Chapter 13: Nutrition Support in the Oncology Setting Flashcards
What is Enteral nutrition (EN)?
Enteral nutrition (EN) provides nutritin directly into the GI system, bypassing the oral route via NG or directly into the stomach or small intestines.
T/F: EN is most appropriate in patients receiving active anticancer treatment who are malnourished and who are anticipated to be unable to ingest or absorb nutrients for greater than 7-10 days.
True
For which cancers is EN most common?
head/neck, gastric, esophageal and pancreatic
T/F: Compared to PN, EN has less risk of infection and costs less?
True
Indications for post-pyloric feedings?
gastroparesis, gastric outlet, duodenal obstruction and fistula proximal to the feeding tube location.
What size tube is used for standard formula?
5-8 F
When would you use a larger tube (>8 F)?
higher volume of formula, viscous and energy dense formulas, and they are preferred for bolus and gravity feeds.
Contraindicatins for enteral feedings?
bowl obstruction, low BP, intractable diarrhea, severe active GI bleed, ischemic or perforated gut, high output fistula/ostomy, extensive resection of small bowel and you need at least 100 cm jejunum and 150 cm ileum with ileocecal valve for adequate GI absorption.
What are the four primary methods of EN administration?
Bolus, intermittent or gravity, cyclic or continuous.
What are some possible complications with EN?
metabolic aberrations, GI intolerances, enteral misconnections, mechanical/tube complications, microbial contamination and drug-nutrient interactions..
What is Refeeding Syndrome?
occurs when malnourished patients are fed full energy needs and or a high carbohydrate diet. It is potentially life-threatening and is characterized by severe electrolyte abnormalities, and glucose and fluid shifts which can result in fluid retention, cardiac dysfunction and respiratory failure.
Conditions that increase risk for referring syndrome?
Chronic malnutrition, malnutrition, prolonged hypocaloric feeding or fasting, NPO greater than 7 days, chronic alcoholism and anorexia nervosa.
What labs should you monitor with refeeding syndrome?
phosphorous, potassium, magnesium
How do you start EN when referring syndrome is a concern?
Start feeding at 25% of estimated nutritional needs and advance over 3-5 days to feeding goals. Review labs, vital signs and fluid balance.
Recommendations for putting medications through a feeding tube?
use liquid suspension formulations when possible. Tablets must me thoroughly crushed. Avoid crushing time-released or enterically coated medications.
