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Questions and Answers
What is the recommended maximum duration for PEG tube use in adults and children according to current literature?
What is the recommended maximum duration for PEG tube use in adults and children according to current literature?
The recommended maximum duration for PEG tube use is ≤4 hours.
How should enteral feeding be initiated according to best practices?
How should enteral feeding be initiated according to best practices?
Enteral feeding should be initiated at full strength, at a slow rate, and progressively advanced.
List the main categories of enteral formulas.
List the main categories of enteral formulas.
The main categories of enteral formulas are polymeric, monomeric, fiber-containing, disease-specific, modular, and rehydration.
What types of enteral nutrition supplements are considered polymeric?
What types of enteral nutrition supplements are considered polymeric?
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Explain the characteristics of polymeric formulas used in enteral feeding.
Explain the characteristics of polymeric formulas used in enteral feeding.
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What are the main characteristics and benefits of nasogastric tube feeding?
What are the main characteristics and benefits of nasogastric tube feeding?
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What guidelines should be followed for initiating feedings after the placement of a PEG tube?
What guidelines should be followed for initiating feedings after the placement of a PEG tube?
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List the classifications of enteral formulas and briefly describe their purpose.
List the classifications of enteral formulas and briefly describe their purpose.
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What is the purpose of oral nutrition supplements (ONS) in patient care?
What is the purpose of oral nutrition supplements (ONS) in patient care?
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What factors determine the placement site for enteral nutrition tubes?
What factors determine the placement site for enteral nutrition tubes?
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Study Notes
Indications for Nutritional Support
- Severe anorexia can result from conditions like chemotherapy, HIV, and sepsis.
- Upper gastrointestinal (GI) obstruction may involve an esophageal stricture or tumor.
- Increased metabolic and nutritional demands are seen in sepsis, cystic fibrosis, and burns.
- Mental illnesses, including dementia, can influence nutritional intake and management.
Contraindications for Enteral Nutrition
- Per ASPEN consensus statement 2022, specific contraindications must be noted before initiating enteral nutrition.
Oral Nutrition Supplement (ONS)
- ONS can be provided between meals or added to food and liquids.
- Supplements are designed to complement poor oral intake.
Tube Feeding Administration Techniques
- Bolus: Rapid delivery via syringe in less than 10 minutes.
- Intermittent: Scheduled feedings using a designated time frame.
- Continuous: Gradual feeding over 18-24 hours using a pump.
Types of Tube Feeding Access
- Nasogastric (NG) tube: Typically for short-term use (up to 30 days).
- Gastrostomy and jejunostomy: Surgical options for long-term feeding access, including PEG or RIG.
- Nasojejunal: For access directly into the jejunum, often used in specific cases.
Factors for EN Tube Placement
- Considerations include length of therapy, aspiration risk, tube displacement risk, digestion status, and patient comfort.
Initiation of Feeding
- Initiate tube feedings at full strength, avoiding dilution, and gradually increase the rate.
- For PEG tubes, feedings may start within hours post-placement.
Enteral Formulas
- Formulas are designed to meet various nutritional needs and provide complete diets when given at sufficient volume.
- Types include polymeric, monomeric, fibre-containing, disease-specific, and modular formulas.
Oral Nutrition Supplement Examples
- Polymeric: Ensure, Nutren, Enercal.
- Monomeric: Peptamen, Vivonex.
- Fibre-containing: Nutren Fibre, Glucerna.
- Disease-specific: Pulmocare, Nepro.
- Modular: MCT oil, Polycose.
Polymeric Formulas
- Provide intact nutrition for individuals with normal digestive capacity.
- Generally lactose-free, gluten-free, and low viscosity; use non-TAP water in Malaysia.
Parenteral Nutrition (PN)
- TPN solutions consist of carbohydrates (dextrose), protein (amino acids), and fats (suspension of oils with emulsifiers).
Lesson Outcomes in Nutritional Support
- Understanding indications for enteral and parenteral nutrition.
- Recognizing benefits of early feeding in critically ill patients.
- Differentiating between routes for enteral and parenteral feeding.
- Identifying pros and cons of both nutrition types.
- Managing drug interactions with EN and PN.
- Addressing complications such as refeeding syndrome and ensuring nutrient adequacy.
Drug Delivery via Enteral Feeding Tube
- Applicable for patients who are intubated, comatose, cannot swallow meds, or have limited IV access.
Complications of Enteral Nutrition
- Potential complications include access problems, gastrointestinal issues, metabolic disturbances, and psychological effects.
Monitoring Gastric Residual Volume (GRV)
- GRV evaluation involves withdrawing gastric content to measure volume; serves as an indicator for aspiration risk and safe feeding practices.
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