unit 8 Feeding patients and surgical nutrition 2 57J .pdf

Feeding patient hospital foods and surgical nutrition Unit 7 , Nurs 200  Enteral Nutrition Definition n Nutritional support via placement through the nose, esophagus, stomach, or intestines (duodenum or jejunum) —Tube feedings —Must have fun...

Feeding patient hospital foods and surgical nutrition Unit 7 , Nurs 200  Enteral Nutrition Definition n Nutritional support via placement through the nose, esophagus, stomach, or intestines (duodenum or jejunum) —Tube feedings —Must have functioning GI tract —IF THE GUT WORKS, USE IT! —Exhaust all oral diet methods first. © 2004, 2002 Elsevier Inc. All rights reserved.  Conditions That Require Other Nutrition Support n Enteral —Impaired ingestion —Inability to consume adequate nutrition orally —Impaired digestion, absorption, metabolism —Severe wasting or depressed growth n Parenteral —Gastrointestinal incompetency —Hyper metabolic state with poor GI intake © 2004, 2002 Elsevier Inc. All rights reserved.  Enteral Access: Clinical Considerations n Duration of tube feeding —Nasogastric or nasoenteric tube for short term (less than four weeks) —Gastrostomy and jejunostomy tubes for long term. NB. Gastric feedings, such as the nasogastric and gastrostomy routes, are preferred whenever possible. These feedings are more easily tolerated and less complicated to deliver than intestinal feedings because the stomach controls the rate at which nutrients enter the intestine. © 2004, 2002 Elsevier Inc. All rights reserved. Enteral Tube Placement © 2004, 2002 Elsevier Inc. All rights reserved.  Advantages—Enteral Nutrition n Intake easily/accurately monitored n Provides nutrition when oral is not possible or adequate n Costs less than parenteral nutrition n Supplies readily available n Reduces risks associated with disease state © 2004, 2002 Elsevier Inc. All rights reserved.  Complications of Enteral Feeding n Access problems (tube obstruction) n Administration problems (aspiration) n Gastrointestinal complications (diarrhea) n Metabolic complications (overhydration) © 2004, 2002 Elsevier Inc. All rights reserved.  Aspiration Pneumonia n Can result from enteral feeds n High-risk patients —Poor gag reflex —Depressed mental status © 2004, 2002 Elsevier Inc. All rights reserved.  Reducing Risk of Aspiration n Check gastric residuals if receiving gastric feeds n Elevate head of the bed >30 degrees during feedings © 2004, 2002 Elsevier Inc. All rights reserved. Formula Delivery A day’s nutrient needs can be met by: Delivering relatively large amounts of formula several times per day (intermittent feedings). OR Smaller amounts continuously throughout the day (continuous feedings). © 2004, 2002 Elsevier Inc. All rights reserved.  Intermittent feedings Rate of delivery: 300 to 400 ml, 20 to 30 minutes, several times/day via syringe. Disadvantages: Because of the relatively high volume of formula delivered at a time, intermittent feedings may be difficult for some patients to tolerate, and the risk of aspiration may be higher than with continuous feedings. Advantage of intermittent feedings is that they are similar to the usual pattern of eating and allow the patient freedom of movement between meals. © 2004, 2002 Elsevier Inc. All rights reserved. Continuous feedings Disadvantages: An infusion pump is required to ensure accurate and steady flow rates; consequently, the feedings can limit the patient’s freedom of movement and are also more costly. Advantages: delivered slowly and at a constant rate over a period of 8 to 24 hours. Continuous feedings are used in patients who receive intestinal feedings. This method of feeding is also recommended for critically ill patients, because delivering relatively small volumes at a time may reduce nausea, diarrhea, and possibly, the risk of aspiration. © 2004, 2002 Elsevier Inc. All rights reserved.  Checking Gastric Residuals n When a patient receives a gastric feeding, the nurse regularly measures the gastric residual volume (the volume of formula remaining in the stomach after feeding) to ensure that the stomach is emptying properly. n The gastric residual is measured by gently withdrawing the gastric contents through the feeding tube using a syringe, usually before each intermittent feeding and every 4 hours during continuous feedings. © 2004, 2002 Elsevier Inc. All rights reserved. Enteral Nutrition Monitoring © 2004, 2002 Elsevier Inc. All rights reserved.  Routes of Parenteral Nutrition n Administration of nutrition through vein n Central venous access given ( Total parenteral Nutrition ,TPN ) —Used for both long- and short-term placement n Peripheral or PPN is through a peripheral vein (short term access) basic difference between both is concentration of solution administered. © 2004, 2002 Elsevier Inc. All rights reserved.  Advantages—Parenteral Nutrition n It is given when GI intolerance prevents oral or enteral support. n TPN is more concentrated (hypertonic ) than PPN(Peripheral parenteral nutrition ) n PPN is isotonic solution – lesser concentration of dextrose and amino acids as suitable to a peripheral blood vessel. © 2004, 2002 Elsevier Inc. All rights reserved.  Why Total Parenteral Nutrition ? n GI is non functioning n NPO >5 days n Not absorbing food from intestine for more than 10 days n Short bowel syndrome n Malnutrition with >10% weight loss of pre illness weight n Nutritional needs not met and patient refuses food © 2004, 2002 Elsevier Inc. All rights reserved.  Complications n Infection n Fluid and electrolyte imbalances n Phlebitis n Pneumothorax n Thromboembolism (inflammation of a blood vessel and formation of a clot ) n Metabolic changes as hyperglycemia or hypoglycemia. © 2004, 2002 Elsevier Inc. All rights reserved.  Clear liquid diet n Consists of clear liquids — such as water, broth and plain gelatin — n that are easily digested and leave no undigested residue in your intestinal tract. n Your doctor may prescribe a clear liquid diet before certain medical procedures or if you have certain digestive problems © 2004, 2002 Elsevier Inc. All rights reserved.  Soft diet n A soft diet is made up of foods that are soft and easy to chew and swallow. These foods may be chopped, ground, mashed, pureed, and moist. You may need to follow this diet if you have had certain types of surgery, such as head, neck, or stomach surgery. © 2004, 2002 Elsevier Inc. All rights reserved.  Questions: Which of the definition refer to nutritional support via placement through the nose, esophagus, stomach, or intestines (duodenum or jejunum)? nA. Enteral Nutrition nB. TPN Nutrition nC. PPN Nutrition nD. Normal nutrition © 2004, 2002 Elsevier Inc. All rights reserved.  Questions: Which of the following is indication of enteral nutrition? nA. Impaired ingestion nB. Ability swallowing nC. Good digestion nD. Good metabolism © 2004, 2002 Elsevier Inc. All rights reserved.  Questions: What is the duration of nasogastric tube feeding? nA. Less than four weeks nB. More than four weeks nC. Less than three weeks nD. Less than seven weeks © 2004, 2002 Elsevier Inc. All rights reserved.  REFERENCE Read text book :CH 10 pages 630-650 Read text book :Miller Chirs H. nutrition in health and illness3 rd ed. London: Health Science, 2015, CH 11 pages 512-20 Mahan I.L &Escott, S (2000). Krause’s Food, Nutrition, and Diet Therapy. 10th ed. W.B. Sunders Company, Philadelphia, USA Dudek, S.G (2001). Nutrition essential for Nursing Practice. 4th ed., Lippincott, Philadelphia, USA. © 2004, 2002 Elsevier Inc. All rights reserved.