EN

Question 1

Indications for EN

Answer 1

inadequate or expected inadequate oral intake 7-14 days

Question 2

Contraindications

Answer 2

obstruction, severe GIB, GI malabsorption, EN failed, no GI access

Question 3

Critically ill when to start EN

Answer 3

24-48 hrs

Question 4

Water in Standard formula

Answer 4

82-85%/liter

Question 5

Water in 1.5 cal/cc formula

Answer 5

76-78%/L

Question 6

Water in 2 cal/cc formula

Answer 6

70%/L

Question 7

Tap water for flushes?

Answer 7

Adequate for healthy populations, but nosocomial infections in critically ill or immune compromised

Question 8

Soluble Fiber

Answer 8

inc Na and water absorption

Question 9

Insoluble Fiber

Answer 9

Dec transit time by inc fecal weight

Question 10

Immune enhancing formula

Answer 10

beneficial with major surgery vs. critical illness=ASPEN dec vent, dec infection, dec LOS but no overall impact on mortality

Question 11

Hang time OPEN SYSTEM

Answer 11

8 hrs

Question 12

Hang time CLOSED SYSTEM

Answer 12

24-48 hrs

Question 13

Hang time RECONSTITUTED

Answer 13

4 hours

Question 14

What slows gastric emptying

Answer 14

opiates/meds, dec BP, sepsis, anesthesia, autoimmune dz, rapid TF rate, cold sol’n, inc fat sol’n

Question 15

What meds can aid slow gastric emptying

Answer 15

prokinetic agent, anit-emetics

Question 16

Contraindications EN-GI related

Answer 16

Intractable N/V, Severe short gut, ileus, distal high output fistula

Question 17

severe short bowel is how much sm bowel remaining

Answer 17

less 100cm

Question 18

Contraindications to EN- nourished status

Answer 18

malnourished <5-7 days, 7-9 days for nourished pts

Question 19

Secretory Diarrhea causes dz related

Answer 19

IBS, intestinal resection, bile/fatty acid malabsorption, celiac sprue, sm int lymphoma, villous adenoma rectum, Zollinger-Ellison syndrome

Question 20

Secretory Diarrhea-infectious/med related

Answer 20

C.Diff, laxative abuse, chronic infections

Question 21

Meds that increase diarrhea

Answer 21

digoxin, Mag containing, metoclopramide (reglan), neomycin, theophylline

Question 22

Treat Diarrhea with TF Tx such as

Answer 22

continuous infusion, feed into duodenum, dec rate

Question 23

Systemic hypotensive status- avoid what TF

Answer 23

fiber

Question 24

Who is at risk for aspiration

Answer 24

hx aspiration, neuro dz, ETT, vomit, high residuals, supine, ABD/THORACIC SURGERY

Question 25

HOw much average gastric residuals/day

Answer 25

2-3 liters

Question 26

Add promotility agent when residuals are

Answer 26

over 250cc x 2

Question 27

Hold TF and reassess when residuals are

Answer 27

over 500cc, consistently over 500—post pyloric tube

Question 28

Refeeding, start TF to meet what % nutrient needs

Answer 28

25% goal, adv 3-5 days

Question 29

Transition protocol: PN to TF

Answer 29

Dec PN once tolerates 33-50% TF, d/c PN once tol 50-75% TF

Question 30

Transition protocol: TF to Po

Answer 30

Cal count, night cycle or bolus feeds, D/C TF if po greater 75%

Question 31

Osmotic Diarrhea

Answer 31

Lactose malabsorption, Tf cause, inc SCFA