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Enteral nutrition (Goal of nutrition (avoid adverse consequences of…

- - - - maintain mucosal integrity
    - - prevent hepatic encephalopathy
    - - decrease nitrogen loss after trauma, promote wound healing
    - - prevent intestinal mucosal atrophy
      - intestinal modulation after chronic diarrhea
      - reduce risk of wound infection
    - - essential for premature infants
  - - - starch/polysaccharide/oligosaccharide
      - disaccharides
      - monosaccharides
  - - - constipation
      - tube feeding-associated diarrhea
      - improve wound healing
      - support gut barrier
      - adapted in short-bowel syndrome
- - - - bowel sounds
      - soft abdomen
      - passage of flatus or stool
      - intact appetite
- - - - oroenteric tube
      - nasoenteric tube
        
        nasoduodenal
        
        nasojejunal
        
        nasogastric
      - transpyrolic feeding tube
    - - endoscopic techniques
        
        percutaneous endoscopic gastrostomy
        
        percutaneous endoscopic jejunostromy
      - laparoscopic techniques
        
        laparoscopic gastrostomy
        
        laparoscopic jejunostromy
      - open surgical techniques
        
        gastrostomy
        
        jejunostromy
  - - - administered over 20-30 minutes/period
      - feeding with container and gravity drip
    - - delivered slowly over 12-24 hours
      - usually with an infusion pump
    - - administered by gravity over a short time
      - reservoir up to 400 ml
- - - - osmolality
        
        measure concentration of free particles, molecule, ions
        
        isotonic formula 280-320 mOsm/kg
        
        enteral formula 270-700 mOsm/kg
      - renal solute load
        
        must be excrete by kidney
        
        protein, sodium, potassium, chloride
        
        renal solute load increases,patient requires more water
      - hydrogen ion concentration
        
        commonly : pH > 3.5
        
        avoid
        
        pH < 3.5 : decrease gastric motility
        
        pH level : clogging feeding tube
      - calories density
        
        1.0 , 1.2, 1.5, 2.0 kcal/ml
        
        more nutrient-dense, less water content
        
        high calorie density formulas, slow gastric emptying rate
  - - - hydrolysed nutrients, hyperosmolar
        
        CHO : oligosaccharide, monosaccharide
        
        protein : free amino acid, peptides
        
        Fat: medium chain triglycerides, long chain triglycerides
      - for patients with impaired digestion and absorption
      - modular formulas contain single nutrients
        
        protein powder
        
        liquid carbohydrate
        
        corn oil
        
        MCT
    - - formulas
        
        blenderizes preparation
        
        reconstituted powder preparation
        
        real-to-feed products
      - nutritionally complete, 1-1.5 liters, 1 kcal/ml
      - CHO 50-55%, Protein 15-20%, Lipid 30%
    - - patients with specific condition
        
        renal disease
        
        low protein, potassium, phosphorus, magnesium
        
        calorically dense
        
        pulmonary disease
        
        low CHO,high fact
        
        hepatic disease
        
        high BCAA, low AAA
        
        diabetes mellitus
        
        low CHO,high fat
        
        CHO : oligosaccharide, fructose, cornstarch, fiber
        
        hypermetabolic states
        
        immunocompromised states
        
        arginine, glutamine, nucleotides, omega-3 fatty acids
        
        fat or carbohydrate malabsorption
        
        patients with allergy
        
        เด็ก มักแพ้ cow's milk, eggs, wheat, soy
        
        ผู้ใหญ่มักแพ้ seafood, peanuts, tree nuts
- - - - vital signs
    - - electrolyte : magnesium, calcium, phosphate, blood glucose, BUN, creatinine
    - - total protein, albumin, prealbumin, CBC, AST, ALT