Enteral nutrition monitoring patient

Formulate a monitoring plan for an enteral nutrition (EN) patient. 

Monitor patients for adequate oral intake. If the patient has weight loss, assess whether enteral or parenteral nutrition is needed. 

The goal is to transition the patient to enteral or oral nutrition and taper off PN as soon as feasible clinically. When initiating enteral or oral nutrition, monitor the patient for glucose, fluid, and electrolyte abnormalities. Perform calorie counts to determine the adequacy of nutrition via the oral or enteral route. When the patient is tolerating more than 50% of total estimated daily calorie and protein requirements via the oral or enteral route, wean PN by about 50%. PN can be stopped once the patient is tolerating more than 75% of total estimated daily calorie and protein requirements via the oral or enteral route, assuming that intestinal absorption is maintained. 

The most common electrolyte disorder in ARF is hyperkalemia. Life-threatening cardiac arrhythmias may occur from hyperkalemia, so potassium restriction is essential. The treatment of hyperkalemia is discussed in Chap. 50. Typically no potassium should be added to parenteral solutions unless hypokalemia is documented. Patients receiving enteral nutrition should be limited to a 3-g potassium diet. Serum potassium concentrations should be monitored daily, even in patients receiving RRT. Some centers add no potassium to their CRRT solutions and hypokalemia can result with prolonged therapy. 

The gastrointestinal (Gl) tract is the optimal route for providing nutrients unless obstruction, severe pancreatitis, or other Gl complications are present (see Fig. 136-1). Other considerations that may have an impact on determination of an appropriate route for nutrition support include expected duration of nutrition therapy and risk of aspiration. Patients who have nonfunctional Gl tracts or are otherwise not candidates for enteral nutrition (EN) may benefit from PN. Use of the intravenous route for nutrition support is also commonly referred to as total parenteral nutrition (TPN) or hyperalimentation. Routine monitoring is necessary to ensure that the nutrition regimen is suitable for a given patient as his or her clinical condition changes and to minimize or treat complications early. 

Nutritional assessment upon admission is necessary. Enteral nutrition is preferred in those patients unable to maintain an adequate caloric intake by the oral route. Overfeeding needs to be avoided, and monitoring of the glycemic levels needs to be strict. As many patients experience diarrhea, especially on implementation of enteral feedings, this needs to be... 

The candidates for home nutrition support should be clinically stable patients that require enteral or parenteral nutrition for a long term. Before initiation of home nutrition support, a nutrition assessment and a care plan should be performed and after initiation nutrition status should be monitored on a regular basis. 

Phosphorus can be omitted from the nutritional formula of patients receiving PN until the phosphorus level approaches normal (<5 mg/dL). It is prudent to monitor phosphorus concentrations daily and to add phosphorus in small doses once the serum concentration is below 4 mg/dL. Failure to do so can lead to severe hypophosphatemia (see Chap. 49) despite continued renal failure, especially in the patient treated with CRRT. Patients with persistently high serum phosphorus concentrations who have a functional gastrointestinal tract (GIT) can be prescribed phosphate-binding therapy (see Chap. 44) and enteral feedings low in phosphorus to minimize the absorption of exogenous phosphorus. 

Interactions between theophylline and food have been thoroughly studied but there seems to be no consistent pattern in the way the absorption of different theophylline preparations is affected. Be alert for any evidence of an inadequate response that can be related to food intake. Avoid switching between different preparations, and monitor the effects if this is necessary. Consult the product literature for any specific information on food and encourage patients to take their theophylline consistently in relation to meals where this is considered necessary. Advise patients not make major changes in their diet without consultation. Monitor the effects of both enteral and parenteral nutrition, since theophylline dosage adjustments may he required. 

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