NUR 242 Nutrition

Study Guide Ch 15 Enteral and Parenteral Nutrition Support

Vocab: enteral, parenteral, nasogastric, nasoduodenal, nasojejual, orogastric,
gastrostomy, jejunostomy, isotonic, hypertonic, intermittent feeding, bolus feeding,
continuous feedings, PPN, TPN
Fig 15-1 Selecting a Feeding Route—is the GI tract functional?
Use GI tract if at all possible—why?
Enteral feeding—provides nutrients to GI tract via tube;
Parenteral feeding—(“beside intestines”)—provides nutrients intravenously

Tube Feeding
List reasons to use a tube feeding.
Tube feeding routes—know words/locations of (5th ed: Fig 15-2)(6th ed: Fig 15-3)
and Glossary of TF Routes (5th ed: pg 437)(6th ed: pg 429)
What placement is typically used if risk of aspiration?
Table 15-1 which ones have lower risk of aspiration?/need a pump?/need surgery
to place tube?
Be able to differentiate formulas: standard, elemental, specialized, modular
What are some indications for these various formulas?

Protein needs are ____ for metabolic stress, _____ for chronic kidney disease.
Standard formulas provide about ______ kcal/cc.
A formula with 2 kcal/cc would be useful for patients with what 2 situations:
Fiber in formula is useful for (name 3-4 conditions):
Avoid fiber with (1-2 conditions)
Osmolality: isotonic, hypertonic.
Osmolality of blood serum is about ______________
What components influence osmolality?
Adding extra sugars and salts to a solution will (draw or repel) water to it?

Advantages/disadvantages of open and closed feeding systems

Intermittent vs continuous feedings vs bolus feedings. Usually delivered to where?
Initiating and Advancing Tube Feedings—who needs slower rates of delivery?
How to administer meds—pg 445.
Complications of TF: Table 15-2
How to transition to table food? How much should oral intake supply before EN is
discontinued?

Parenteral Nutrition
Candidates for PN:
PPN vs TPN: access location, osmolality, length of time of use, kcal content
Amino acids = 4 kcal/g, dextrose monohydrate (glucose) = 3.4 kcal/g,
lipid emulsions by percent, so 10% lipid = 1.1 kcal/ml, 20% lipid = 2 kcal/ml
Are RDA values useful for vitamins and minerals for TPN solutions? Why not?
Why are there vitamin preparations without vitamin K?
Are meds generally added to the TPN solution? Why not?
Which two meds are ok?
Total nutrient admixture (3-in-1) vs 2-in-1 solutions—how are they different?
Why are lipids sometimes hung separately? Should you hang a bag of TPN that
has a layer of lipids on top?
Table 15-3 Potential complications of parenteral nutrition.
What components of TPN contribute to osmolality?
What can happen if you rapidly change the infusion rate of a TPN solution?
Recommendations for discontinuing TPN:
What are signs/symptoms that intestines have not adapted to feeding yet?
What percent of the calories should be taken enterally before discontinuing TPN?
Managing metabolic complications—what to do for:
Hyperglycemia
Hypoglycemia
Hypertriglyceridemia
Refeeding syndrome
Liver disease
Gallbladder disease