AC GI intubation & nutrition

*Religious restrictions

• muslims

• christians

• hinduism

• judaism

• church of christ of latter-day saints

• muslims: no pork, alcohol, caffeine

  • ramadan: fasting from sunrise to sunset

• christianity:

  • baptists: minimal or no alcohol assumption

  • catholics: lent and meatless days

• hinduism: no meats, alcohol

• judaism: no pork, mixing with milk or dairy products with meat dishes

• church of christ of latter day saints: no alcohol, tobacco, no caffeine

*Alternative food diets

• vegans?

• ovo-lacto?

• lacto?

• pescatarian?

• medical diets are.. (2)

• vegans: no meats (incl. dairy & eggs)

• ovo-lacto: no meats, dairy, and eggs are okay

• lacto: no meats, eggs, milk is okay

• pescatarian: no meat, fish, and shellfish is okay

• medical diets: casein & gluten free +++ ketogenic diets (for epilepsy)

Nutritional screening

• purpose?

• risk factors?

• lab tests!

• to identify malnutrition or at risk patients

• risk factors: unintentional weight loss, modified diets, altered nutritional symptoms (diarrhea + constipation) (iV fluids for more than 4-7 days)

• lab tests: the most readily plasma protein is albumin

*Types of therapeutic diets? (liquids)

• name as many as discussed!

• if they are NPO for an extensive amount of time/ any GI surgery, they are at risk for… ? and they should be put on what diet?

• clear liquids (tea)

• full liquid (ice cream, custards)

• pureed/thickened liquids

• mechanical soft (flaked fish, cottage cheese, rice)

• soft/low residue (pasta, casseroles)

• high fiber (fresh uncooked fruits, steamed veggies)

• low sodium (restrictions: 4g, 2g, 1g, 500mg

• risk for aspiration, put them on clear liquids

Promoting appetite

• number one way to promote appetite is to?

• brush your teeth

Oral feedings:

• maintain independence & dignity by..

• assess for?

  • high risk patients have:

• verbal coaching while feeding provides positive reinforcements

• allow patients to select their own foods

• aspiration risk

  • decreased alertness, poor gag reflex, difficulty managing saliva, oral suction at bedside

Decrease risk for aspiration

• provide __ minute rest periods before eating

• feed on the stronger side of their mouth (unilateral weakness (1/2- 1tsp)

• remain upright for at least 30-60 min after meal

• patient should swallow twice to clear pharynx

• inspect mouth for pocket of food

• 30 min

Dysphagia

• defined as?

• warning signs?

• leads to?

• be aware of ?

• put them on a ___ diet

• feed slowly, smaller size bites

• match speeding of feeding to patients readiness

• difficulty swallowing

  • due to neurological, muscular, obstruction type of disorders

• cough during eating, change in voice after swallowing food, abnormal movements of mouth, tongue, lips, abnormal gag reflex

• malnutrition and aspiration pneumonia

• be aware of silent aspiration

• put them on a liquid, thin/ low viscosity diet, honey-like

Oral feedings: visual deficits

• identify food location on meal plate (meat at 9 o clock)

GI Intubation - types

• temporary tubes

• small bore: Dobhoff (weighted)

• DONT NEED TO KNOW NAMES OF TUBES

• You need something large to decompress the stomach. if you’re feeding alone, use a small one because its more comfortable

• Nasogastric (ng)

*Inserting an NG tube

• place patient in..

• determine the length and mark with tape (NEMU. no longer NEX).

  • nemu: nose, ears, mid umbilicus

• if patient is awake, have them ___ ___ while placing GI tube (it simulates actually swallowing and can ease the tube down quicker + more comfortably)

• remove tube if they go through respiratory distress

• high Fowlers position (90 degree

*NEX vs NEMU

• always use NEMU for ___

• NEX(xyphoid) in general underestimates the length and ends up more in lungs than it actually sits int he stomach

• kids

*Contraindications for NGT?

• suspected or confirmed basilar skull fractures

• trauma to the face or facial fractures

• esophageal obstruction or perforation

• combative patients

*GI intubation

• how do you check that its properly in there?

• still perform oral care

• if you see red color on strip, do not need xray

• use Xray (KUB), or pH strips

*Oral Medication via enteral tube

• flush tube with at least _ sterile water in between meds

• 15-30mL but depends on patient

*Enteral feeding

• when you’re feeding them, they should be in ___ position

  • if not?

• start them off full strength, but if its uncomfortable then do half strength

• high Fowlers

  • they aspirate if not