funds 28 nutritional therapy & assisted feeding

goals of nutritional therapy

treat & manage disease

prevent complications & restore health

• specific diet for each pt prescribed & written

nasogastric & eternal tubes

temporary measure to provide nutritional support

• irrigate/ flush to ensure patency

• placement must be checked prior to feeding / adm meds

- initial placement, x-ray done. markings on tube are correct

- aspirate (pull back on syringe connected to end of tube) to make sure gastric secretions. look at color, consistency. check pH. (1-4). anything 6+ may be trachea-bronchial

- aspirate to check residual volume to see if food has been digested. amount. some facilities have you put it back

gastrostomy tube

directly into stomach. surgically placed

balloon inside stomach helps it to stay in place

peg (percutaneous endoscopic gastronomy): inserted via mouth

reasons for NGT & eternal tubes

• dysphagia

• inflammatory bowel disease

• obtaining gastric specimens for analysis

• gastric feeding

• administration of meds

• decompression (emptying) of the stomach before / after surgery

how is determined how far NGT goes in?

N: nose

E: ear

X: typhoid process

PEG tube or Jejungostomy tube

percutaneous endoscopic gastrostomy tube

long-term nutritional support

tube placement should be checked every shift. ac / adm med

• assess bowel sounds, soft & non-distended

• stomach needs to be bypassed / problems w upper GI or risk for aspirations

assessing gastrostomy tube site

assess site for leakage, breakdown. must be kept clean

if breakdown, notify

• some facilities clean w water. others gauze & saline

enteral feedings

continuous feedings: via pump. certain mL per hour

intermittent/ bolus feedings: specific times during the day

• via syringe (GRAVITY. NOT PUSHED). or via pump.

- 240 - 360 mL per feeding

included in order: type of formula, volume, rate

if can, top needs to be cleaned off before opening.

principals of tube feeding

• elevate HOB 30 - 90* ac & leave up 30-60 min ac

• keep HOB elevated at least 30* if continuous feeding

• if aspiration, nausea or vom, stop feeding and call pcp.

• assess bowel sounds at least once q8h

• check placement ac / med adm or at least once a shift

• tube should be flushed 30-60 mL ac & pc & med adm mL water

• maintain accurate I & O. dehydration may occur bc diarrhea or high glucose

• if residual > 500mL, replace residual, document & notify. delay next feeding or as appriortire to policy

intermittent feeding steps

check order. formula, volume

check placement

hob 30-90*

flush w water 30-60mL. have formula ready and put in before water empties

gravity feeding

flush w water 30-60mL.

tpn / total parental nutrition

via central line. iv.

malabsorption, GI surgery NPO, burns, bowel disease, aids, cancer

high concentration of carbs. monitor sugar & fluid overload I & O

custom to pt

start slowly for body to adjust to high glucose.

patients needing feeding assistance

• pt w paralysis of arms

• pt w visual impairment. (fork at 3oclock, mash at 6oclock)

• pt w IV lines in their hands

• severely impaired, weak or confused

dysphagia

signs: coughing when ingesting, drooling, food remaining in mouth

risk for aspiration. HOB 60-90*. no straw. tuck chin when swallowing

speech pathologist evaluates pt. gives diff foods to see what issues

dietary modifications

liquid

• npo

• clear liquids (clear fruit juices, gelatin, broth)

• full liquids: clear liquids + dairy, all juices. can include pureed veggies

dietary modifications

solid

pureed

mechanical soft

soft/ low residue: low in fiber, easy digest.

low sodium

low cholesterol

diabetic, dysphagia, regular

thickened liquids

part of order

post-op patients nutrition

should be well-nourished pre-op. usually npo 6-8h before

post-op: checking for gag reflex and bowel awake → clear liquid to full liquid diet → soft diet → regular diet

clear vs full liquids

anorexia nervosa

refusal to maintain normal weight. fear of becoming obese

treatment: nutritional intervention. counseling

bulimia nervosa

binge episode followed by purging, laxatives, fasting

• aware of behavior and often ashamed

treatment: nutritional intervention. counseling

what deficiency is often seen is alcohol abuse?

thiamine aka vitamin b1 deficiency