutrition as their sole source of nutrition receive daily?
Multivitamins and trace elements
Why is iron not normally part of parenteral infusions?
It is incompatible with lipids
How should the first dose of iron be administered to patients on an outpatient basis?
In a controlled setting like an outpatient infusion suite
Which patients are especially sensitive to fluid administration?
Patients with cardiopulmonary, renal, and hepatic failure
What is the maximum volume of central parenteral nutrition that is generally prescribed daily?
$1.5$ to $3$ L
For patients on home parenteral nutrition, how should higher volumes of fluids be administered?
In separate infusions
What is the primary complication associated with Parenteral Nutrition (PN)?
Infection
How often is initial monitoring recommended for patients receiving Home Parenteral Nutrition (HPN)?
Weekly
What signs of infection should be monitored for in patients receiving PN?
Elevated white blood cell count
Why is monitoring metabolic tolerance critical in patients on Parenteral Nutrition (PN)?
To evaluate response to therapy
Which of the following is a potential source for introducing microorganisms into a major vein during PN administration?
CPN catheter site
What is of utmost importance in preventing catheter-related bloodstream infections in patients receiving PN?
CPN catheter site care
What is recommended before discontinuing Parenteral Nutrition (PN)?
Ensure 100% of nutrient needs are met consistently by oral intake
How can hunger and satiety cues be reestablished for oral intake during the daytime?
Transitioning from continuous feeding to a 12- and then an 8-hour formula administration cycle during the night
When are oral diets often attempted in practice after enteral feeding?
After inadvertent or deliberate removal of a nasoenteric tube
What is the primary purpose of commercial formulas for oral supplementation?
Augment the intake of solid foods
How many grams of intact protein do most commercial oral supplements provide approximately in an 8 oz portion?
8 to 14 g
What is an important consideration when transitioning from Enteral Feeding to Oral Feeding?
Reduce formula administration cycle during the night
Study Notes
Diarrhea and Constipation Management
- Adjusting medications or administration methods can reduce or eliminate diarrhea.
- FOS, pectin, guar gum, bulking agents, and antidiarrheal medications can be beneficial in managing diarrhea.
- Constipation is a concern, especially among bedbound patients, and fiber-containing formulas or stool-bulking medications may be helpful.
- Narcotic pain relievers and iron supplements can cause constipation.
Monitoring Tolerance and Nutrient Intake
- Monitoring a patient's actual intake and tolerance is crucial to ensure nutrition goals are achieved.
- Monitoring metabolic and gastrointestinal tolerance, hydration status, weight, and lean body mass is essential.
- Patients receiving PN require added multivitamins and trace elements daily and close monitoring.
Fluid and Electrolyte Balance
- Fluid needs for PN or EN are calculated similarly, with maximum volumes rarely exceeding 3 L.
- Volumes of prescribed CPN should be coordinated with the overall care plan, especially for patients with cardiopulmonary, renal, and hepatic failure.
Monitoring and Evaluation
- Routine monitoring of PN is necessary, especially for hospital patients.
- Monitoring is done to evaluate response to therapy and ensure compliance with the treatment plan.
Complications
- Infection is the primary complication associated with PN, and strict adherence to protocols is necessary.
- Monitoring for signs of infection, such as chills, fever, tachycardia, sudden hyperglycemia, or elevated white blood cell count, is crucial.
Transitioning to Oral Feeding
- A stepwise decrease in EN is used to transition to oral feeding.
- Oral supplements can be used to augment solid foods, providing approximately 250 kcal/8 oz or 240-ml portion and approximately 8 to 14 g of intact protein.
Formula Administration
- Formula administration is initiated at 100 to 150 ml per feeding and increased incrementally as tolerated.
- Cyclic feeding allows for a period of time away from the tube feeding.
Continuous Feeding
- Continuous infusion of EN requires a pump and is appropriate for patients who do not tolerate volume infusion used with bolus, cyclical, or intermittent methods.
- Patients with compromised gastrointestinal function are candidates for continuous feedings.
Test your knowledge on the administration of enteral feeding. Learn about the recommended initial feeding amounts, strategies for increasing feeds, and the benefits of cyclic feeding. Explore typical daily feeding schedules and the use of enteral feeding as a transition to oral feedings.
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