TY - CHAP M1 - Book, Section TI - Enteral Nutrition A1 - Kumpf, Vanessa J. A1 - Chessman, Katherine H. A2 - DiPiro, Joseph T. A2 - Talbert, Robert L. A2 - Yee, Gary C. A2 - Matzke, Gary R. A2 - Wells, Barbara G. A2 - Posey, L. Michael PY - 2017 T2 - Pharmacotherapy: A Pathophysiologic Approach, 10e AB - Patient Care Process for the Use of Enteral NutritionCollectPatient characteristics (e.g., age, race, sex)Patient history (past medical, surgical, family, social—alcohol use)Nutrition history (dietary history, weight history, dietary intolerance, prior enteral or parenteral nutrition therapy)Procedures related to enteral access placementCurrent medications (including nutritional supplements)Objective dataHeight, weight, BMIFluid balance (intake and output)Labs (e.g., serum electrolytes, Scr, BUN, glucose, albumin)Other diagnostic tests when indicated (e.g., gastric emptying study, swallow study)Assess*Appropriate time to initiate enteral nutritionPresence of altered GI anatomy or function (e.g., bariatric surgery, delayed gastric emptying, pancreatic insufficiency)Nutritional status and risk of refeeding syndrome (e.g., unintentional weight loss, prolonged time period with poor nutritional intake, BMI <18, low visceral proteins, muscle wasting; see Tables 141-2, 141-5, 141-7)Nutrition requirements (goal protein, calories, fluid, and micronutrient intake; see Tables 141-9, 141-10, 141-14) Appropriate enteral access (see Table 143-3)Plan*Enteral nutrition regimen including specific enteral feeding formulation, method of administration (continuous, bolus), and initiation and advancement guidelines (see Tables 143-5 and 143-6)Monitoring parameters for efficacy (weight, growth in children, enteral intake), GI tolerance (gastric residual volumes, stool output, nausea, vomiting, abdominal distention), and metabolic complications (serum electrolytes, Scr, BUN, glucose, LFTs; see Table 143-7) Implement*Initiate enteral nutrition when the oral route fails or is not possible, the GI tract is functional, and enteral access can be safely achievedPatient education when home enteral nutrition is indicatedFollow-up: Monitor and Evaluate*Determine nutrition goal attainmentProvide adjustments to the enteral nutrition regimen when nutrition goals are not achieved and consider transition to parenteral nutrition if repeated adjustments fail or intolerance developsTransition off enteral nutrition when nutrition needs are safely met by oral dietary intake Presence of adverse effects and GI intolerancePlan for transitioning off enteral nutrition *Collaborate with patient, caregivers, and other health professionals SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1148582233 ER -