EN or PN?
A 62-year-old patient is recovering from a total gastrectomy and has been experiencing persistent nausea and vomiting
PN - due to lack of a functional stomach for enteral feeding
Which of the following patient conditions would NOT be appropriate for a polymeric tube feed formula?
A. A patient with normal digestion and no issues with nutrient absorption
B. A patient with severe malabsorption due to short bowel syndrome
C. A patient recovering from surgery with intact GI function
D. A patient with mild pancreatitis
B. A patient with severe malabsorption due to short bowel syndrome
What is one primary benefit of EN compared to PN?
A. Increased risk of infection
B. Better preservation of gut integrity
C. Lower calorie intake
D. No requirement for GI function
B. Better preservation of gut integrity
Name one suggestion to improve tolerance to EN for a patient with delayed gastric emptying
- Post pyloric placement of FT
- Prokinetic agent
- Switch to low fat EN formula
- Reduce advancement rate
Formulas designed for EN must always contain fiber to prevent GI complications such as constipation
False
A patient with severe dysphagia due to a recent stroke has been advised not to eat by mouth. They have a functional GI tract but cannot safely swallow
EN - can provide nutrition without the risk of aspiration
A patient is post-op day 1 from a Whipple Procedure due to pancreatic cancer. Which type of formula would be most appropriate?
A. Standard polymeric formula
B. Fiber-enriched formula
C. Hydrolyzed or elemental formula
D. High protein formula
C. Hydrolyzed or elemental formula
What is the primary benefit of early initiation of EN for patients with severe malnutrition?
A. Prevents the development of metabolic syndrome
B. Enhances the body's ability to recover and rebuild lean body mass
C. Eliminates the need for any oral intake
D. Reduces the likelihood of GI side effects
B. Enhances the body's ability to recover and rebuild lean body mass
Name a suggestion to improve tolerance to EN for a patient with recurrent emesis
- Advance FT into small bowel
- Hold TF
- Check last BM
- Consider semi-elemental formula
Clinicians should routinely assess gastric residuals as a standard practice to prevent complications associated with enteral feeding
False - no longer routinely used; if being used, avoid holding TF if GRV is less than 500ml if the patient has no other signs of feeding intolerance
A 45-year-old patient undergoing chemotherapy has developed severe mucositis. They have a history of bowel resection but can still absorb nutrients
EN
Name two advantages of standard tube feed formulas (polymeric) compared to elemental formulas
- Cost-effective
- Availability of specialized options
- Typically less volume required
- Lower risk of GI side effects (diarrhea, bloating, etc)
- More widely available
A patient with a severe traumatic brain injury is admitted to the ICU. What is the primary reason for these patients' increasing calorie and protein needs?
A. Provide enough energy for tissue repair and prevent negative nitrogen balance
B. Increase fat oxidation and decrease protein synthesis
C. Promote glucose sparing and stimulate production of ketones
D. Enhance glycogen storage and decrease muscle synthesis
A. Provide enough energy for tissue repair and prevent negative nitrogen balance
Name two potential causes of hyperglycemia for patients receiving enteral nutrition
- Refeeding syndrome
- Diabetes, sepsis, catabolism, trauma, etc.
- Steroids
- High CHO formula
EN formulas can be tailored to address specific conditions, such as providing higher protein content for patients with wounds or pressure ulcers
True
A patient in the ICU has undergone multiple surgeries for abdominal trauma and has been experiencing an ongoing ileus. They have been NPO for five days
PN - until GI function returns to normal
Which of the following conditions most likely does NOT require a semi-elemental or elemental formula?
A. Significant bowel resection and/or SBS
B. GI fistulas
C. Severe pancreatic insufficiency
D. End-stage renal disease requiring dialysis
D. End-stage renal disease requiring dialysis
Patients with sepsis experience a hyperinflammatory response - what is one key reason for recommending a high-calorie, high-protein EN formula during recovery from sepsis?
A. Promote fat synthesis and prevent further inflammation
B. Replace lost glycogen stores and enhance fat metabolism
C. Support immune response and repair tissue damage
D. Reduce the workload on the liver and prevent the bile duct clogging
C. Support immune response and repair tissue damage
Name two potential causes for thiamine deficiency for patients receiving enteral nutrition
- Chronic alcoholism
- Long-term malnutrition
- Malabsorption
- Chronic diarrhea
- Advanced age
In patients receiving EN, medications must be given via the feeding tube to ensure optimal absorption
False
A patient with severe burns has been receiving EN but is experiencing persistent high amounts of diarrhea. They are becoming increasingly malnourished. What nutritional adjustments would you consider?
EN - trial switching to a different formula or adjusting the feeding regimen
If EN cannot be maintained, PN should be considered
A patient with short bowel syndrome is receiving an elemental tube feed but continues to experience weight loss. What factors might you consider to adjust their nutrition plan, and which alternative formula could you recommend?
- Re-assess the patient's total nutrition needs
- Evaluate the caloric density of the formula
- Slower infusion rate may enhance absorption and tolerance
- Monitor for micronutrient deficiencies
How does EN preserve gut integrity compared to PN?
A. by stimulating peristalsis and increasing gut motility, leading to more efficient nutrient absorption
B. by delivering nutrients into the bloodstream, bypassing the GI tract, and preventing gut atrophy
C. by maintaining mucosal integrity through the stimulation of GI hormones and enzymes, which help prevent bacterial translocation
D. by enhancing fluid retention in the intestines, which improves electrolyte absorption and preventing dehydration
C. by maintaining mucosal integrity through the stimulation of GI hormones and enzymes, which help prevent bacterial translocation
Name two recommendations to minimize the risk of refeeding syndrome for patients starting EN
- Slow initiation (~25% of estimated goal needs on day 1), and gradually increase to goal over 3-5 days
- Check K, Mg, and Phos levels more frequently
- Thiamine supplementation (5-7 days)
- Close monitoring
Patients receiving EN can experience blood sugar changes regardless of whether the formula is specifically designed for diabetics
True