1. Exam 180 minutes 120 multiple choice questions-120 points -4 short answer question-60 points multiple choice-lecture 7a onwards short answer-whole year

2. Nutrition 265-Fall 2011- Principles of Nutrition in Human Metabolism Nutrition 205-Nutritional Assessment-Theory Fall 2011 Nutrition 207- Nutritional Assessment- Application- Winter 2012 or Nutrition 201- Sports Nutrition-Winter 2012-pending approval of 201

3. Lecture 10a 21 March 2011 Enteral and Parenteral Feeding

4. Enteral Feeding -use intestine (oral or tube) -complete if formula is primary source of nutrients -complete formulas can be used in smaller quantities to supplement table foods -complete formulas required if patient is on tube feeding or oral liquid diet for more than a few days

5. Types of formulas -characterised by type of protein -standardised -hydrolysed -modular

6. Types of formulas Standardised Appropriate for people who are able to digest and absorb Contain complete proteins (whole proteins or combination of protein isolates(purified proteins)) Blenderised formulas contain protein from pureed foods (eg meats)

7. Types of formulas Hydrolysed Pre-digested protein- so only get small peptides or just free amino acids Some have medium chain triglycerides or are very low in fat

8. Types of formulas Modular Provide a single nutrient Modules can be combined with other modules or with minerals and/or vitamins to address the specific needs of a patient

9. Candidates for tube feeding Anybody who can not get food down orally or are malnourished or have high nutrient requirements or extensive intestinal resections or unable to get a hydrolysed formula down orally

10. Distinguishing characteristics of formulae Nutrient density 1.0 kcal/ml- standard 1.2 – 2.0 kcal/ml for nutrient dense formulas – smaller volumes -fluid balance issue

11. Distinguishing characteristics Residue and fibre Low to moderate fibre if administered over short time- gas and distension can be an issue If long time administration then higher amounts of fibre

12. Distinguishing characteristics Osmolality- measure of concentration of molecular and ionic particles in solution -serum is 300 milliosmoles/kg -isotonic solution is 300 milliosmoles/kg -hypertonic is greater than 300 milliosmoles/kg -isotonic and hypertonic alright in blood but hypertonic can induce diarrhea in intestine- slow introduction of hypertonic solution for intestinal route is essential

13. Tube placement Transnasal Nasogastric-children and adults-larger nose than infants Orogastric-infants- smaller nose than adults and children-aspiration is also an issue Nasoduodenal-nose to duodenum Nasojejunal placement-nose to jejunum

14. Tube placement Enterostomies- surgical placement of catheter Gastrostomy- direct to stomach Jejunostomy-direct to jejunum

17. Safehandling Open and closed systems Open- exposed to air Closed-not exposed to air Keep your fingers out of the soup

18. Initiating and progressing a tube feeding Formula delivery techniques Intermittent feeding Best to stomach No more than 250-400 ml over 30 minutes Use- depends on tolerance Bolus feeding included here (300- 400 ml) in 10 minutes

19. Initiating and progressing a tube feeding Formula delivery techniques Continuous feeding Delivered slowly over 8-24 hours Good for people who have received nothing though GI tract for a long time, hypermetabolising persons and those receiving intestinal feedings Formula volume and strength institutionally based- sops

20. Initiating and progressing a tube feeding Additional matters Supplemental water -standard formulas contain about 850 ml of water/per formula -most people need about 2 L of water per day Gastric residuals -amount left over from previous feedings-significance of this?

21. Class activity Design an enteral feeding for the pathology/problem of your choice that meets the dietary principles of adequacy, variety, moderation, nutrient density, energy control, and balance