RT Book, Section
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
SR Print(0)
ID 1148582233
T1 Enteral Nutrition
T2 Pharmacotherapy: A Pathophysiologic Approach, 10e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259587481
LK accesspharmacy.mhmedical.com/content.aspx?aid=1148582233
RD 2024/04/25
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