PrepU Chapter 16: Enteral and Parenteral Nutrition

Which client population will the nurse identify as being at risk of refeeding syndrome with initiation of supplemental nutrition? Select all that apply.

- Clients with chronic alcoholism - clients with cancer cachexia

Monitoring and adjusting the temperature of the formula is a nursing intervention and consideration in which of the following nutrition-related problems in tube-fed patients? Select all that apply.

- clogged tube - diarrhea

Which of the following feeding routes require care of a surgically created opening? Select all that apply.

- gastrostomy - jejunostomy

A hospitalized client weighs 220 pounds. When planning his nutritional intake, the nurse knows the client needs how many calories to maintain his body weight?

2500 to 3000 -A range of 25 to 30 calories per kilogram is used to maintain body weight (220 pounds divided by 2.2 pounds per kilogram is 100 kg).

The nurse is preparing to flush a client's gastrostomy tube. The nurse should administer which of the following?

30 mL of warm water

The nurse is considering nutritional support options for a client who is on day 3 of hospitalization. What does the nurse identify as the minimum percentage of the client's nutritional needs that can be met through an oral diet to avoid the need for enteral nutrition? Provide your answer as a whole number.

70 -The nurse identifies a minimum of 70% of the client's nutritional needs being met through an oral diet on days 3 through 7 as being adequate, thus avoiding the need for enteral nutrition.

When considering nutrition support in a patient, which of the following is CORRECT?

Choose an oral diet over tube feeding or central lines, if possible. -Oral diets are the easiest and most preferred method of providing nutrition. Enteral nutrition is a way of providing nutrition for patients who are unable to consume an adequate oral intake but have at least a partially functional GI tract. Parenteral nutrition should be used only when an enteral intake is inadequate or contraindicated or when the duration of nutritional support is expected to be 7 days or more. Overall, studies support the use of cyclic parenteral nutrition instead of continuous parenteral nutrition for stable patients who require long-term or home PN.

A nurse is caring for a client with refeeding syndrome. The nurse knows that a sign or symptom of refeeding syndrome includes which of the following?

Edema

The critical care nurse is providing input on the ordering of enteral formulas for the unit. Which specialized enteral formula will the nurse support ordering?

Formula developed for obese clients -The nurse understands that a low-caloric density formula with a reduced nonprotein calorie-to-nitrogen ratio is suggested for obese clients and supports its purchase for the unit. The nurse identifies research findings indicating no benefit for the use of other disease-specific specialty enteral formulas, including hepatic and pulmonary formulas. The nurse does not support the purchase of enteral glutamine supplement for routine addition to formula based on randomized clinical trials that showed added glutamine had no significant effect on key metrics, including mortality and length of stay.

A client's health care provider wants to order a high-calorie formula for long-term use and the client will then need bolus administration of water to meet fluid requirements. Which feeding route will the nurse identify as being appropriate for this client?

Gastrostomy

The nurse is caring for a patient who has a fluid restriction but receiving enteral nutrition. Which of the following formulas would be best suited to this client's health needs?

High calorie -High-calorie formulas provide 1.5 to 2.0 cal/mL and are appropriate for patients who need a fluid restriction or those who are intolerant of higher volumes of formula.

A client scheduled to receive enteral therapy is complaining of abdominal pain and distension. Which intervention is most appropriate?

Hold the tube feeding

A client with a diagnosis of irritable bowel syndrome was admitted to inpatient care for enteral nutrition therapy. Which enteral formula would the client receive based on their diagnosis?

Hydrolyzed formula -Hydrolyzed, or elemental formulas, contain very little residue and are intended for clients with impaired digestion or absorption, such as people with inflammatory bowel disease, cystic fibrosis, and pancreatic disorders. Standard, intact, and blenderized formulas need to be fully digested.

A nursing student asks the nurse educator what causes refeeding syndrome. Refeeding syndrome is caused primarily by a drastic increase in which of the following?

Insulin

The nurse knows that parenteral nutrition is administered into which of the following?

Into the bloodstream -Parenteral nutrition (PN) is the delivery of nutrients by vein directly into the bloodstream. Parenteral nutrition bypasses the gastrointestinal (GI) tract and is not given via the skin (dermal route) or the lymphatic system.

The nurse is caring for a patient who will have short-term parenteral nutrition through a peripheral intravenous line. Which type of parenteral solution will the nurse ensure is being used?

