NUTRI FINALS Flashcards
TYPES OF ENTERAL FEEDING
this type of feeding may be prepared from regular foods.
Tube Feedings
TYPES OF ENTERAL FEEDING
This type of feeding is fiber-free and high in cholesterol, fat, and sugar. It is a milk- based formulation with sugar and soft cooked eggs.
Standard Tube Feeding
TYPES OF ENTERAL FEEDING
it consists of soft diet allowances which can be blenderized easily.
Blenderized Tube Feeding
TYPES AND EXAMPLES OF READY-TO-USE FORMULA
can be used alone and provides total needs in a specified volume of formula.
Nutritionally complete formulation
TYPES AND EXAMPLES OF READY-TO-USE FORMULA
provides the different nutrients to supplement existing formulas.
Modular formulation
TYPES AND EXAMPLES OF READY-TO-USE FORMULA
meets the therapeutic needs.
Combined formulation
Tube extends from nose into the stomach
Nasogastric
Rapid placement requiring minimal equipment; feedings can be immediately following confirmation of tube placement and bowel sounds; formula can be delivered or continuous infusion
Advantages of Nasogastric
Tube can be easily removed by patient; tube can be inadvertently inserted into trachea, especially among patients with poor gag reflexes. Anomalies in nose and neck (deviated septum, esophageal strictures) may prevent tube placement.
Disadvantages of Nasogastric
tube extends from nose through the pylorus into the duodenum; Tube may be advanced by peristalsis or videofluoroscopy
Nasoduodenal
tube extends from nose through pylorus into the jejunum and is usually placed by videofluoroscopy.
Nasojejunal
Risk for aspiration may be reduced. Feedings are better tolerated by patients with poor tolerance to gastric feedings (gastric retention or reflux) ______ feedings permit enteral feedings in patients with partial gastric outlet obstruction or doudenal fistula.
Advantages of Nasoduodenal or nasojejunal
Dislodgment of tube into the stomach by coughing or vomiting is common (will increase risk of aspiration in patients with altered gastric motility. Administration usually limited to continuous delivery of formula (small intestine does not tolerate bolus feedings or sudden rate changes well. May require use of pump.)
Disadvantages of Nasoduodenal or nasojejunal
Surgical formation of opening into neck through which a feeding tube is placed into esophagus and down into the stomach (sometimes used in patients with head and neck cancer
Esophagostomy
Procedure can be performed under local anesthesia. It does not require opening the abdominal wall. Feeding can begin immediately.
Advantages of Esophagostomy
Route requires surgery and formation of a stoma, which must be carefully maintained. Skin surrounding stoma may become irritated. Wound may become infected. Excessive granulation of tissue surrounding stoma may occur. Accidental dislodgment of tube is common. Requires immediate replacement of tube to prevent closure of stoma. Gastric contents mayy leak around the tube with gastrotomy. Wound dehiscence may occur. GI bleeding and aspiration may occur. Gastrotomy feedings usually cannot be started until up to 72 hours after surgery PEG placement is often difficult or impossible in severe obesity.
Disadvantages of Esophagostomy
Tube is passed through incision in abdominal wall into the stomach PEG. Tube is percutaneously placed in the stomach under endoscopic guidance, secured by rubber “bumpers” or inflated balloon catheter.
Gastrostomy or Percutaneous Endoscopic Gastrostomy (PEG)
Takes advantage of the stomach’s natural function of adjusting osmolarity, mixing, and serving as a reservoir; ensures provided nutrients are allowed maximal opportunity for absorption; closely simulates natural delivery of nutrients into the stomach; eliminates nasal or esophageal irritation, esophageal sphincter closed, may reduced risk of aspiration; tube is unobtrusive; PEG placement can be performed under local anesthesia (less expensive); PEG feedings can be started after approximately 24 hours
Advantages of Gastrostomy or Percutaneous Endoscopic Gastrostomy (PEG)
Types include needle catheter placement, direct tube placement, and creation of jejunal stoma that is catheterized intermittently PEJ: Weighted feeding tube passed endoscopically through as trostomy tube (from PEG insertion) into the duodenum; Peristaltic action advances tube into the jejunum
Jejunostomy or Percutaneous Endoscopic Jejunostomy (PEJ)
Permits feeding in patients with upper GI tract obstruction, esophageal reflux, ulcerative or neoplastic disease of stomach, impaired gastric emptying; reduces risk for aspiration; early postoperative feeding possible jejunum rapidly resumes its function within 12-24 hours)
Advantages of Jejunostomy or Percutaneous Endoscopic Jejunostomy (PEJ)
Surgical procedure is required. Ambulatory patients may find jejunal feeding restrictive because of the need for continuous infusion of formula.
