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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?
The recommended maximum duration for PEG tube use is ≤4 hours.
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.
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?
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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?
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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.
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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?
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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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