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EN (monitor/eval, adminitration, access, formula selection) - Coggle…
EN
monitor/eval
see Box 13-3 Krause
Aspiration. head/shoulders above chest
gastroparesis present. promotility drug
diarrhea (r/t antibiotic therapy, bacterial overgrowth, GI motility d/o r/t acute/critical illness) (also r/t hyperosmol meds [mg-containing antacids, sorbitol-containing elixers, electrolyte supp])
adjust meds/admin methods.
add thickener or antidiarrheal agent can help
(careful about clogging)
constipation (esp in bedbound pts w/ LT EN)
fiber-containing formula, stool-bulking meds
adequate fluid
slow GI activity - narcotic pain relievers
iron supp cause constipation
monitor intake
common reasons for 'held' feeds: NPO for procedures, clogged tubes, dislodged/misplaced tubes, perceived/actual GI intolerance
incr feeding rate to make up for lose feeding time
adminitration
types
inttermittent
pros: QOL>continuous (time off the pump)
typical: 4-6 qd, 20-60min each, initiate 100-150ml/feed -> adv as tolerated
cyclic: 90-125ml/h x 18-20h
pro: able to participate in activity (PT, etc) and
continuous
pro: for pts who do not tolerate volume
NE tube tip in SI
rate: total volume (mL) / hrs of admin per day
initiate 1/4~1/2 goal rate, advance q8-12h until final volume
meds may require empty stomach
bolus
adeq GI fn, stable
convenient, less expensive
based on: clinical status, living situation, QOL
transitional
closed vs open enteral system
hang time
up to 4h (open), 24-48h (closed)
access
nasoenteric tubes (NDT/NJT)
gastric feeds not tolerated
s/s: abd distention, discomfort; n/v; persistent diarrhea
potential complications
esophageal strictures
GE reflux -> aspiration pneumonia
tracheoseophageal fistula
incorrect positioning -> pulmonary injury
mucosal dmg @ insertion site
nasal irritation/errosion
pharyngeal/vocal cord paralysis
rhinorrhea, sinusitis, otitis media
ruptured GE varices in hepatic dz
ulcerations or perforations of upper GI tract/airway
gastrostomy/jejunostomy
LT (>3-4wks)
pros: pt comfort; minimize nasal/upper GI irritation
PEG/PEJ
endoscope + local anesthesia
*also can use radiologic/laparoscopic
PRO: non-surgical. short procedure time, limited anesthesia
large tube to admin meds + prevent clogging.
NGT
formula selection
classification
based pn pro/macro composition
specialized
renal/hepatic failure - ↓vit A, D, E, na, k
supp antioxidant vit/min (wound healing, immune fn)
elemental
standard
Oral supplements
energy-dense - fluid restriction, intol. to larger volume
**
in J.I., list of specific formulas
blenderized (homemade)
concerns: nutr adequacy, food safety, burden on caregivers
contraindic: immunocompromised, smaller tubes (<10 French), continuous feeds (>2h), fluid restriction <900ml/d, food allergies, JT
pros: cist effectiveness, health benefits from whole foods, ability to tailor to needs, potential bond btwn caregiver/pt
considerations
nutr needs
kcal/PRO density
Na, K, mg, Pi
fluid
GI fn
form/amount of macros/fiber
clinical status
compliance
cost + availability after d/c