Nutritional Support and Care Ch. 24 (A&N Exam 2)

Fundamentals of Nutritional Care and Support

Supporting Nutritional Intake

• Focused Assessment:

  • Importance of assessing individual needs for nutritional support.

• Mealtime Preparation:

  • Considerations:

    • Odors might influence appetite.

    • Environment affects comfort and meal experience.

    • Ensure proper toileting facilities.

    • Patient comfort and positioning are crucial.

    • Maintain patient cleanliness during meals.

  • Assistance with Eating:

    • Provide support as needed based on patient capabilities.

Monitoring Intake and Output (I&Os)

• Fluid & Electrolyte Balance:

  • Aim for 1,500-2,500 mL of fluid intake per 24 hours.

  • Output should be within 200-300 mL of intake to ensure balance.

Supporting Patients with Nutritional Needs

• Food Allergies:

  • Immune response triggers, common allergies include peanuts, wheat, dairy, eggs.

• Food Intolerance:

  • Adverse reactions not involving the immune system, such as gluten intolerance and IBS.

  • Treatment involves eliminating offending foods.

Therapeutic Diets

• Types of Diets:

  • NPO (Nothing by Mouth):

  • Regular Diet:

• Diets Modified by Consistency:

  • Clear liquid, full liquid, mechanical soft, pureed as tolerated.

• Diets Modified for Disease:

  • Diabetic, calorie-restricted, sodium-restricted, fat-restricted, fiber-restricted, renal, protein-restricted, high-calorie high-protein.

  • Recommended: Five to six small, frequent feedings.

Nursing Responsibilities

• Monitor diet type, percentage eaten, meal tolerance.

• Determine when to advance patient's diet based on tolerance and progression.

Enteral Access Feeding Routes

• Feeding Routes:

  • Short-term: Nasogastric (NG) or Nasointestinal (NI).

  • Long-term: PEG (Percutaneous Endoscopic Gastrostomy) & J-tube.

Enteral Nutrition Plans

• Enteral Feeding:

  • NG and NI tubes are softer and smaller for easier insertion; appropriate for short-term feeding.

  • PEG and J-tubes used for long-term feeding solutions, may involve button devices.

Insertion Techniques for Feeding Tubes

• NG Tube Insertion for Gastric Decompression:

  • Prepare the patient and supplies.

  • Measure from nares to xiphoid process.

  • Monitoring for dyspnea; stop and let the patient breathe if occurs.

  • Ensure proper placement via gastric pH, X-ray, or air injection.

Checking Feeding Tube Placement

• Verification Methods:

  • X-ray is the most reliable method.

  • Gastric pH testing (ideal below 5.5) and measurement from insertion point to tube end.

Responsibilities for NG Tubes on Suction

• Regular assessment for patency, suction settings, and observe for complications.

• Ensure tube security and monitor gastric drainage characteristics.

• Provide mouth care routinely.

Tube Feeding Formulas

Types of Enteral Feeding Formulas

• Standard Formulas:

  • Balanced nutrients for patients who can digest but can’t eat sufficiently.

• Hydrolyzed Formulas:

  • For patients with compromised digestion; predigested nutrients.

• High-Protein Formulas:

  • Additional protein for patients with high nutritional needs.

• Diabetic Formulas:

  • Lower carbohydrate content for diabetes management.

Complications and Nursing Responsibilities

Complications Associated with Tube Feedings

• Nausea and diarrhea

• Clogged tubes

• Aspiration risk

• Metabolic problems

• Risk of contamination

Preventing Aspiration

• Use smallest diameter tube possible and confirm placement before feeding.

• Elevate head of bed to 30-45 degrees before and during feeding.

Administering Medication through PEG

• Check medication orders and ensure proper PEG placement.

• Administer via the '7 Rights' of medication administration and document.

Parenteral Nutrition

• Types of Parenteral Nutrition:

  • Partial Nutrition (PPN) via peripheral IV.

  • Total Parenteral Nutrition (TPN) via central venous access.

• Monitoring Nutritional Status:

  • Daily weights, vital lab results, electrolyte levels, and protein levels.