Disadvantages of Jejunostomy or Percutaneous Endoscopic Jejunostomy (PEJ)
This route is intended for patients with mild to moderate nutritional deficiency.
Peripheral Vein Route
This is a long-term nutritional support of 2 weeks for patients who cannot be fed through the GIT.
Parenteral Hyperalimentation (TVH)
COMPLICATIONS OF ENTERAL FEEDING
Nasopharyngeal irritation (Ice chips, topical anesthetic, and decongestant)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Mucosal erosions (reposition tube; ice water lavage; remove tube)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Tube displacement (replace tube)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Aspiration (discontinue tube feeding)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Luminal obstruction (Flush; replace tube)
Mechanical
COMPLICATIONS OF ENTERAL FEEDING
Cramping/Distention (change formula; reduce infusion rate)
Gastrointestinal
COMPLICATIONS OF ENTERAL FEEDING
Vomiting/Diarrhea (dilute formula; reduce infusion rate; anti-diarrheal agents)
Gastrointestinal
COMPLICATIONS OF ENTERAL FEEDING
Constipation (promote sufficient fluids and fibers; encourage patient activity)
Gastrointestinal
COMPLICATIONS OF ENTERAL FEEDING
Hypertonic dehydration (increase free water)
Metabolic
COMPLICATIONS OF ENTERAL FEEDING
Glucose intolerance (reduce infusion rate)
Metabolic
COMPLICATIONS OF ENTERAL FEEDING
Cardiac failure (reduce sodium content; fluid restriction)
Metabolic
COMPLICATIONS OF ENTERAL FEEDING
Renal failure (decrease phosphate, magnesium, potassium, protein restriction, essential amino acid solution)
Metabolic
COMPLICATIONS OF ENTERAL FEEDING
Hepatic encephalopathy (decrease amount of protein)
Metabolic
DIFFERENT TYPES OF HOSPITAL DIETS
This is an allowance of tea, coffee or coffee substitute, and fat-free broth. Ginger ale, fruit juices, gelatin, fruit ices, and water gruels are sometimes also given. Small amounts of fluid are offered every hour or two to the patient. The diet is used for 24-48 hours following acute vomiting, diarrhea, or surgery. The primary purpose of this diet is to relieve thirst and to help maintain water balance. Broth provides sodium. Broth and fruit juices contribute potassium. Carbonated beverages, sugar, and fruit juices, when used, furnish a small amount or carbohydrate.
Clear Liquid Diet
DIFFERENT TYPES OF HOSPITAL DIETS
This is a nutritionally adequate diet consisting of liquids and foods that liquefy at body temperature. It is used for acute infections and fever of short duration and for patients who are too ill to chew. It may be ordered as the first progressive from the clear fluid diet following surgery or in the treatment of acute gastrointestinal (GI) upsets. The diet is offered in 6 feedings or more. Initially, amounts smaller than those represented by the plan may be given. To increase the calorie intake, one pint ot light cream may be substituted for one pint of milk. The protein level of the full fluid diet may be increased approximately 30 g by including 3 oz non-fat dry milk each day. This may be added to fresh milk, cream soups, cereal gruels, or custards. Strained meat may be added to broth or hot tomato juice. Raw eggs are sometimes a source of Salmonella infection. Therefore, only pasteurized dried egg powder should be used.
Full Liquid Diet