Isotonic -Peripheral parenteral nutrition (PPN) is not widely used because solutions infused into peripheral veins must have lower osmolarity (in other words, they must have low concentrations of dextrose and amino acids) to prevent phlebitis and increased risk of thrombus formation (Boullata et al., 2014). PPN solutions must be isotonic; the nurse will ensure that this requirement is met. A disease-specific solution may or may not be appropriate, depending on the client's condition. A hypertonic solution is not used in PPN. Dextrose concentrations for central PN range from 25% to 70%, but only concentrations of 10% or less are used for PPN to avoid damage to the peripheral vein.

The nurse knows a malnourished patient with a gastrointestinal fistula is receiving parenteral nutrition because it has which of the following benefits?

It offers aggressive nutrition support

The nurse is providing an educational workshop to caregivers of individuals who require supplemental nutritional interventions. Which feeding route does the nurse identify as extending from the nose to the small intestines?

Nasojejunal -Transnasal routes are feeding routes that extend from the nose to the stomach or small intestines and include nasogastric and nasojejunal routes. Jejunostomy is an ostomy rather than a transnasal route of feeding and nutrients are delivered directly to the jejunum. Central vein parenteral nutrition and peripheral parenteral nutrition deliver nutrients via a central or peripheral vein respectively.

A client recently started dialysis for kidney failure. Which of the following tube-feeding formulas should be used?

Nepro with Carb Steady -Novasource Renal and Nepro Carb Steady are designed for patients with renal failure after dialysis has been instituted.

A hospitalized patient is malnourished. Which of the following would help to promote an adequate intake?

Offer alternatives to the menu selections.

The nurse is planning a client's transition from enteral nutrition to an oral diet. Which guideline for transition to an oral diet will the nurse identify as being correct?

Oral feeding frequency is gradually increased to achieve 6 small oral feedings -To begin the transition process, the tube feedings should be stopped for 1 hour before each meal. Meal frequency should be gradually increased until 6 small oral feedings are accepted. When oral calorie intake consistently reaches 500 to 750 calories per day, tube feedings may be given only during the night. When the client consistently consumes two-thirds of protein and calorie needs and 1000 mL fluid orally for 3 consecutive days, the tube feedings can be discontinued.

The nurse knows that parenteral nutrition (PN) can be discontinued at which of the following stages?

Oral/enteral intake provides at least 50% of client needs -Parenteral nutrition (PN) can be discontinued when oral/enteral intake provides 50-75% of client needs. The client does not need to have 100% of their needs met nutritionally to be discontinued from PN.

Which of the following CORRECTLY matches the source to the nutrient it provides in formulas?

Pea provides fiber. -Pea and guar gum are sources of fiber, canola oil is a source of fat, and sucrose is a source of carbohydrate.

A client has a nasogastric (NG) tube placed for enteral therapy. Which of the following is an intervention to decrease aspiration?

Placing the client upright in a chair if able Elevating the head of the bed to 30° to 45° and positioning the client upright in a chair if able are interventions that decrease the risk of aspiration. Factors contributing to aspiration risk include inability to protect the airway, presence of an NG tube, mechanical ventilation, age of 70 years or older, reduced level of consciousness, poor oral care, inadequate amount of nurses for the number of clients, supine positioning, neurologic deficits, gastroesophageal reflux, and use of bolus eternal nutrition (EN). Aspiration risk is reduced by switching from bolus gastric feedings to continuous infusion and delivering EN into the small bowel instead of the stomach. Coughing and deep breathing will not prevent aspiration.

The nurse is caring for a client who has recently been extubated and is attempting to resume an oral diet but does not feel hungry enough for a full meal. Which strategy will the nurse employ to optimize the client's oral intake?

Provide small, frequent meals with high nutrient-density

The nurse is caring for a client who has had a stroke and has difficulty swallowing. The nurse should ensure an order for which type of oral diet?

Pureed -Dysphagia diets, in which any food is allowed but must be pureed, are variations of modified consistency diets and are appropriate for some individuals with swallowing disorders. A regular diet would increase the client's choking risk. A clear liquid diet is lacking in nutrients, and thin liquids are an aspiration risk for individuals with swallowing disorders. A high fiber diet is a therapeutic diet intended to address constipation, diabetes, irritable bowel syndrome, hypercholesterolemia, or obesity; however, it is not intended specifically for individuals with swallowing difficulties.

The nurse plans to determine calorie needs for a client in the critical care unit to start enteral nutrition (EN), but does not have the equiptment to perform indirect calorimetry. Which plan of action is the nurse's best option to an ensure accurate calculation?

Recalulate caloric need by means of either the weight-based equation or a predictive equation more than weekly

A patient has been admitted to the hospital with an obstruction in the small intestines and has evidence of malnutrition from low intake of protein and calories. Which of the following is appropriate for her nutrition therapy?

Start parenteral nutrition as soon as possible.

