Name

EN Complications Pre-Lecture Worksheet

20 points

1. List 4 factors that can cause delayed gastric emptying with enteral nutrition (2 points):

Anesthesia, surgery, sepsis, hypotension

2. List 5 risk factors for aspiration in patients receiving tube feedings (2.5 points):

GI reflux disease
Vomiting
Low Glasgow coma score
Gastric tube feedings
Low hemoglobin

3. Dehydration is common in patients receiving EN. List 4 alterations in laboratory values

seen with dehydration (2 points).
Plasma osmolality
Hematocrit
Low creatinine
Increased BUN

4. In hospitalized patients at risk for dehydration, fluid status can be tracked via what 2
methods (2 points):
Output and intake measurements
Daily weight

5. Hyperglycemia is common in ICU patients. List 2 strategies discussed in the ASPEN Core
Chapter to use for controlling glucose levels (2 points):
Formula developed to upgrade glycemic control
Advancement of EN

6. Refeeding syndrome is common in patients receiving nutrition support. What 3

laboratory values should be evaluated on a regular basis (1.5 points)?
Magnesium
Phosphate
Potassium

7. List 2 strategies to employ when using tube feedings in patients experiencing elevated
gastric residuals (2 points):
Slow rate feeding
HOB elevation

8. List 4 signs of intolerance to gastric tube feedings (2 points):

Vomiting
Constipation
Abdominal distention
Nausea
9. Briefly discuss the recommendations set forth in the ASPEN Clinical Guidelines
regarding checking gastric residuals volumes (1 points):
According to SCCM/ASPEN 2016 guidelines, GRVs shouldn't be used to routinely
monitor ICU patients receiving EN.In the absence of additional indications of feeding
intolerance, clinicians are advised not to hold RN for GRVs smaller than 500 mL if ICUs
continue to use them. Additionally, it is advised to get GRV measurements from
surgical ICU patients and to change the rate at which EN is delivered when GRV gets to
200 mL.

10. Go to the ASPEN Clinical Guidelines for Nutrition Support in Adults posted on D2L. What
do the Guidelines recommend regarding whether to use immune-modulating enteral
formulas in ICU patients (2 points)?
When starting EN in an ICU setting, the ASPEN clinical guidelines recommend
using an established polymeric formula. All formulas should not be routinely
used in a MICU for critically ill patients, and disease-specific formulas should
not be routinely used in a SICU. It should be avoided to use immune-
modulating enteral formulations on a regular basis in the MICU. Patients who
have had traumatic brain injuries (TBIs) and perioperative SICU patients
should be the only ones to consider these medication regimens.