What are the 5 main indicators for enteral nutrition? correct answers1. protein-energy malnutrition and inadequate oral nutrient intake for >5 days
2. meeting <50% of nutrient needs for 5-7 days
3. severe dysphagia
4. coma
5. low output enterocutaneous fistula
What is protein-energy ma...
What are the 5 main indicators for enteral nutrition? correct answers1. protein-energy malnutrition and
inadequate oral nutrient intake for >5 days
2. meeting <50% of nutrient needs for 5-7 days
3. severe dysphagia
4. coma
5. low output enterocutaneous fistula
What is protein-energy malnutrition? correct answersAccording to World Health Organization, protein
energy malnutrition (PEM) refers to "an imbalance between the supply of protein and energy and the
body's demand for them to ensure optimal growth and function".
What is dysphagia? How is it diagnosed? correct answersdifficulty swallowing
A videofluoroscopy assesses your swallowing ability. It takes place in the X-ray department and provides
a moving image of your swallowing in real time. You'll be asked to swallow different types of food and
drink of different consistencies, mixed with a non-toxic liquid called barium that shows up on X-rays.
Why might EN be preferred over PN in coma patients? correct answersIt is less expensive than parenteral
nutrition and is preferred in most cases because of less severe complications and better patient
outcomes, including infections, and hospital cost and length of stay.
If the gut works, use it!!
What is an enterocutaneous fistula? correct answersAn enterocutaneous fistula (ECF) is an abnormal
connection that develops between the intestinal tract or stomach and the skin. As a result, contents of
the stomach or intestines leak through to the skin. Most ECFs occur after bowel surgery.
In adult patients with ECF, what is the preferred route of nutrition therapy (oral diet, EN, or PN)? correct
answersAfter stabilization of fluid and electrolyte balance, we suggest that oral diet or EN may be
,feasible and tolerated in patients with low-output (<500 mL/d) ECF (suggesting no distal obstruction).
However, patients with high-output ECF (>500 mL/d) may require PN to meet fluid, electrolyte, and
nutrient requirements to support spontaneous or surgical closure of the ECF.
What are the 6 contraindications for enteral nutrition use? correct answers1. intestinal obstruction,
ileus, or hypo motility
2. severe diarrhea or vomiting
3. severe hemodynamic instability
4. major upper GI bleeding
5. prognosis doesn't warrant aggressive nutrition support
6. high output enterocutaneous fistula (>500 ml/d)
What is an ileus? correct answersloss of peristalsis w/o structural obstruction
What is the difference between an ileus and bowel obstruction? correct answersIleus and intestinal
obstruction have similarities. However, ileus results from muscle or nerve problems that stop peristalsis.
Known as a on-mechanical obstruction of bowel usually secondary to inhibition of peristalsis.
Small bowel obstruction defined as mechanical obstruction of small bowel due to adhesions, mass,
volvulus or other internal or external compression.
a type of ileus known as paralytic ileus can cause a physical block due to a food buildup in the intestines.
Why is severe diarrhea a contraindication for enteral nutrition? correct answersIt results in electrolyte
imbalance, dehydration, perianal skin breakdown, and wound contamination.
Formula content may cause diarrhea: the type and amount of fiber, FODMAP content, osmolality,
delivery mode, EN contamination, medication, infections (C. diff)
**per ASPEN, clinicians need to look at the source of diarrhea before stopping EN. (Infectious diarrhea
vs. osmotic diarrhea)
, What are the signs and symptoms of shock? correct answersCool, clammy skin
Pale or ashen skin
Bluish tinge to lips or fingernails (or gray in the case of dark complexions)
Rapid pulse
Rapid breathing
Nausea or vomiting
Enlarged pupils
Weakness or fatigue
Dizziness or fainting
Changes in mental status or behavior, such as anxiousness or agitation
Should EN be initiated in patients with acute pancreatitis? correct answersenteral nutrition significantly
reduces the mortality rate of severe acute pancreatitis compared to parenteral feeding. To maintain gut
barrier function and prevent early bacterial translocation, enteral feeding should be commenced within
the first 24 h of hospital admission.
can be gastric or jejunal feeding of standard polymeric formula
What are examples of "prognosis that doesn't warrant aggressive nutrition support"? correct answers1.
if patient has intact, functioning GI tract with anorexia nervosa
2. if patient has mild dysphagia that can eat IDDSI foods and/or oral nutrition supplements
3. patient who is not at risk for malnutrition
What is a high-output fistula a contraindication for EN? correct answersenteral nutrition in high output
fistula was found useless, and didn't provide any benefit to the patients, and had compounded
metabolic and management complications. EN does not replace the large amounts of fluid lost as quickly
as it should.
Explain a nasogastric EN feeding. correct answersIt is a flexible tube that is fed through the nose, down
the back of the throat, and terminates in the stomach.
This is more for short-term access only.
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