The nurse is caring for a client for whom oral supplements are not adequate. The client is capable of consuming an oral diet and has normal digestion and absorption. Which intervention does the nurse identify as being appropriate for this client?

Supplemental enteral nutrition

The nurse is caring for a hospitalized patient who is prescribed a regular diet. The nurse knows which of the following is true about a regular diet?

They vary on the basis of patient preferences.

The family of a hospitalized patient diet note there is maltodextrin in the patient's enteral formula. The nurse explains correctly that this is a form of which of the following nutrients?

a carbohydrate. -Maltodextrin in enteral formula provides a source of carbohydrate to the patient.

A physician wants to administer an acidic drug through a feeding tube. How should the drug be administered?

after feeding is stopped and the tube has been flushed

What is the most serious potential complication with enteral nutrition?

aspiration

Switching to a different formula is a nursing intervention and consideration for all of the following nutrition-related problems in tube-fed patients EXCEPT:

aspiration.

Which type of feeding is administered into a feeding tube through a large syringe?

bolus

Which of the following is an example of parenteral nutrition?

catheter through a subclavian vein -For central parenteral nutrition, a physician threads a central venous catheter through the jugular or subclavian vein until the tip is located just above the heart. Enteral nutrition includes transnasal routes (feeding routes that extend from the nose to either the stomach or the small intestines) and ostomy (a surgically created opening made to deliver feedings directly into the stomach or intestines).

Which of the following formulas contains protein that has been broken down into its building blocks?

completely hydrolyzed

The nurse is taking steps to minimize the growth of microorganisms to prevent which of the following nutrition-related problems in tube-fed patients?

diarrhea -Nursing interventions and considerations for diarrhea include following handwashing and sanitation protocol, refrigerating unused formula promptly, discarding opened cans within 24 hours, flushing the tubing as per protocol, hanging formulas for fewer than 24 hours, changing the extension tubing every 24 hours, and initiating and advancing feedings according to the protocol.

Ice chips, sugarless gum, and hard candies can be helpful for which of the following nutrition-related problems in tube-fed patients?

dry mouth

A client is unable to obtain enough nutrients from oral feedings even though her GI tract is functional. She will need long-term feedings. She should receive which of the following tube feedings?

gastrostomy

Compared to the blood, a solution has more sugars, amino acids, and electrolytes in the same volume. The nurse recognizes that this solution is which of the following?

hypertonic. -Osmolarity is a measure of the number of particles in a solution and is determined by the concentration of sugars, amino acids, and electrolytes. Hypertonic solutions have a greater concentration of solutes than blood.

Which of the following is an example of enteral nutrition?

nasogastric tube -Enteral nutrition includes tubes inserted into the stomach or intestines through the nose (nasogastric or nasoenteral) or through the skin (gastrostomy or jejunostomy).

The nurse recognizes what is the easiest method to provide nutrition to hospitalize patients?

oral diets

A patient was admitted to the hospital with normal digestion and absorption. He was prescribed an oral diet after admission but became malnourished. Which of the following interventions are required for this patient?

oral supplements.

Compared to parenteral nutrition, enteral nutrition in critically ill adults:

presents a lower risk of infection.

Which of the following is recommended for confirmation of tube placement before feedings begin?

radiography -Before initiating a feeding, tube placement is verified, ideally by radiography. Other common verification methods, such as auscultation, aspirating gastric contents, and pH testing, are less reliable and not recommended.

A client is taking warfarin due to her history of blood clots. Which of the following should be used for her parenteral nutrition?

solution without vitamin K

What is the most commonly used liquid for periodic flushing of feeding tubes?

water

A client with dysphagia is receiving enteral nutrition. Which assessment requires immediate intervention?

Abdominal discomfort and distension

The nurse is adding a modular formula to a client's existing formula. For which reason will the nurse implement this intervention?

Add calories

The nurse is instructing the student nurse in nursing management considerations for parenteral nutrition. Which strategy does the nursing student identify as accurate?

Allow patients to eat when hungry, if possible -Some patients may feel hungry while receiving parenteral nutrition and should be allowed to eat if possible. Nursing management considerations for parenteral nutrition include removing solutions from the refrigerator 1 to 2 hours before they are hung and, once hung, completing infusion or discarding solution within 24 hours. An "oiled out" solution cannot be infused. Parenteral nutrition can be discontinued when enteral intake provides at least 60% of estimated calorie requirements.

The nurse is planning care for a client who has been prescribed cyclic tube feedings. For which complication(s) will the nurse consider switching to the continuous drip method? SATA

Aspiration due to delayed gastric emptying

The nurse is checking gastric residual volume (GRV) for a client's gastrostomy tube. For which purpose is this procedure performed?

Assessing the amount of fluid left from the previous feeding