Enteral Nutrition Support Fluid and electrolyte requirements. Calculate enteral and parenteral nutrition formulations.

ENS Selecting the formula –Integrity of GI system –Type of protein, fat, CHO, fiber in formula –Kcal & protein density of formula

ENS Selecting the formula –Ability of formula as taken to meet pt nutrient needs –Viscosity of formula and TF equipment –Cost of formula

ENS Components Intact or polymeric formulas Hydrolyzed or elemental formulas

ENS Components Molality and molarity –number of free particles/unit wt or volume –the higher the number the more free particles –the higher the number more osmotic force –mOsm

ENS Components Isotonic - –350 mOsm/kg or less Intact formulas – mOsm/kg Hydrolyzed nutrient formulas - hyperosmolar –900 mOsm/kg

ENS Components Density of formulas –more nutrients or kcal/ml the more dense –less free water Dense formulas used –restrict water –other source of water

ENS Components Protein –polymeric formulas - intact HBV protein What if small intestine can’t digest protein?

ENS Components CHO –starch hydrolysates –maltodextrins –sucrose –fructose –glucose

ENS Components CHO –osmolality increases as mover towards simple sugars

ENS Components Fat –corn, soy, safflower, canola –need 4% of total kcal as linoleic –some have MCT

ENS Components Fluid –need to check free water –standard formulas % –calorie dense - 60%

ENS Components Fiber –soy polysaccaharide –fructooligosaccharides – g/L

Chart showing narrowing the choice of formulas next

Narrowing the choice of formulas

ENS Things to consider when selecting –ability to digest –absorption –colonic residue –length of time on TF –risk of aspiration

ENS Routes of Admin Nasogastric Nasoduodenal or jasojejunal Enterostomies –percutaneous endoscopic gastrostomy (PEG) –percutaneous endoscopic jejunostomy (PEJ)

ENS Admin Bolus administration –maximum bolus ml –4 - 6 times/day Check gastric residual Contraindications? Describe pt this might work?

ENS Admin Continuous drip –infusion hours –start ml/hr –advance hr as tolerate –flush with water

What steps would you take in planning a tube feeding?

Starting ENS 300 mOsm - full strength, full rate >600 mOsm - full strength, low rate & as tolerated advance

Monitoring ENS Table 22-5 Mahan What would you monitor?

Monitoring ENS Gastric residuals –> ml without feeding –maintain elevation –wait min –check again

Monitoring ENS Gastric residuals –if always ml –find out why –if have this and greater with feeding - stop feeding or slow rate

Complications ENS Dehydration –why dehydrated –increase fluid –lower protein intake

Complications ENS Signs of excessive protein –dehydration –inadequate fluid intake –hypernatremia –hypercholremia

Complications ENS Signs of excessive protein –azotemia –pt appears confused

Complications ENS Aspiration pneumonia –make sure correct tube and placement of end of tube –elevate head 30 degrees –continuous drip hrs

Complications ENS Diarrhea –lactose intolerance –bacterial contamination –hyperosmolar formula –low serum alb –medication

END ENS Questions? Calculations next